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Introduction Of Effectiveness Of Treatment/Management For Asthma

Asthma is a chronic non-communicable disease of the lung that affects individuals of all ages. It causes inflammation, narrowing, swelling, and muscle tightening around the airways and creates difficulties in breathing. It affected daily activities and causes life-threatening attacks. In 2019, the estimation reflects that this disease, which caused 455000 deaths (WHO, 2023), affected 262 million people. Therefore, healthcare organizations including the WHO tried to improve the diagnosis process by offering effective and advanced treatment. The continuous monitoring process helps to reduce the global burden of asthma. The symptoms including coughing, breathing issues, chest tightness, and wheezing can be treated effectively through inhaler and self-treatment immediately after diagnosis (Buhl et al. 2022). Global Experts in asthma and biological medication identified different clinical variables to manage severe asthma. During an emergency, types of quick-relief medication including short-acting beta-agonists help to provide relief to the patient. Anti-inflammatory reliever therapy and bronchial thermoplastic are found to be effective in the management of asthma. Along with the different medications, the reduction of tobacco use helps to prevent the risk of asthma.

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Pathophysiology of mild asthma, moderate asthma, and severe asthma

The pathophysiology of asthma is a complex process and involves inflammation of airways, intermittent airflow obstruction, and hyper responsiveness of the bronchial. According to,Carpaij et al. (2019), it is a highly prevalent disease worldwide and there is no cure available at present. Therefore, public health organizations increase their concerns about the management of asthma by providing effective treatment procedures. The research reflects that the asthma patient can enter remission of the disease in later life. Thus, complete remission and clinical remission are used to manage the pathophysiology of asthma. The differences in asthma help to identify the severity, persistence, and disease duration (NCBI, 2023). The characteristics of pathophysiological features affected many cell types and multiple mediators with the air track of affected individuals. The inflammation of the airways does not depend on the severity or other factors and the cellular profile and cell structure remain quite consistent. On the other hand,Yamauchi and Ogasawara (2019), stated that mast cells play a critical role in allergic asthma pathogenesis. Mast cell release histamine and created an allergic reaction and causing airway obstruction through airway mucosal edema, bronchial secretion, and smooth muscle construction. Other inflammatory cells including lymphocytes affected the function of the respiratory tract and influence allergic inflammation.

Different pathophysiological factors such as bronchial inflammation, shortness of betting and wheezing affected the trachea, bronchi, and bronchioles. Different chemicals released from the mast cells are known as a mediator and activated that influence the reversible and diffuse airway inflammation that results in the narrowing of airways. The pathophysiology of acute asthma reflects hyper responsiveness, airway remodelling, gluing inflammation, and hypersecretion of mucus (Myamericannurse, 2023). The symptoms of asthma increase due to increased contact with dust. Apart from that, the smoke of tobacco and other substances increases the risk of severity of asthma. Therefore, it is important to manage the risk of the disease. Due to excessive air pollution, irrespective of age and gender, a non-communicable disease that created a negative impact on health at a later age affects people. It gives the risk of other respiratory diseases. The disease causes due to various lifestyle factors, including obesity, exposure to environmental allergens, eczema, and rhinitis (WHO, 2023).

Along with these factors, genetic factors also have an impact on the contamination of the diseases. In many cases, asthma came from the either father or mother.As opinedbyThomson (2019), Bronchial thermo plasty effectively controls the causes of asthma. It assesses different causes that affected disease control and create an impact on nonadherence, poor inhaler techniques, comorbidities, other treatments, and behavioural factors. This therapy reduces the obstruction of the airways and improves small airway functions.On the contrary,Kaplan et al. (2020), described that the treatment for the management of asthma is conducted as per the severity of the disease. Standard asthma treatment is tried to prevent by monotherapy including short-acting beta-agonists (SABA) among the patients. In the Global Initiative for Asthma 2019, different strategies are introduced for management of the Asthma. Public health focuses on the improvement of the availability of non-steroid alternative therapies (Papadopoulos et al. 2019). Lack of clinical efficacy and safety evidence influences the petro physical factors of asthma.

