Recently, final year pharmacy student or/also known as the pharmacist-to-be, asked me about some questions regarding management of an asthmatic patient. So to summarise the discussion, When comes to asthmatic patients, there are few things you ned to make it clear before you jump into recommendation: 1) Patient’s compliance on inhaler techniques. If non-compliance, there is a bigger issue for u to address before you add in an extra med. 2)How to step up and to step down in asthma management? What parameters you look at ? 3) think about what is the pathophysiology of asthma? 4) How different is the management of asthma vs COPD? why is it so? 5) How the difference of management of acute exacerbation of asthma vs chronic asthma?
If to step up, which agent will you choose ? What monitoring parameters are you interested to look at?
- after corticosteroid, what is next in the list?
- can long acting beta-agonist be given alone?
- what are the up-coming innovation in management of asthma patients, that could improve compliance, improve efficacy and reduce side effect?
- why we will step up to inhale corticosteroid instead of other agent?
- why do we have an invention of inhaler?
- When do we oral (systemic) corticosteroid in management of asthma patient?
7) Check the differences in each corticosteroid inhaler (Budesonide, beclomethasone, ciclesonide, fluticasone, betamethasone) By finding the differences, You will then understand why in the market, there is so many different corticosteroid inhalers, and why some inhale corticosteroid were phased out from the market already.
8) can asthma patient be given aspirin?
if can, what would be your concern?
if cant, what would you recommend to your doctor?
If you could find out all the answers, you will have a better understanding of how to manage an asthma patient! But dont forget about his/her other co-morbidity(ies).
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