Ben was also given an additional breathing treatment. After an additional hour, peak flow measurement was 450 ml/L, 75% of his personal best. Ben was kept in the ER for an additional hour before being discharged.
The ER physician instructed Ben to follow-up with his personal physician. He has prescribed a 10-day course of the oral corticosteroid he was given in the ER, Medrol™.
Before being discharged, Ben met with the respiratory therapist and reviewed proper technique for using his inhaler and peak flow meter. Ben set up an appointment with his personal physician. At this appointment, he reviewed his asthma action plan. This plan divides the patient's peak flow into three zones: green, yellow, and red. When the patient is free of symptoms, a "personal best" peak flow is established by assessing several peak flow results. The green zone indicates the patient's peak flow is within 80% of normal. The yellow zone indicates a peak flow of 50-79%. The red zone indicates a peak flow of less than 50%.
- 17. What symptoms will the patient experience or how does the patient feel when they are in the green zone?
- 18. What symptoms will the patient experience that indicates they are in the yellow zone?
- 19. What symptoms will the patient experience that indicates they are in the red zone?
Each physician establishes a personal treatment plan for the patient that should be used with the asthma action plan. Inhaled corticosteroids (ICS), administered by an inhaler, are the first line medication to control asthma. ICSs include medications such as Flovent™ (fluticasone), Pulmicort™ (budesonide), Qvar™ (beclomethasone), Asmanex™ (mometasone), and Alvesco™ (ciclesonide). It's not important to remember the names of these medications but it is important to remember how they work. Inhaled corticosteroids reduce inflammation in the lungs and reduce mucus production. Remember that asthma is an inflammatory disease so a steroid is critical for good, effective management of an asthma patient.
If the patient's asthma is not well controlled with an ICS, a long-acting beta agonist (LABA) may be added. These medications help by dilating (opening) the airways. You may recognize some of the names of the LABAs which include Advair™, Symbicort™, and Dulera™.
Asthma exacerbations (flare-ups) are controlled using a rescue inhaler that uses a short-acting beta agonist. This is the same type of medication that Ben was given by nebulizer treatment. These medications act quickly to relax bronchial muscles causing bronchospasm. Common names include ProAir™, Proventil™, and Ventolin™. Patients are often advised to use their rescue inhaler before exercising.
Oral corticosteroids are typically used short-term to reduce severe exacerbations. Examples are Medrol™ that was used for Ben, prednisone, and dexamethasone.
| Medication | Action | Examples |
|---|---|---|
| Short-acting beta-agonist (SABA) | Quickly relax bronchial muscles causing bronchospasm. | Albuterol administered in the brands ProAir™, Proventil™, and Ventolin™ |
| Inhaled corticosteroid (ICS) | Reduce inflammation in the lungs and reduce mucus production. | Flovent™, Pulmicort™, Qvar™, Asmanex™, and Alvesco™ |
| Long-acting beta agonist (LABA) | Bronchodilators | Advair™, Symbicort™, and Dulera™ |
| Oral corticosteroids | Reduce severe inflammation in the lungs. Used in severe exacerbations. |
Medrol™, Prednisone, Dexamethasone. |
There are other treatment medications that may also be used depending on the cause of asthma. Some specifically treat mediators of allergic types of asthma by blocking leukotrienes (a compound that acts like histamine to cause allergic reactions). An example of an anti-leukotriene is Singulair™, which you may have heard advertised on TV. You should be familiar with the four types of medications listed in the table, but be aware that other medications may be used in combination with these.
Ben's exacerbation on the soccer field scared him, and he's working harder to follow his asthma action plan to keep his asthma under control. Asthma can be controlled but at this point, cannot be cured. Asthma may change over time, and most asthma patients have both good and bad days. By paying closer attention to his symptoms, and following his plan, Ben hopes to minimize exacerbations and keep his asthma under control.