Explore the pharmacology of a MART regime

Maintenance and Reliever Therapy (MART) is the combination of formoterol and inhaled corticosteroids ICS and LABA treatment to provide relief and the daily maintenance of therapy with a single inhaler. It is used to reduce the inflammation of the affected individuals and clear the airways. This medication provides ongoing relief from the emergency attack of asthma such as breathlessness and a tight chest. The using of an inhaler is the most effective way to treat the attacks to prevent the symptoms of asthma. Healthcare organizations introduced the "ideal inhaler" with guaranteed accuracy, dose consistency, and resistance to stress conditions (Marco, 2020). The individual suffering from asthma got the attack in a stressful situation and also the comfort decreases while going to high places. Thus, an inhaler has to be carried by the patient in every situation as it is able to provide sudden relief to fight the uncomfortable situation at that moment.

Different studies found that the effectiveness of the MART regime helps to increase the effectiveness of asthma treatment. Although there is no specific cure method is invented, medical personalities and scientists invented several medication processes along with yoga and other physical activity to prevent the prevalence of asthma. ICS therapies influence the MART and offer various dosing regimens of budesonide (BUD) and fluticasone propionate (FP) (Singh et al. 2022). It is found that regular use of ICS dosing regimens provide benefits to asthma patients and was diminished when adherence was low (50%). The findings explain that these treatment options help the asthma management process and help to provide relief to the patients. Fluticasone furoate (FF) and vilanterol tridentate (Vi)is an example of ICS and LABA that provides several advantages to create favourable landscapes(Dhar et al. 2022). Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines did not clearly define its effectiveness yet it assures the safety and efficacy of this treatment process.

Research on MART

Guidelines

Asthma affects a wide range of people worldwide and increases the concerns of health organizations. The physicians applied different treatment processes to reduce the health problems rises due to asthma. The guideline of NICE includes ESNM3, ESNM22, ESNM34, ESNM53, and ESNM55, which concerns with the diagnosis, monitoring, and management of asthma in adults, young people, and children by improving the accuracy of diagnosis (NICE, 2021). It helps to control asthma and reduces the risk of asthma attacks. It recommended initial assessment, diagnosis of asthma in young children, tests conducted, pharmacological treatment execution, adherence, and self-management. NICE monitors asthma controlling and decreasing treatment procedures. NICE, BTS, and SIGN together look forward to the management of asthma along with the outcome of their unique partnership. The National Guideline Centre has commissioned these guidelines (Britthoracic, 2023).ERS ATS guided the medical personalities to provide the basis for rational decisions to treat asthma patients. It suggested identifying the comorbidities and providing treatment accordingly and in case of the severity of disease the the dosage is applied. A systematic corticosteroid helps to prevent uncontrolled asthma. It suggests high-dose inhaled corticosteroids plus for the treatment of this disease. ERS ATS-guided therapy uses specific recommendations on the application of sputum eosinophil count and exhaled nitric oxideErsjournals (2023). It also suggestsanti-IgE antibodies, methotrexate, macrolide antibiotics, antifungal agents, and bronchial thermoplastic for the treatment of asthma.GINA suggested through its guidelines that it is often underdiagnosed, diagnosed with lung function testing, and provides the best quality treatment before striking long-term treatment (Ginasthma, 2023).Global Strategy for Asthma Management and Prevention in 2022 incorporates new scientific methodsto increase the effectiveness of treatment. The guideline suggested that patients having symptoms of less than twice a month and with no exacerbation risk factors require a low dose of ICS-formoterol.

