The Role of Pharmacology in the Treatment of Asthma

Asthma is a recurrent chronic disorder that involves the inflammation and obstruction of airways. A variety of cells and cellular complements are involved in the condition. Asthma is characterized by hyperresponsiveness of the airways, which causes recurrent occurrences of breathlessness, coughing at night or early in the morning, wheezing and tightening of the chest. The essay gives an in-depth explanation of the usage of pharmacology in the treatment of asthma, relative to the respirational structures.

The Link between the Context and Theory of Pharmacology

Scholars have defined the link between the context and theory of pharmacology to be as follows. The primary role of pharmacology over the years is that pharmacology has been an integrative discipline that focuses on the evaluation of disease hypotheses and cumulative properties (Winquist, Mullane & Williams, 2014, 4-5). The discipline grew from activities that sought to recognize therapeutics from natural sources. Researchers in the 19th century concentrated on the Law of Mass Action (LMA) to illustrate that compound effects depended on dosage and the concentration of doses. The discovery led to the receptor concept, which became critical in understanding the causes of diseases and action of drugs. The accuracy of understanding the concept increased with the evolution of pharmacology in the 20th century. On the contrary, the discovery also caused the development of data that lacks a physiological understanding and ignored the integration of the LMA at the organism’s tissue level. The reductionism caused the fall of pharmacology. The fall aroused concerns concerning the existing disconnect between research efforts and the approving of newly developed drugs, which caused the rebirth of pharmacology. As a result, the field has seen the integration of new technologies along with a pharmacological context, so researchers use testable hypotheses instead of relying on technology only.

The Pathogenesis of Asthma

The prevalence of asthma diagnosis and symptoms of the condition vary worldwide, probably due to the use of different diagnosis criteria and strategies for confirmation. Researchers agree that the pathogenesis of the state is intricate and different among medical endotypes (Olin & Wechsler, 2014, 2-3). The presentation of the endotypes inpatients depends on interactions between the inherited, epigenetic and environmental influences that patients are predisposed to. Studies show there is 60% chance that asthma is hereditary and there are some genes involved in the condition’s pathogenesis. The prevalence of the disease changes over time due to the impact of environmental influences. The environmental changes take effect due to epigenetic variations observed in DNA methylation. Epigenetic changes in infants can be caused by smoking during pregnancy, but such does not suggest a direct link to asthmatics.  Scholars attribute some environmental exposures to asthma. One is a severe infection of respiratory syncytial virus in childhood. The infection predisposes patients with asthma complications much later in adulthood. On the other hand, people who had early exposure to an environment with high microbial contents had low chances of developing asthma.

I           n another research, scientists have developed a paradigm for the pathogenesis asthma. The paradigm illustrates that the airway epithelium is at the center of the disease pathogenesis (Holgate, 2013, 346). To orchestrate the response of airways to different environmental exposures, the epithelium and mesenchyme underneath are in a good position to control the inflammatory response, the changes in structure in the airways associated with the various asthma phenotypes, responses to treatment and the evolution of the condition progressively over time. The discoveries have facilitated the creation of therapies that aim at increasing the resistance of the lungs instead of the suppression of inflammation.

The Pharmacology of Asthma

The signs and symptoms of asthma arise due to biochemical reactions that are initiated by the combinations of antibodies with antigens. The mast cell theory developed by scientists states that the reaction between the antigens and antibodies that results in asthma transpires on the surface of a mast cell (Austen & Lichtenstein, 2013, 104). Scholars question how the antigens reach the cell and argue that one needs to demonstrate the physiological irregularity that mast cell degranulation causes when the degranulation occurs in lungs. The irregularity is similar to asthma. A scholar proposed that a reaction occurs between inhaled antigens and specific antibodies, which are fixed to sensitized cells in lung tissues (Austen & Lichtenstein, 2013, 171).  The interaction arouses the cell to discharge histamine and other anaphylaxis mediators. The discharge induces the contraction of smooth muscle, which causes asthma.

