Introduction

When hearing the phrase asthma, what comes to mind? If you’re an advanced practice registered nurse (APRN) with prescriptive authority, you’ve definitely heard of asthma before. Even as a nurse or maybe before nursing school, conversations about prescription drug use and respiratory health existed every so often.

Presently, patients seek guidance and information on various health topics from APRNs, including medication management and respiratory health. The information in this course will serve as a valuable resource for APRNs with prescriptive authority across all specialties, education levels, and backgrounds to learn more about medications that can treat and manage asthma.

Defining Asthma

What Is Asthma?

Asthma is a non-communicable, chronic health condition that affects the lungs’ airways and millions of people nationwide. Asthma is often diagnosed in childhood and can resolve in adulthood or continue for the rest of a patient’s life. Several studies postulate the cause of asthma, but there is no definitive cause.

Genetics, age, environmental exposures, smoking, and a history of allergies are thought to play a role in asthma severity and development. Clinical presentation of asthma often includes trouble breathing, chronic airway inflammation, and airway hyperresponsiveness. Assessment for asthma often includes patient history, clinical presentation, spirometry testing, and pulmonary function tests (PFTs).

What Are the Stages of Asthma?

Since asthma is a chronic condition, several established guidelines can be used to determine its severity and explore possible medication options. Treatment and management vary depending on the stage of asthma and the patient’s response to existing therapy.

The four stages of asthma are intermittent, mild, moderate, and severe. Based on the 2020 National Asthma Education and Prevention Program (NAEPP) guidelines, here are the standard criteria for each stage of asthma (2).

Intermittent asthma is characterized by the following clinical presentation and assessment (2):

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness <2 times a week
• Asthmatic flare-ups are short-lived with varying intensity
• Symptoms at night are <2 a month
• No asthmatic symptoms between flare-ups
• Lung function test FEV 1 at >80% above normal values
• Peak flow has <20% variability am-to-am or am-to-pm, day-to-day

Mild persistent asthma is characterized by the following clinical presentation and assessment (2):

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness 3-6 times a week
• Asthmatic flare-ups may affect activity level and can vary in intensity
• Symptoms at night are 3-4 times a month
• Lung function test FEV1 is >80% above normal values
• Peak flow has less than 20-30% variability

Moderate persistent asthma is characterized with the following clinical presentation and assessment (2):

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness, daily
• Asthmatic flare-ups may affect activity level and can vary in intensity
• Symptoms at night are >5 times a month
• Lung function test FEV1 is 60%-80% of normal values
• Peak flow has more than 30% variability

Severe persistent asthma is characterized with the following clinical presentation and assessment (2):

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness, continuously
• Asthmatic flare-ups affect activity level and often vary in intensity
• Asthmatic symptoms at night are constant
• Lung function test FEV1 is <60% of normal values
• Peak flow has more than 30% variability

Based on patient history, clinical presentation, and these criteria, treatment can be administered to decrease the patient’s symptoms. If a patient presents with symptoms outside your scope of work or understanding, you can always refer them to a pulmonologist or asthma specialist.

Often, more severe cases of asthma and asthma emergencies require increased frequency and dosing of asthma-related medications. Health care provider discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history, pulmonary function, and health history before prescribing asthma medications (1).

What Are Asthmatic Emergencies?

Asthmatic emergencies occur when a patient has asthma symptoms that are beyond what they typically experience and is unable to function without immediate medical intervention. They can occur as a result of a patient being unable to access their asthmatic medications, being exposed to a possible allergen, or being under increased stress on the body.

Asthmatic emergencies often require collaborative medical intervention, increased dosages of medications discussed below, and patient education to prevent future asthmatic emergencies (1).

What If Asthma Is Left Untreated?

Depending on the clinical presentation and severity of asthma, it can cause several long-term complications if left untreated. If asthma is not correctly managed, several complications, such as chronic obstructive pulmonary disease (COPD), decreased lung function, permanent changes to the lungs’ airways, and death, can occur (1, 2).

Asthma Medications

What Are Commonly Used Medications to Manage Asthma?