Stepwise Approach to asthma management

The Global Initiative for Asthma (GINA) provides a stepwise approach as the guideline for asthma that influence the objective of MART. All the guidelines provide a similar system to manage the treatment and adapt preventive measures for asthma. The first step of management includes maintenance and reliever therapy (MART) (Mauer and Taliercio, 2020). It is the combination of inhaled corticosteroid (ICS)or formoterol (FORM) and is recommended as option art steps 3-5 for all people belonging to different age groups. This process easily affects the person having the tendency to allergy. It gradually increases or decreases the severity of the disease. Inhaled corticosteroids are a type of medication used to prevent the symptoms of asthma

As, asthma is a chronic disease; hence, inhaled corticosteroids are a type of medication used to prevent the symptoms of asthma. Regular use of inhaled corticosteroids reduces the severity of asthma attacks. Inhaled corticosteroids are helpful helps to relax certain cells in lungs, which eases process of breathing (Marco, 2020). However, use of Inhaled corticosteroids side-effects like glaucoma, skin fragility, acne vulgaris, and hirsutism. Therefore, after being diagnosed with asthma symptoms, an individual has to start self-care and follow the restrictions to prevent the disease severity along with taking proper medication. The medication of dosage is continued through "step up" or "step down" until the best balance or cures found. It is important to take medicines and inhalers regularly as per the suggestions of the doctors.

Systematic review

Authors name Title Methods Relevance to the topic
Chapman et al. 2021 Asthma patients' and physicians' perspectives on the burden and management of asthma Online survey The guideline of GINA increases the effectiveness of MART to conduct asthma management.
Jenkins et al. 2020 What have we learned about asthma control from trials of budesonide/formoterol as maintenance and reliever? Primary research Along with the improvement of the medicationprocess, device, and disease understanding help to provide an effective treatment to the patients. MART is the relevant comparator approach to asthma management.
Reddel et al. 2022 Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes Secondary research The assessment of the severity of asthma influences the dose of medication across all age groups. Self-management, risk factors, education, and skills training influence the medication process of MART.
Matera et al. 2020 Emerging muscarinic receptor antagonists for the treatment of asthma Secondary research Glycopyrronium and umeclidinium are going to be included under the GINA strategy that influences the amang4ent of asthma through the effectiveness of MART. Effective technologies allow the effective delivery of drugs to provide relief to patients.
Levy et al. 2023 Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update Primary research GINA provides different recommendations to improve the health conditions of asthma patients. The guidance strategy of GINA suggests different treatments for adults and children after assessing other health issues to ensure health safety.
Wilkinson and Woodcock, 2022 The environmental impact of inhalers for asthma: A green challenge and a golden opportunity Primary research The effectiveness of an asthma control drug is measured by its ability and thus itwith safer technologies and elements to increase its safety.
Booth, A., 2020 Inhaled therapy for asthma Secondary research Inhaled therapy is considered the most effective treatment of asthma. Along with drugs, different devices consisting of aerosol inhalers helps in increasing the effectiveness of MART.
Henry, H., 2021 Understanding personal asthma action plans Primary research Personal asthma action plans (PAAPs) help to build the consciousnessamong the affected individual to increase self-care. It helps to monitor the asthma control process.

Different research reflects that the effectiveness of MART is significantly influenced by advanced technologies and innovation. As stated byBooth(2020), Different doses of drugs create an impact on the speed of recovery of patients. Dry powder inhalers also help to reduce the danger of asthma attacks during emergency conditions. The drugs for asthma consist of bronchodilators and anti-inflammatories. Aerosol inhalers effectively function in the clinical treatment of asthma, which improves the control process and reduces exacerbations. On the contrary,Reddel et al. (2022), described that apart from medication there are also other ways to reduce the prevalence of this non-communicable disease. Increasing self-awareness, yoga, reducing smoking consumption, and avoiding allergic substances helps to prevent an asthma attack. The monitoring process also helps to increase the management process of asthma. The effectiveness of MART helps to increase drug use and improvers health conditions. MART provides drugs suggestion for the different age groups to provide safety for affected individuals with different medications.

