Question

Select either mild, moderate, or severe persistent asthma. Describe a patient with your selected asthma. Describe the symptoms the patient would present with. Describe your treatment of choice and what your patient’s treatment goals would be.

Answer 1

A. Severe asthma

Asthma is defined as a chronic inflammatory disorder of the airway which is charecterized by narrowing of the airway and reversible airway obstruction.When asthma is not controlled by high dose treatment with inhaled corticosteroids and additional controllers like beta 2 agonist, leukotriene modifiers, bronchodilators or oral corticosteroids for more than 6 months per year is called severe asthma.

Mainly people with chronic conditions like diabetes, people who are current smokers, people who have trouble in taking long term asthma medications regularly on time will develop this severe asthma.

The severity is determined by signs and symptoms of patients and their pulmonary function test result.

B. Signs and symptoms of severe asthma

Shortness of breath

Dyspnea even in lie down

Chest tightness

Severe wheezing and cough

Cyanosis starting from perpheral areas

Feel agitated, confused and unable to concentrate

Difficulty in speaking full sentences

Hunched shoulders, strained abdominal and neck muscles

C. Treatment

Goal- preventing chronic symptoms that interefere with activities of daily living and improve quality of life

Optimizing inhaled therapy- High dose of Ipratropium bromide (corticosteroid)

Treating comorbid conditions like chronic rhinosinusitis, gastro esophageal reflux disease, depression and anxiety disorders.

Long acting anticholinergics to reduce smooth muscle tone in airways

Anti IgE therapy to stop triggers of inflammation

Macrolides- Immunomodulators to reduce inflammation

In case of acute severe asthma administer oxygen, long term oxygen therapy is needed for some of the severe asthma cases.

Pulmonary Rehabilitation

D. Emerging treatments for severe asthma:

Tiotropium bromide- long acting anti muscarinic agent

Omalizumab- recombinant humanized IgG1 monoclonal anti IgE antibody

Mepolizumab- humanized monoclonal antibody against interleukin-5

Thermoplasty- reduce smooth muscle in the airways.