Commonly used medications to manage asthma include inhaled corticosteroids, oral corticosteroids, short-acting beta agonists (SABAs), long-acting beta agonists (LABAs), long-acting muscarinic antagonists (LABAs), adenosine receptor antagonists, leukotriene modifiers, mast cell stabilizers, and monoclonal antibodies. The dosage, frequency, amount of asthma management medications, and medication administration route can vary depending on clinical presentation, patient health history, and more.

How and Where are Asthma Medications Used?

Depending on the patient, asthma medications can be used routinely or as needed to manage asthma symptoms. They can be used at home, in public places, and in health care facilities. Depending on the specific asthma medication and dosage, these medications can be taken by mouth or via an external device, such as an inhaler, subcutaneous injection, or intravenous solution (1).

What Are the Clinical Criteria for Prescribing Asthma Medication?

Clinical criteria for prescribing asthma medication can depend on a patient’s clinical presentation. Assessment of lung health and patient history is essential to determining the dosage and medications needed for adequate asthmatic symptom control.

Clinical guidelines from reputable organizations, such as the National Asthma Education and Prevention Program (NAEPP), the National Institutes of Health (NIH), the Global Initiative for Asthma (GINA), and the American Academy of Family Physicians (AAFP) can provide insight into the latest recommendations for asthma management (1, 2). In addition, local laws or health departments might have suggestions for asthma medication guidelines.

What Is the Average Cost for Asthma Medications?

The cost of asthma medications can significantly vary depending on the type of medication, insurance, dosage, frequency, medication administration route, and other factors. Cost is a leading reason many patients cannot maintain their medication regimen (3). If cost is a concern for your patient, consider reaching out to your local pharmacies or patient care teams to find cost-effective solutions.

Inhaled Corticosteroids Pharmacokinetics

Therapy should be guided by the healthcare provider’s professional discretion and the patient’s condition. Consider reviewing a patient’s medication history and health history before prescribing asthma medications.

Drug Class – Inhaled Corticosteroids

Commercially available inhaled corticosteroids include: ciclesonide (Alvesco HFA), fluticasone propionate (Flovent Diskus, Flovent HFA, Armon Digihaler), budesonide (Pulmicort Flexhaler), beclomethasone dipropionate (QVAR RediHaler), fluticasone furoate (Arnuity Ellipta), and mometasone furoate (Asmanex HFA, Asmanex Twisthaler).

Clinical criteria for prescribing an inhaled corticosteroid include adherence to the latest clinical guidelines, patient medical history, clinical presentation, and drug availability (4).

Inhaled Corticosteroids: Method of Action

Inhaled corticosteroids have an intricate action mechanism involving several immune system responses. They decrease the existing initial inflammatory response by decreasing the creation and slowing the release of inflammatory mediators. Common inflammatory mediators include histamine, cytokines, eicosanoids, and leukotrienes. Inhaled corticosteroids can also induce vasoconstrictive mechanisms, which can lead to less blood flow, resulting in less discomfort and edema (4).

In addition to anti-inflammatory properties, inhaled corticosteroids can create a localized immunosuppressive state that limits the airways’ hypersensitivity reaction, which is thought to reduce bronchospasms and other asthma-associated symptoms. It is important to note that inhaled corticosteroids often do not produce therapeutic effects immediately, as many patients may not see a change in their asthma symptoms for at least a week after beginning inhaled corticosteroid therapy (4).

Inhaled Corticosteroids Side Effects

Every medication has the possibility of side effects, and inhaled corticosteroids are no exception. Common side effects of inhaled corticosteroids include oral candidiasis (thrush), throat irritation, headache, and cough.

Patient education about rinsing their mouth and oral hygiene after use is essential to avoid the possibility of thrush and other oral infections and irritations. More severe side effects can include prolonged immunosuppression, reduction in bone density, and adrenal dysfunction (4).

Inhaled Corticosteroids Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with inhaled corticosteroids, so additional medication, increased dosage, a change in frequency, or a new medication class might need to be considered (4).

Oral Corticosteroids Pharmacokinetics

The health care provider’s professional discretion and the patient’s condition should guide therapy. Consider reviewing a patient’s medication history and health history before prescribing asthma medications.

Drug Class – Oral Corticosteroids

Commercially available oral corticosteroids include methylprednisolone, prednisolone, and prednisone. Clinical criteria for prescribing an oral corticosteroid include adherence to the latest clinical guidelines, patient medical history, clinical presentation, and drug availability (4).