Findings of the Literature

Reliability of research

Different research study indicates that MART is an effective process to manage the disease by providing an effective treatment process. The reliability of research can be accessed by the results of the studies. According toMatera et al. (2020), the pharmacological profile influences the choice of therapy by applying the strategies of GINA. The guidelines for controlling asthma influence the treatment process of asthma. The research focuses on the different ways of treatment and the use of different drugs to cure patients. On the contrary,Jenkins et al. (2020), described that extra doses of ICS influence the treatment of asthma patients and use as a reliever. The pieces of literature reflect different treatment processes along with advanced medication techniques. Different treatment process helps to treat mild, moderate, and severe asthma. Inhaled corticosteroids (ICS) influence the prevention of asthma exacerbation among patients with persistent asthma. According to the severity of asthma, oral corticosteroids are used to provide relief to the patients.

Implementation of the Intervention

Different intervention strategies are adopted while offering effective therapy to the patients. Systematic and theory-based approaches evaluate the intervention strategies for asthma. It helps to develop and adopt the appropriate and scalable solution for the management of asthma in low- and middle-income countries(LMIC) settings Romani et al. (2020). The affected individuals had trouble in participating in social activities due to their health conditions. Thesocio-political implications of COPD refer to the anxiety and depressive symptoms while participating in different activities. Panic disorder influences asthma attacks, which increases the risk of health. Every affected individual needs treatment and cure for this disease as it creates a long-term impact on human health.

Importance of HCP

HCP engagement influences the improvement process of patient health along with that it enhances the reputation of pharmaceutical companies by supporting their overall performance. It helps to gain better control over the symptoms of asthma, helps to maintain normal activity levels, and reduces the affecting factors and disease risk (Busby et al. 2022). A group of minority people did not follow the treatment advice of HCP, which created a negative impact on human health. It helps to reduce the severity of the disease through the self-care of the patients. It allows the patients to follow the treatment process to overcome the risk factors. It is important to control asthma as it affected the daily activity of the patients by increasing the shortness of breath at different times. Different symptoms of the disease give rise to the risk of other diseases that affect the healthy lifestyle of the individuals.

Clinical and non-clinical effects

Asthma increases the risk of cardiovascular diseases and develops long-term impacts on human health. Apart from that, it created mood disorders and other psychological disturbances among the affected individual. Therefore, the management and treatment process helps to reduce the disease risk and ensures the health safety of the individual. Along with that, it helps participation in different socio-cultural activities and helps in better relationships with the surrounding people (Carpaij et al. 2019). Mild Asthma, moderate asthma, and severe asthma created a different clinical and non-clinical effect on the health of affected individuals. In controlling mild asthma, self-control, and minimum drug dose are required. In moderate asthma, the treatment continues a bit long by inhaler with the maintenance of restrictions. Severe asthma needs high doses of medication including an inhaler and the treatment continues for a long time.

Recommendations

It is recommended that in asthma attack every guideline need to be accepted and all-purpose of the condition need to be cured with the important application of MART. If an attack happens suddenly then a person needs to sit up straight and he needs to keep calm. One puff of the reliever is needed to take at an interval of every 30 to 60 seconds up to 10 puffs. After 10 puffs if the person is not feeling good then he needs to see a doctor for extended treatment. The details of the medicines need to be taken with the patient so that the doctor can understand the condition immediately. In the conditions of MART these part of the procedure is not required and in general, if the condition arises then GP or asthma nurse need to be informed (Levy et al. 2023). An action plan needs to be developed for the asthma patient so that the person can follow the action plan to improve the health condition. The friend and family of an asthma patient need to know how an emergency condition can be handled. A copy of the action plan needs to be kept handy so that in requirement it can be used and can be shared. The patient has to increase self-consciousness and have to take an inhaler along with the other medicines according to the time regularly. Healthcare organizations and doctors have to follow the guideline of GINA while treating patients to increase the effectiveness of treatment.

