Understanding Asthma
Asthma is a global burden with a lot of misconception and myth, this is giving rise to an increasing incidence of deterioration of Health and poor quality of life for asthmatic patient.
Asthma is a Non-communicable disease, if properly managed, the health burden of asthma can be lessen among the population,. Which will thereby reduce accompanying disability and morbidity as a result of asthmatic attacks and poor Management.
Healthcare providers in all tiers have an impact to make on the management of asthma as its cause varies from person to person.
A proper breakdown of what asthma is all about to each patient and possible ways to go about asthma management beyond medication prescription and administration will greatly improve clinical outcome.
The Global initiative for asthma (2020). Describe asthma as “A heterogeneous disease, usually characterized by chronic airway inflammation, it is defined by the history of respiratory symptoms such as; wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity together with variable respiratory air flow limitations”.
This description by GINA, highlights and pinpoint clinical observations in an asthmatic patient, in it’s right algorithm.
Asthma Trigger Factors
Although the etiology of asthma varies between patient. Allergens have a high percentage as a trigger factor of asthma. Asthma also can be genetically transferred as it had been proven and reported to run in families.
Lifestyle effect on asthma cannot be overemphasize, sensitisation of the body cells from smoking of tobacco and tobacco exposure is also a trigger factor for asthma.
Exposure to chemicals substances and medications can also be a trigger factor in some asthmatic patient. Some asthma patients have also been observe to have other trigger resulting from psychological causes, emotional clauses and trauma from past experience.
Medications and Asthma
Medication are also a trigger cause of asthma, resulting to bronchospasm in the patient. This bronchospasm as explained in the GINA description of asthma ( wheezing, shortness of breath, chest tightness, cough), if not attended to can cause serious disability or Even death.
It is necessary that Healthcare providers put into consideration the patient past medication history and allergies to prescribed medications and over the counter drugs (OTC).
- Allergies to common O.T.C such as
Vitamins - Pain relievers
- Eye drops
- Ear drops
- Oral contraceptives
- Aphrodisiacs
- Cold preparations
- Simple linctus e.t.c
…. Should be enquired from patient before prescribing and dispensing of this medication.
This will help in avoidance of an asthmatic attack and help prescribe and dispense suitable alternatives to the patient.
Drug induced asthma are common with these category of prescription medication
- Non-steroidal anti inflammatory drugs (NSAIDS) /Aspirin
- Angiotensin converting enzyme inhibitors (ACEI)
- B- adrenergic antagonist
NSAIDS such as Ibuprofen, Diclofenac, ketoprofen, aceclofenac, piroxicam, aspirin e.t.c provoke asthma by causing bronchospasm due to the inhibition of cyclo- oxygenase enzyme 1 (Cox-1 inhibition) in sensitive patient.
ACEI which include captopril, Lisinopril are use in the management of hypertension and are known for their effect on increasing bradykinin and substance P. level, causing lung inflammation. This usually stimulate cough in sensitive patient on this medication.
B- adrenergic antagonist such as the beta blockers are known to aggravate asthma. Eye drops and transdermal patches formulations containing beta blockers which are also absorbed into systemic circulation, like the other dosage formulations which are not left out as they are being use in the treatment of other conditions such as glaucoma.
Pharmacists’ Role
In Developing countries, the clinical pharmacist is challenged with Cases of asthmatic attacks, the clinical pharmacist needs to be well equipped with knowledge on proper management of the disease state to provide a whole some care in line with recommended guidelines and the rational use of drugs.
The rational use of drug requires that patient receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community (WHO 1985).
A proper examination of the patient, history taking will help point out the possible trigger’s of the patient, once the trigger factors are known, the Pharmacist can advise on avoidance of allergens and in some cases there will be need for Desensitisation, the Pharmacist Should go about it rightly.
In cases of Dispensing over the counter medications, the Pharmacist can enquire From the patient on history of allergy’s as to recommend a better and suitable alternative. And also in cases of poly Pharmacy where the physicians will not be aware of all the patient medications, the Pharmacist can counsel the patient and Carry out medication reconciliation and recommend better alternatives.
Clinical pharmacist can Advance patient care to asthmatics by integrating patient specific care and intervention into their plans and also advancing their knowledge on the disease condition, the proper usage of asthma medication and the delivery devices. The clinical pharmacist should also strive to become a certified asthma educator(AE-C)
REFERENCES
Guideline for asthma management in Nigeria (Nigeria Thoracic society). (2017).
Global initiave for asthma: Global strategy for asthma management and prevention (2020).
The Global asthma report (2018).
Suzanne, G. B (2013). ACSAP; New therapies in Asthma.
Joel, S. K; and Loren, W. H; (1994). Drug induced asthma: immunological mechanism and practical implications. Pp: 181-187.