Evidence-Based Treatment for Asthma
The selected evidence-based treatment medicine for Asthma management are inhaled corticosteroids (ICS). The ICS is the most effective controllers in the market that are used to suppress the inflammation in the asthmatic airways even in low doses (Daley-Yates, 2015). The suppression is achieved through switching off the activated inflammatory genes and replacing them with histone acetylation through the secretion of histone deacetylase 2 (HDAC2) (Daley-Yates, 2015). The impact of the suppression of the inflammatory airways is the reduction of airway hyperresponsiveness enabling better management of asthma symptoms (Jin, 2011). ICS is currently the first line of therapy for all patients with persistent asthma assisting in the management of the symptoms as well as preventing exacerbation. Before, during treatment, it was recommended that asthmatic patients should begin with small doses and increase the doses until asthma is completely controlled. However, it was established that the response effect of ICS was extremely flat and there was little improvement in the lung function after dose increase (Jin, 2011). A recent study recommends that the addition of another class of controller drugs along with ICS would be more effective than increasing ICS dose for the majority of the patients.
The local side effects of the ICS is related to the deposition of steroid in the oropharynx, which depends on the frequency of administration and the dosage. One of the commonest complaints of the dysphonia, which is the hoarseness of the voice that occurs among 50 percent of the patients (Daley-Yates, 2015). In the majority of the patients, this condition may not be troublesome except for singers and teachers. Large volume spacers are effective in the management of this local side effect by reducing ICS deposits on the oropharynx (Randolph, 2012). Other side effects include psychiatric impacts such as depression, euphoria, insomnia, and aggressiveness after the administration of ICS.
References
Daley-Yates, P. (2015). Inhaled corticosteroids: potency, dose equivalence, and therapeutic index. British Journal of Clinical Pharmacology, 80(3), 372-380. doi: 10.1111/bcp.12637
Jin, Y. (2011). Activities of Aldo-keto reductase 1 enzymes on two inhaled corticosteroids: Implications for the pharmacological effects of inhaled corticosteroids. Chemico-Biological Interactions, 191(1-3), 234-238. doi: 10.1016/j.cbi.2011.01.019
Randolph, C. (2012). Allergy and Asthma Connection—from the American Academy of Allergy, Asthma, and Immunology. Asthma Magazine, 8(2), 24-26. doi: 10.1067/mas.2003.25