Conclusion

It is to conclude that the study is a part of the information, whichcan describe the value of MART a process to care the critical condition based on asthma. A particular health condition is very dangerous for people and in the study, it is seen how a particular patient with asthma can be treated with full of potential. The condition of the health regarding the situation can be controlled in various ways discussed in the study. The research on the particular service is mentioned in the part of the study that can show the value of MART. The research criteria are given in the study with an effective review of the research. The health condition comprised with asthma can be deliberately used for the imposition of the process that can be important for the prevention of the condition. Vast information is given in order to show the importance of the disease and its prevention. The effects and symptoms of the disease are clearly defined in the study and it is seen that the symptoms of asthma are a very pain-producing factor. The immediate remedies need to be sorted so that the condition can be cured and controlled over time. The guideline of GINA and other helps to increase the effectiveness of treatment and the management of asthma.

References

Journals

  • Booth, A., 2020. Inhaled therapy for asthma. Practice Nursing, 31(7), pp.290-299.
  • Buhl, R., Bel, E., Bourdin, A., Dávila, I., Douglass, J.A., FitzGerald, J.M., Jackson, D.J., Lugogo, N.L., Matucci, A., Pavord, I.D. and Wechsler, M.E., 2022. Effective management of severe asthma with biologic medications in adult patients: a literature review and international expert opinion.The Journal of Allergy and Clinical Immunology: In Practice, 10(2), pp.422-432.
  • Busby, J., Matthews, J.G., Chaudhuri, R., Pavord, I.D., Hardman, T.C., Arron, J.R., Bradding, P., Brightling, C.E., Choy, D.F., Cowan, D.C. and Djukanovic, R., 2022. Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma. European Respiratory Journal, 59(4).
  • Carpaij, O.A., Burgess, J.K., Kerstjens, H.A., Nawijn, M.C. and van den Berge, M., 2019. A review on the pathophysiology of asthma remission. Pharmacology & therapeutics, 201, pp.8-24.
  • Chapman, K.R., An, L., Bosnic-Anticevich, S., Campomanes, C.M., Espinosa, J., Jain, P., Lavoie, K.L., Li, J. and Butta, A.K., 2021. Asthma patients' and physicians' perspectives on the burden and management of asthma. Respiratory Medicine, 186, p.106524.
  • Dhar, R., Talwar, D., James, P., Mishra, A., Vachaparambil, J., Patil, S., Khatri, N., Bhagat, S. and Barkate, H., 2022. ICS/Ultra LABA in the Treatment of Obstructive Airway Diseases: A Consensus of Indian Experts. Advances in Respiratory Medicine, 90(5), pp.407-424.
  • Henry, H., 2021. Understanding personal asthma action plans. Practice Nursing, 32(3), pp.96-100.
  • Jenkins, C.R., Bateman, E.D., Sears, M.R. and O'Byrne, P.M., 2020. What have we learnt about asthma control from trials of budesonide/formoterol as maintenance and reliever?.Respirology, 25(8), pp.804-815.
  • Kaplan, A., Mitchell, P.D., Cave, A.J., Gagnon, R., Foran, V. and Ellis, A.K., 2020. Effective asthma management: is it time to let the AIR out of SABA?. Journal of Clinical Medicine, 9(4), p.921.
  • Levy, M.L., Bacharier, L.B., Bateman, E., Boulet, L.P., Brightling, C., Buhl, R., Brusselle, G., Cruz, A.A., Drazen, J.M., Duijts, L. and Fleming, L., 2023. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. npj Primary Care Respiratory Medicine, 33(1), p.7.
  • Matera, M.G., Belardo, C., Rinaldi, M., Rinaldi, B. and Cazzola, M., 2020. Emerging muscarinic receptor antagonists for the treatment of asthma. Expert Opinion on Emerging Drugs, 25(2), pp.123-130.
  • Mauer, Y. and Taliercio, R.M., 2020. Managing adult asthma: The 2019 GINA guidelines. Cleveland Clinic journal of medicine, 87(9), pp.569-575.
  • Papadopoulos, N.G., ?ustovi?, A., Cabana, M.D., Dell, S.D., Deschildre, A., Hedlin, G., Hossny, E., Le Souëf, P., Matricardi, P.M., Nieto, A. and Phipatanakul, W., 2019. Pediatric asthma: an unmet need for more effective, focused treatments.Pediatric Allergy and Immunology, 30(1), pp.7-16.
  • Reddel, H.K., Bacharier, L.B., Bateman, E.D., Brightling, C.E., Brusselle, G.G., Buhl, R., Cruz, A.A., Duijts, L., Drazen, J.M., FitzGerald, J.M. and Fleming, L.J., 2022. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. American Journal of Respiratory and Critical Care Medicine, 205(1), pp.17-35.
  • Romani, E.D., Siddharthan, T., Lovatón, N., Alvítez-Luna, C.C., Flores-Flores, O. and Pollard, S.L., 2020. Implementation of an intervention to improve the adoption of asthma self-management practices in Peru: Asthma Implementation Research (AIRE) randomized trial study protocol. Trials, 21(1), pp.1-10.
  • Singh, D., Garcia, G., Maneechotesuwan, K., Daley-Yates, P., Irusen, E., Aggarwal, B., Boucot, I. and Berend, N., 2022. New versus old: The impact of changing patterns of inhaled corticosteroid prescribing and dosing regimens in asthma management. Advances in Therapy, 39(5), pp.1895-1914.
  • Thomson, N.C., 2019. Recent developments in bronchial thermoplasty for severe asthma. Journal of asthma and allergy, pp.375-387.
  • Wilkinson, A. and Woodcock, A., 2022. The environmental impact of inhalers for asthma: A green challenge and a golden opportunity. British Journal of Clinical Pharmacology, 88(7), pp.3016-3022.
  • Yamauchi, K. and Ogasawara, M., 2019. The role of histamine in the pathophysiology of asthma and the clinical efficacy of antihistamines in asthma therapy. International journal of molecular sciences, 20(7), p.1733.