Another researcher also noted the impacted of genetics on asthma infection. Monozygotic twins have a high concordance of the disease (Sreedharan, 2013, 4-52). Primary relatives have a raised incidence of the disease. The possession of a susceptibility gene for relatives could be a contributing factor. Such genes include ADAM-33, ADRB2, DQB1, FCEDR1B, CD-14, TNF, IL-4, DRB1, IL-4Ra, TNF, and IL-13. People with the gene often display atopic asthma. Atopic asthma arises from environmental antigens. Asthma can also arise from respiratory viruses such as rhinovirus and respiratory syncytial virus. Atopic asthma is not severe. On the other hand, non-atopic asthma is more severe and prolonged, and the triggers for non-atopic asthma are unclear. The inflammatory cells involved are mast cells, eosinophils, neutrophils, monocytes, and lymphocytes.

Use of Pharmacology in Asthma Treatment

Researchers have examined the effectiveness of various drugs in the treatment of asthma. The results researchers obtained from the use of pharmacological therapy in the treatment of asthma suggest that cholinergic pathways are accountable for the smooth muscle contractions observable in asthma (Austen & Lichtenstein, 2013, 179). In the past, Dr. Sims observed the use of Datura stramonium for treating asthma in India and introduced the remedy back home. Other studies show the injection or inhalation of atropine was also effective. Recently, the anti-asthmatic drugs that are used commonly include anti-inflammatory agents and bronchodilators (Garishah, 2012, 9-13). Such is necessary for the treatment of acute asthma. In the case of severe acute asthma, the treatment incorporates a high oxygen concentration, nebulized salbutamol, hydrocortisone and orally-administrated prednisolone, nebulized ipratropium, aminophylline and antibiotics in the presence of a bacterial infection.

Medical researchers have also compared the effectiveness of several drugs. The use of adenosine 5’-monophosphate (AMP) causes a pronounced reduction in the magnitude of airway hyper responsiveness than methacholine after the use of fluticasone, as early as 48 hours after administration of the dosage (Polosa, 2000, 1).   The use of adenosine proves sensitive and fitting for testing asthmatic inflammation and use in the diagnosis, monitoring of the disease and the evaluation of the treatment’s efficacy. The researchers also noted that there was increased ease in monitoring the changes in airway reactivity with the use of anti-inflammatory treatment as compared to the use of methacholine and histamine. In the findings, inhaled budesonide and corticosteroid were more active. Ultimately, the use of fluticasone in treatment created a larger broncho-protective outcome when used with AMP as compared with salmeterol. Salmeterol controls asthma efficiently after a six-week treatment program, and so fluticasone would be preferable when used with AMP. AMP gives better specificity in the observation of changes in airway inflammation than the use of methacholine. AMP would be a desirable indicator of an efficient anti-asthma therapy.

Pharmacological Management of Asthma

The pharmacological management looks into various ways of preventing and handling asthma complications. One needs to control asthma triggers (Fanta, 2018). Triggers are factors that cause the onset and worsening of asthma symptoms. The triggers include items that fall into the categories of allergens, stress, respiratory infections, beta blockers, and physical activity in cold weather, irritants and sometimes the onset of a menstrual cycle.  Some patients develop asthma symptoms upon exposure to anti-inflammatory medications that do not contain steroids. Once a caregiver identifies the potential asthma triggers of a patient, the caregiver develops a plan to deal with the triggers. The plan may include complete avoidance of the triggers, limited exposure to the triggers if complete avoidance is impossible, and the consumption of an extra dose of medication (allergy shots) before exposure to potential triggers. Taking the precautionary measures will allow the observance of any side effects of the medication and enable proper handling of any complications that may arise. One will also be able to prevent the triggering of asthma symptoms where possible successfully. A caregiver and the asthmatic person can also develop a workable action plan in case of an asthma attack.

The choice of pharmacological therapy depends on the level of asthma symptoms in a patient. Treatment involved in the therapy consists of the administration of medication either through inhalation or a systemic method (Patel & Shaw, 2015, 165). The inhaled options provide short-term remedies for symptoms and suppress airway inflammation. The treatment fits the severity of the disease. The severity is measured by taking a look at the symptoms, the functioning of the lungs, and assessment of the possibility of adverse outcomes to the given medication. The intensity involved in the treatment varies according to need and the type of anti-inflammatory therapy in use. One needs to undertake strict observance of medication, observe side effects and assess any impending effect of potential triggers.

