Asthma Evidence Based Pharmacology
Asthma is a chronic debilitating disease which affects children and adults. According to the National Heart, Lung, and Blood Institute (NHLBI), “asthma affects people of all ages, but it most often starts during childhood. In the United states, more than 25 million people are known to have asthma. About 7 million of these people are children.” Asthma is most commonly diagnosed during childhood.
Pathophysiology and Age Continuum Implications Asthma is a disorder that affects the airways; it is an obstruction of the airways that takes place due to inflammation, chronic airway hyperactivity, and remodeling of the airway. According to Maddox & Schwartz (2002), “the etiology of asthma is complex and multifactorial. It involves the interaction between genetic factors and environmental stimuli” (p. 477). Therefore, patients suffering from asthma are not only susceptible to un-modifiable genetic factors but also environmental factors that trigger the airway obstructions. Essentially asthma is an inflammation of the airways in which there is an infiltration into the walls of the airway by mast cells, eosinophils, T-helper cell type two (Th2), and T-lymphocytes (Bonsignore, Profita, Gagliardo, Riccobono, Chiappara, Pace, and Gjomarkaj, 2015). According to Bonsignore, et al. (2015), “persistence of chronic inflammation may alter the homeostasis of lung tissue, leading to airway remodeling. Tissue remodeling includes epithelial alterations (epithelial shedding), increased matrix deposition, matrix degradation and accumulation of plasma proteins. Genetic influences, fetal exposures, early life events, and long-term uncontrolled inflammation may all contribute to airway remodeling” (pg. 32). The chronic inflammation leads to more damage caused to the airway, the more uncontrolled the asthma is the greater the assault to the airway.
During an asthma attack the airway is constricted it is difficult for the patient to breath, with episodes of coughing, wheezing, shortness of breath, and chest pain. The symptoms can be more severe according to the severity of the disease. Some only experience the dry cough and minor wheezing with occasional flare ups; while others experience greater shortness of breath, trouble breathing, and have more recurrent attacks (Akimbame, Moorman, and Liu, 2011).
Asthma can be diagnosed early on in life; in children asthma can be a major burden. Children with asthma face social issues such as missing school, parents missing work, it can also present as a financial problem as medications are very expensive (Lawlor, 2015). For children with asthma extra steps must be taken, a plan of care must be discussed with the child’s school officials. There needs to be more education provided for the parents, including an action plan which can help the parent identify an exacerbation (Lawlor, 2015). According to Lawlor (2015), “children should have safe supervised access to prescribed medication during school hours” (pg. 327). A child must always have access to their medication at all times, this is why it is important to correctly educate parents and ensure good medication adherence.
In the elderly asthma can
Asthma and Genetics Although it is known that genetics plays a role in the development of asthma it is unknown which specific gene is responsible. According to Ober, & Yao (2011), “because the pathogenesis of asthma is unknown and there are no test or biomarkers that definitively diagnose asthma or distinguish it from other disease, diagnosis is based on clinical features, demonstration of reversible expiratory airflow obstruction” (pg 11). Although much is known about the disease the concrete biomarkers are not yet known. Medical advances have found that there is a genetic link to the disease but there no specific genes have been found for all variations.
Literature Review
In their article Guilbert, Bacharier, and Fitzpatrick (2014) discuss the implications of asthma in children. They classify the severity of asthma in children into two different categories, difficult to treat and severe therapy resistant asthma. In the article it is explained that often asthma exacerbations are brought on by a viral infection or exposure to an allergen, this causes a flare up that often times requires emergency room visits (Guilbert, Bacharier, and Fitszpatrick, 2014). There is also discussion that children with atopic asthma often times have a slow but steady decrease in lung function. In this article severe asthma is described as “highly heterogeneous condition that remains poorly understood in children” (pg. 491). Although much is known about asthma, it is still difficult to understand and depending on severity treat in children.
Similarly in their article Giovannini-Chami, Albertini, Scheinmann, and de Blic (2015), classify asthma in two categories; difficult to treat, and treatment resistant. This article discusses the difficulties faced when treating patients with glucocorticoid steroids. It explains that should be evaluated when corticosteroids are not helpful in the treatment of asthma in a patient. It discusses the evidence that has been found that there is congenital steroid resistance in these patients due to a mutation in glucocorticoid receptors, but there is no link to the direct resistance of steroids. According to Giovannini-Chami, Albertini, Scheinmann, and de Blic (2015), “acquired steroid resistance in asthma is mainly due to Th2 pro-inflammatory cytokines and oxidative stress. This can, in theory, be overcome with high doses of corticosteroids at the expense of a major risk of side effects” (pg. 168). The article discusses that inhaled corticosteroid (ICS) continues to be the most effective treatment in severe asthma patients. But there is a high probability of adverse effects such as growth retardation and adrenal suppression. Because of this the article explains that new therapies are aimed to treat asthma with fewer adverse effects to this population. There are new medications being used, and also the addition of a second medication to help improve outcome and decrease corticosteroid resistance.
The literature review was completed by utilizing South Universities’ online library. The searches were completed by utilizing key words such as “asthma in children”, “adult onset asthma”, “asthma prevalence”, and “asthma treatment”. These searches yielded more than one million results; the searches were narrowed by filtering to the most recent articles within the past five years. The searches were also narrowed by reducing articles to printed in the United States.

Reference:
Akinbami, O. J., Moorman, J. E., & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005-2009. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
Bonsignore, M. R., Profita, M., Gagliardo, R., Riccobono, L., Chiappara, G., Pace, E., & Gjomarkaj, M. (2015). Advances in asthma pathophysiology: Stepping forward from the maurizio vignola experience. European Respiratory Review : An Official Journal of the European Respiratory Society, 24(135), 30-39. doi:10.1183/09059180.10011114
Giovannini-Chami, L., Albertini, M., Scheinmann, P., & de Blic, J. (2015). New insights into the treatment of severe asthma in children. Paediatric Respiratory Reviews, 16(3), 167-173. doi:10.1016/j.prrv.2014.07.006
Guilbert, T. W., Bacharier, L. B., & Fitzpatrick, A. M. (2014). Severe asthma in children. Journal of Allergy and Clinical Immunology.in Practice, 2(5), 489-500. doi:http://dx.doi.org/10.1016/j.jaip.2014.06.022
Lawlor, R. (2015). Management of asthma in children. Practice Nursing, 26(7), 326-330 5p.
Maddox, L., & Schwartz, D. A. (2002). The pathophysiology of asthma. Annual Review of Medicine, 53, 477. Retrieved from http://search.proquest.com/docview/222628534?accountid=87314
Ober, C., & Yao, T. (2011). The genetics of asthma and allergic disease: A 21st century perspective. Immunological Reviews, 242(1), 10-30. doi:10.1111/j.1600-065X.2011.01029.x