Oral Corticosteroids Method of Action

Methylprednisolone and prednisolone have a method of action as intermediate, long-lasting, synthetic glucocorticoids, have COX-2 inhibitory properties, and inhibit the creation of inflammatory cytokines (5).

Prednisone is a prodrug to prednisolone and has anti-inflammatory and immunomodulating glucocorticoid properties. Prednisone has a method of decreasing inflammation by reversing increased capillary permeability and suppressing the movement of certain leukocytes (6).

Oral Corticosteroids Side Effects

Every medication has the possibility of side effects, and oral corticosteroids are no exception. Methylprednisolone and prednisolone have possible side effects of skin changes, weight gain, increased intraocular pressure, neuropsychiatric events, neutrophilia, immunocompromised state, fluid retention, and GI upset.

Consider monitoring symptoms and overall health of patients on systemic corticosteroids to assess for long-term side effects (5). Prednisone has possible side effects of changes in blood glucose, changes in sleep habits, changes in appetite, increased bone loss, an immunocompromised state, changes in adrenal function, and changes in blood pressure (6).

Oral Corticosteroids Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with oral corticosteroids, so additional medication, increased dosage, a change in frequency, or a new medication class might need to be considered (6).

Short-Acting Beta Agonists (SABAs)

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history and health history prior to prescribing asthma medications.

Drug Class – SABAs

Common commercially available SABAs include albuterol sulfate (ProAir HFA, Proventil HFA, Ventolin HFA), albuterol sulfate inhalation powder (ProAir RespiClick, ProAir Digihaler), levalbuterol tartrate (Xopenex HFA), and levalbuterol hydrochloride (Xopenex) (4).

SABAs Method of Action

Short-acting beta-agonists (SABAs) have a rapid onset as broncho-dilating medications. SABAs, especially albuterol in emergent situations, are often used to quickly relax bronchial smooth muscle from the trachea to the bronchioles through action on the β2-receptors.

While SABAs are effective bronchodilators in the short term for asthma symptoms, they do not affect the underlying mechanism of inflammation. As a result, SABAs are often used for short-acting intervals, such as a few hours, and have limited capabilities to prevent asthma exacerbations alone (4). SABAs can be administered via metered-dose inhalers, intravenous dry powder inhalers, orally, subcutaneously, or nebulizers.

SABAs Side Effects

Every medication has the possibility of side effects, and SABAs are no exception. Because of the beta receptor agonism, possible SABA side effects include increased heart rate, chest pain, chest palpitations, body tremors, and nervousness (4). Chronic side effects are not typically observed because of the short half-life of SABAs.

SABAs Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with SABAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Long-Acting Beta Agonists (LABAs)

Therapy should be guided by the healthcare provider’s professional discretion and the patient’s condition. Consider reviewing a patient’s medication history and health history before prescribing asthma medications.

Drug Class – LABAs

Common commercially available LABAs are salmeterol and formoterol (7).

LABAs Method of Action

Long-acting beta-agonists (LABAs) have a rapid onset like SABAs, but also have a longer half-life. LABAs are often used as asthma maintenance medications to relax bronchial smooth muscle from the trachea to the bronchioles through action on the β2-receptors. While SABAs are effective bronchodilators in the short term for asthma symptoms, LABAs are effective in the long term.

Like SABAs, LABAs do not affect the underlying mechanism of inflammation. LABAs can be administered via metered-dose inhalers, intravenously, dry powder inhalers, orally, subcutaneously, or via nebulizer. LABAs are often effective for 12-hour durations (7).

LABAs Side Effects

Every medication has the possibility of side effects, and LABAs are no exception. Like SABAs, because of the beta receptor agonisms, possible LABA side effects include increased heart rate, chest pain, chest palpitations, body tremors, and nervousness (7). Other, more prolonged side effects can include changes in blood glucose and potassium levels with prolonged LABA use (7).

LABAs Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with LABAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

In addition, combination inhaled corticosteroid/LABA medications can be considered, such as fluticasone propionate and salmeterol (Advair Diskus, Advair HFA, AirDuo Digihaler, AirDuo RespiClick, Wixela Inhub), fluticasone furoate and vilanterol (Breo Ellipta), mometasone furoate and formoterol fumarate dihydrate (Dulera), and budesonide and formoterol fumarate dihydrate (Symbicort) (4).

