The Role of Singulair in the Management of the Asthmatic Patient: A Medicine Review for Medical Assistants

Article excerpt

In a response to increasing incidence and mortality rates from asthma, the National Institutes of Health recruited a panel of experts to study the phenomenon. In 1991, the panel released its findings in a publication titled The Expert Panel Report (NIH). Among several recommendations made by the panel, one in particular is impetus to this article. It is that asthma be considered and managed as a chronic inflammatory disease (EPR).

The panel recommendations were rapidly implemented by the medical community. By 1997, the panel revisited both its work and a body of research done by professionals evaluating its recommendations with clinical trials and studies. It then revised and elaborated on management of the disease as proposed in the original report. The expert panel's second release of the findings (EPR-2) cites the following facts regarding asthma and inflammation:

* Asthma is a chronic inflammatory disorder of the airways

* Environmental and other factors "cause" or provoke the airway inflammation in people with asthma

* Airway inflammation causes recurrent episodes of asthma symptoms

* In asthma, there is variable airflow obstruction that is often reversible

* Inflammation causes an associated increase in the existing airway hyper-responsiveness to a variety of stimuli

* Asthma changes over time and requires active management

Managing the disease as a chronic condition of inflammation required some rethinking about the use of bronchodilators and anti-inflammatory medications. Both have long been mainstays in the management of asthma, however, prior to the survey, asthmatics used bronchodilator medicines at irregular intervals on a PRN basis (in a disturbing majority of case studies, these bronchodilators were being dispensed in hospital emergency departments-often too little, too late). Anti-inflammatory medicines were used on a PRN basis for exacerbations of asthma that were related to upper respiratory infections and allergy. This strategy came from the thinking that asthma was an episodic disease, and only generated treatable symptoms when an "attack" occurred. Once the attack or spasm was broken, most considered the problem as being dealt with until the next episode. Prior to the panel's report, asthma was considered to be extrinsic (triggered by things in the environment), or intrinsic (triggered by internal body processes like allergy or emotions). In between asthma attacks the individual was considered susceptible to asthma, but not requiring medical management or treatment.

The new paradigm of looking at asthma as a chronic inflammatory process, requires that one consider it is always present to some degree. This view mandates addressing the chronic problem with ongoing treatment, as opposed to episodic treatment. Moreover, as the chronic nature of the disease is airways inflammation that leads to varying levels of bronchial tube constriction, physicians must put more emphasis upon treating the cause (inflammation) to prevent the effect (bronchoconstriction). This, indeed, is a recommendation of the committee: using anti-inflammatory therapy medicines daily, instead of on a PRN basis.

Dealing With Inflammation

Some review of this essential process is necessary to better facilitate learning. Inflammation is a vital non-specific response used by the body to maintain homeostasis (Tortora, et al). The term non-specific is used to describe it because many factors can trigger it. It is a standard response to any factors affecting or threatening to affect homeostasis. An injury to a cell, tissue or organ, or an invading pathogen entering the body through an open wound; or an irritated bone-end will cause the local cells to signal for help in starting a process to defend themselves and the area. The signaling process is called chemotaxis. This is a beautiful language of chemicals through which cells and body components speak to each other. …