Websites

  • Britthoracic (2023), BTS/SIGN British Guideline on the Management of Asthma, [Online] Available at: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ [Accessed on: 19thMay, 2023]
  • Community (2023), What Happens in Your Airways When You Have Asthma? [Online] Available at: https://community.aafa.org/blog/what-happens-in-your-airways-when-you-have-asthma [Accessed on: 19thMay, 2023]
  • Ersjournals (2023), International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma, [Online] Available at: https://erj.ersjournals.com/content/43/2/343 [Accessed on: 19thMay, 2023]
  • Ginasthma (2023), 2022 GINA Report, Global Strategy for Asthma Management and Prevention, [Online] Available at: https://ginasthma.org/gina-reports/ [Accessed on: 19thMay, 2023]
  • Marco, F.D., (2020), Today's improvement in asthma treatment: role of MART and Easyhaler, [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460660/ [Accessed on: 19th May, 2023]
  • Myamericannurse (2023), Pathophysiologic, [Online] Available at: https://www.myamericannurse.com/understanding-asthma-pathophysiology/#:~:text=Asthma%20involves%20many%20pathophysiologic%20factors,trachea%2C%20bronchi%2C%20and%20bronchioles. [Accessed on: 19th May, 2023]
  • NCBI (2023), Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma, [Online] Available at:https://www.ncbi.nlm.nih.gov/books/NBK7223/#:~:text=As%20noted%20in%20the%20definition,in%20recurrent%20episodes%20of%20cough%2C [Accessed on: 19th May, 2023]
  • NICE (2021), Asthma: diagnosis, monitoring and chronic asthma management [Online] Available at: https://www.nice.org.uk/guidance/ng80 [Accessed on: 19th May, 2023]
  • Slideshare (2023), Pharmacological Management of Asthma, [Online] Available at: https://www.slideshare.net/PLANnetwork/pharmacological-management-of-asthma [Accessed on: 19thMay, 2023]
  • WHO (2023), Asthma, [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/asthma#:~:text=Asthma%20is%20a%20chronic%20lung,come%20and%20go%20over%20time. [Accessed on: 19th May, 2023]
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