Long-Acting Muscarinic Antagonists (LAMAs)

Health care provider’s professional discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history and health history prior to prescribing asthma medications.

Drug Class – LAMAs

Common commercially available LAMAs include two inhalation powders via inhalers: tiotropium bromide (Spiriva Respimat) and fluticasone furoate, umeclidinium, and vilanterol (Trelegy Ellipta) (4).

LAMAs Method of Action

Both drugs mentioned above are long-acting muscarinic antagonists (LAMAs). LAMAs work to alleviate asthmatic symptoms by antagonizing the type 3 muscarinic receptors in bronchial smooth muscles, resulting in relaxation of muscles in the airway (4). Because LAMAs are long-acting, they are not recommended for cases of acute asthma exacerbations or asthmatic emergencies (4).

LAMAs Side Effects

Possible LAMA side effects include urinary retention, dry mouth, constipation, and glaucoma (4).

LAMAs Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with LAMAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Adenosine Receptor Antagonists Pharmacokinetics

Therapy should be guided by the health care provider’s professional discretion and the patient’s condition. Consider reviewing a patient’s medication history and health history before prescribing asthma medications.

Drug Class – Adenosine Receptor Antagonists

The commercially available adenosine receptor antagonist for asthma management is theophylline as a pill or intravenous (8).

Adenosine Receptor Antagonists: Method of Action

Theophylline’s method of action is to act as a nonselective adenosine receptor antagonist and a competitive, nonselective phosphodiesterase inhibitor and to reduce airway responsiveness to histamine, allergens, and methacholine (8).

Adenosine Receptor Antagonists Side Effects

Common side effects of theophylline include GI upset, headache, dizziness, irritability, and arrhythmias (8).

Adenosine Receptor Antagonists Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with theophylline, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Leukotriene Modifiers Pharmacokinetics

Health care provider’s professional discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history and health history prior to prescribing asthma medications.

Drug Class – Leukotriene Modifiers

Commercially available leukotriene modifiers include montelukast (Singular) and zafirlukast (Accolate), which are oral pills taken once a day. Zileuton (Zyflo CR) is a 5-lipoxygenase inhibitor modifying leukotriene activity (4).

Leukotriene Modifiers: Method of Action

Montelukast and zafirlukast work to control asthma-related symptoms by targeting leukotrienes, which are eicosanoid inflammatory markers. Montelukast works by blocking leukotriene D4 receptors in the lungs, thus allowing decreased lung inflammation and increased relaxation of lung smooth muscle (9).

Zafirlukast works by being a competitive antagonist at the cysteinyl leukotriene-1 receptor (CYSLTR1) (10). Zileuton is a 5-lipoxygenase inhibitor, and 5-lipoxygenase is needed for leukotriene creation. Blocking 5-lipoxygenase decreases the formation of leukotrienes at several receptors. As a result of decreased leukotriene production, there is decreased inflammation, decreased mucus secretion, and decreased bronchoconstriction (11).

Leukotriene Modifiers Side Effects

Possible side effects of montelukast include headaches, GI upset, and upset. Neuropsychiatric events, such as nightmares, changes in sleep, depression, and suicidal ideation, are more severe side effects associated with montelukast.

Possible side effects of zafirlukast include headache, GI upset, and hepatic dysfunction (9).

Possible side effects of zileuton include hepatic dysfunction, changes in sleep, changes in mood, headaches, and GI upset. When the leukotriene modifiers, neuropsychiatric side effects are to be monitored for, in particular, for suicidal ideation (9,10,11).

Leukotriene Modifiers Alternatives

Some patients might not report their symptoms alleviating with leukotriene modifiers, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Mast Cell Stabilizer Pharmacokinetics

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history and health history prior to prescribing asthma medications.

Drug Class – Mast Cell Stabilizer

A commercially available mast cell stabilizer is cromolyn, available via metered-dose inhaler and nebulizer solution (12).

Mast Cell Stabilizer Method of Action

Cromolyn inhibits the release of inflammatory mediators from cells, such as histamine and leukotrienes (12).