Summary

In conclusion, asthma is a recurrent chronic disorder that involves the inflammation and obstruction of airways. The field of pharmacology integrates new technologies in a pharmacological context so that researchers use testable hypotheses instead of relying on technology only. Researchers agree that the pathogenesis of the condition is intricate and different among medical endotypes. The presentation of the endotypes inpatients depends on interactions between the inherited, epigenetic and environmental influences that patients are predisposed to. Medical scientists agree that the signs and symptoms of asthma arise due to biochemical reactions that are initiated by the combinations of antibodies with antigens. A reaction occurs between inhaled antigens and specific antibodies, which are fixed to sensitized cells in lung tissues. The interaction arouses the cell to discharge histamine, and other anaphylaxis mediators and the discharge induces the contraction of smooth muscle, which causes asthma. Researchers have examined the effectiveness of various drugs in the treatment of asthma. The anti-asthmatic medicines that are used commonly include anti-inflammatory agents and bronchodilators. The pharmacological management looks into multiple ways of preventing and handling asthma complications. One needs to control asthma triggers by complete avoidance of the triggers, limited exposure to the triggers if complete avoidance is impossible, and the consumption of an extra dose of medication (allergy shots) before exposure to potential triggers. In any pharmacological therapy, the caregiver takes into consideration lung function and the risk of exacerbations in the future. The intensity involved in the treatment varies according to need and the type of anti-inflammatory therapy in use. The choice of pharmacological therapy depends on the level of asthma symptoms in a patient. Treatment involved in the therapy consists of the administration of medication either through inhalation or a systemic method. Asthma can be managed efficiently in children by observing the guidelines prescribed by medical practitioners strictly. The condition can also be treated successfully with the use of and proper adherence to prescribed medication.

List of References

Austen, K. & Litchenstein, L., 2013, Asthma: Physiology, Immunopharmacology, and             Treatment, Elsevier: Amsterdam, Print

Fanta, C., 2018, Patient education: Asthma treatment in adolescents and adults (Beyond the       Basics), UpToDate, https://www.uptodate.com/contents/asthma-treatment-in-adolescents-    and-adults-beyond-the-basics

Garishah, F., 2012, Pharmacology of Asthmatic Drugs,             https://www.slideshare.net/fadelmuhammad/pharmacology-of-asthmatic-drugs.

Holgate, S., 2013, Mechanisms of Asthma and Implications for Its Prevention and

            Treatment: A Personal Journey, Allergy Asthma Immunol Res. 2013, Vol. 5, No. 6, Pp.   343-347. http://dx.doi.org/10.4168/aair.2013.5.6.343

Olin, J. &  Wechsler, M., 2014, Asthma: pathogenesis and novel drugs for treatment, State Of           The Art Review, Pp. 1-11, BMJ 2014; 349:g5517 doi: 10.1136/bmj.g5517.

Patel, M. & Shaw, D., 2015, A Review of Standard Pharmacological

            Therapy For Adult Asthma – Steps 1 To 5, Chronic Respiratory Disease 2015, Vol. 12,           No. 2, Pp. 165–176. sagepub.co.uk/journalsPermissions.nav DOI:             10.1177/1479972315573529.

Polosa, R., 2000, Letters to the Editor, No. 55, Pp. 628–630, downloaded from             http://thorax.bmj.com/ on April 8, 2018 - Published by group.bmj.com.

Sreedharan, A., 2013, Asthma Pathology, Pathogenesis,             https://www.slideshare.net/dramithsreedharan/asthma-pathogenesis-16101058

Winquist, R., Mullane, K. & Williams, M., 2014, The Fall And Rise Of Pharmacology– (Re-)    Defining The Discipline?, Biochemical Pharmacology, Vol. 87, Pp. 4–24.             www.elsevier.com/locate/biochempharm.