Mast Cell Stabilizer Side Effects

Every medication has the possibility of side effects, and cromolyn is no exception. Common side effects of cromolyn include dry throat, throat irritation, drowsiness, dizziness, cough, headache, and GI upset (12).

Mast Cell Stabilizer Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with mast cell stabilizers, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Monoclonal Antibody Pharmacokinetics

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient’s medication history and health history prior to prescribing asthma medications.

Drug Class – Monoclonal Antibody

Commercially available monoclonal antibodies include Omalizumab (Xolair), mepolizumab (Nucala), reslizumab (Cinqair), benralizumab (Fasenra), dupilumab (Dupixent), and tezepelumab-ekko (Tezspire). Omalizumab, mepolizumab, benralizumab, dupilumab, and texepelumab-ekko are available via subcutaneous injection. Reslizumab is available via intravenous solution (4).

Monoclonal Antibody Method of Action

Omalizumab is an anti-IgE monoclonal antibody that works by inhibiting the binding of IgE to mast cells and basophils. As a result of decreased bound IgE, activation and release of mediators, such as histamine, in the allergic response are decreased (13).

Mepolizumab, reslizumab, and benralizumab are interleukin (IL)-5 antagonists. These IL-5 antagonists inhibit IL-5 signaling, allowing for a decrease in the creation and survival of eosinophils. However, the full method of action for IL-5 antagonists is still unknown, as more evidence-based research is needed (4, 15).

Dupilumab is an IgG4 antibody that inhibits IL-4 and IL-13 signaling by binding to the IL-4Rα subunit. This inhibition of the IL-4Rα subunit allows for the decrease of IL-4 and IL-13 cytokine-induced inflammatory responses (14).

Tezepelumab-ekko is an IgG antibody that binds to the thymic stromal lymphopoietin (TSLP) and prevents TSLP from interacting with the TSLP receptor. Blocking TSLP decreases biomarkers and cytokines associated with inflammation. Knowing this, the full method of action for Tezepelumab-ekko is still unknown, as more evidence-based research is needed4,15.

Monoclonal Antibody Side Effects

Possible side effects of omalizumab include injection site reactions, fracture, anaphylaxis, headache, and sore throat (13). Possible side effects of mepolizumab, reslizumab, and benralizumab include injection site reactions, headache, and hypersensitivity reactions (4). Possible side effects of dupilumab include joint aches, injection site reactions, and headache (14). Possible side effects of tezepelumab-ekko include injection site reactions and headache (14).

Monoclonal Antibody Alternatives

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with monoclonal antibodies, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).

Nursing Considerations

Nurses remain the most trusted profession for a reason, and APRNs are often pillars of patient care in several health care settings. Patients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in asthma education and management, here are some suggestions to provide quality care for patients currently taking medications to manage asthma or concerned about possibly having asthma.

Take a detailed health history. Respiratory symptoms, such as a cough or trouble breathing, are often dismissed in health care settings or seen as “common symptoms with everyone.” If a patient is complaining of symptoms that could be related to asthma, inquire more about that complaint.

Ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a patient’s complaint is not being taken seriously by other health care professionals, advocate for that patient to the best of your abilities.

Review medication history at every encounter. Oftentimes, in busy clinical settings, reviewing health records can be overwhelming. Millions of people take asthma medications at varying dosages, frequencies, and times of day. Many people with asthma take more than one medication to manage their symptoms.
Ask patients how they feel on the medication, if their symptoms are improving, and if there are any changes to medication history.

Be willing to answer questions about asthma, respiratory health, and medication options. Society stigmatizes open discussions of prescription medication and can minimize symptoms of asthma, such as a chronic cough.

Many people do not know about medication options or the long-term effects of undiagnosed or poorly managed asthma. Be willing to be honest with yourself about your comfort level discussing topics and providing education on asthma medications and asthma clinical assessment options.

Inquire about a patient’s life outside of medications, such as their occupation, living situation, and smoking habits. Household exposures, such as carpets or pets, can trigger asthma. Occupations with high exposure to smoke can also trigger asthmatic symptoms. Smoking, living with someone who smokes, or residing in an area with high levels of pollution can also influence asthma symptoms.
Discuss possible solutions to help with symptoms, such as improving ventilation, increasing air quality, and wearing masks when possible.

Communicate the care plan to other staff involved for continuity of care. Care often consists of a team of nurses, specialists, pharmacists, and more for several patients, especially those with severe asthma. Ensure that patients’ records are up to date for ease in record sharing and continuity of care.

Stay current on continuing education related to asthma medications, as evidence-based information is constantly evolving and changing. You can then present your new learnings and findings to other healthcare professionals and educate your patients with the latest information. You can learn more about the latest research on asthma and asthma-related medications by following updates from evidence-based organizations.

How can nurses identify if someone has asthma?

Unfortunately, it is not always possible to look at someone with the naked eye and determine if they have asthma. While some people might have visible asthmatic symptoms, such as wheezing or trouble breathing, asthmatic clinical presentation can significantly vary from person to person.

APRNs can identify and diagnose if someone has asthma by taking a complete health history, listening to the patient’s concerns, and offering pulmonary function testing.

What should patients know about asthma medications?

Patients should know that anyone can experience side effects from medications for asthma management, just like any other medication. They should seek medical care if they notice any mood changes, experience sharp headaches, or feel like something is concerning.

Nurses should also teach patients to advocate for their health to avoid untreated or undetected asthma and possible chronic complications from asthma or asthma-related medications.

Here are essential tips for patient education in the inpatient or outpatient setting:

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors).
• Tell the health care provider of any existing lifestyle concerns, such as tobacco use, other drug use, sleeping habits, occupation, diet, and menstrual cycle changes (need to identify lifestyle factors that can influence asthmatic medication use, asthma severity, and asthma management).
• Tell the health care provider if you have any changes in your breathing, such as pain with deep breathing or persistent coughing (potential asthma exacerbation symptoms or possibility of asthma medications not being as effective for treatment).
• Tell the nurse or health care provider if you experience any pain that becomes increasingly severe or interferes with your quality of life.
• You can track your health, medication use, and health concerns via an app, diary, or journal (self-monitoring for any changes).
• Tell the health care provider right away if you are having thoughts of hurting yourself or others (a possible increased risk of suicidality is a potential side effect of montelukast use).
• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries.
• Tell your health care provider if you notice any changes while taking medications or receiving other treatments to manage asthma (potential worsening or improvement of your health situation).

Research Findings

There is extensive publicly available literature on asthma and asthma-related medications via the National Institutes of Health and other evidence-based journals (1,2,4).

What are some ways for people who take asthma medications to become a part of research?

Patients interested in participating in clinical trial research can seek more information on clinical trials from local universities and health care organizations.

Case Study

Susie is a mom to a 15-year-old named Jill. She arrives for a new patient visit at the pediatric asthma and allergy specialist practice. Susie reports that she has noticed Jill has been having trouble sleeping at night and coughing more during the day for the past month. Jill plays soccer with her school, but her mom is concerned that coughing and trouble sleeping are interfering with her sports.

Susie knows that her dad has asthma, and Jill spends a lot of time with her aunt, who smokes cigarettes. Jill has a history of generalized anxiety disorder and reports no smoking, no drinking, and no recreational drugs. Jill also wants to learn more about her lung health, as she wants to play soccer professionally one day.

Case Study (Continued)

Susie also shares that she is dating a new partner who vapes at home, and they recently got a pet puppy. She states that Jill had trouble sleeping at night and coughing a lot when she was younger, but Susie thought Jill grew out of it. Susie wants to learn more about whether Jill has asthma like her grandfather, if there are any ways to manage this cough, and if any tests can determine Jill’s lung health in the office today.

Case Study (Continued)

Susie agrees to have Jill do allergy testing and an in-office pulmonary function test for teenagers. Jill also wants to learn more about spirometry, which you mentioned earlier, and how to monitor her health outside of the office since she’s busy with school and soccer and doesn’t want to come to the office whenever there’s a problem.

Susie is open to medication options for Jill, but doesn’t want anything that will interfere too much with her social time with her friends. Susie and Jill also want to know if this is a health condition that Jill will have forever or if she will grow out of it.

Conclusion

Asthma is a chronic condition affecting many people from childhood to adulthood. As more medications for asthma come onto the market and more evidence-based approaches to asthma and lung care emerge, APRNs will be at the forefront of primary care and asthma care across the lifespan.