Disease State Overview

Asthma is a long-term condition that affects the airways in your lungs.  These airways can become inflamed and narrowed.  This makes it harder to move air in and out of the lungs.  It can affect people of all ages, although it often begins in childhood.  Certain things – called triggers – can worsen asthma symptoms.  When symptoms suddenly get worse, you may have an asthma attack.

There are several types of asthma, and each may require different treatment or management strategies.  These include:

• Allergic asthma
• Aspirin-induced asthma
• Cough-variant asthma
• Exercise-induced asthma
• Nighttime (or nocturnal) asthma
• Steroid-resistant asthma
• Occupational asthma (related to workplace exposure)

Experts have started to recognize the impact of inflammation in asthma.  Four biological pathways of inflammation have been identified: eosinophilic, neutrophilic, mixed eosinophilic and neutrophilic, and non-inflammatory.  

When asthma does not improve with long-term controller medications, it may be a sign of severe asthma.  There are 2 main types of severe asthma: Type-2 inflammation and Non-Type-2 inflammation.  Those patients with Type-2 severe asthma respond well to biologic medications.  These treatments target specific parts of the immune system and may be obtained at your specialty pharmacy.

Related Health Symptoms and Health Concerns

Asthma can cause a variety of breathing problems.  Common symptoms include:

• Wheezing (a whistling sound when you breathe)
• Coughing
• Shortness of breath
• A feeling of tightness in your chest

For some people, an asthma attack may begin with a cough that doesn’t go away.  Your chest may start to feel tight — some people describe it as having the air “sucked out” of them.  You may also begin to wheeze or feel lightheaded. 

Having and following your asthma action plan is very important.  It helps to know what steps to take when symptoms start, when to use your rescue medication, and when to seek emergency care. 

Call 9-1-1 right away if you are struggling to breathe, your symptoms are getting worse quickly or your rescue inhaler is not helping.  

Treatment

While there is no cure for asthma, there are many treatments that can help you manage your symptoms and live a healthy, active life.  Treatment usually includes monitoring your breathing, avoiding triggers, and using medications to both prevent and treat symptoms.

Most people use a combination of medications to keep their asthma under control. You may have a quick relief (rescue) medication to help stop symptoms and a long-term control medication to help prevent symptoms from happening in the first place.

The types of medications include:

• Bronchodilators
• Corticosteroids (steroids)
• Anticholinergies
• Biologics
• Antibiotics

Treatment Goals

The goals of treating asthma include:

• Improved breathing
• Reduce airway inflammation
• Reduce asthma symptoms
• Improve physical function and quality of life
• Maintaining optimal therapy adherence
• Preventing, minimizing, and managing side effects of therapy

Strategies to Achieve Treatment Goals

• Have an asthma action plan
• Adherence to therapy
• Monitoring and follow-up with physician
• Know and reduce asthma triggers
• Reducing the risk of additional lung damage through smoking cessation
• Immunization against flu and pneumonia
• Appropriate management of other underlying diseases such as allergies, high blood pressure, anxiety, etc.

Additional resources

• https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/types/severe-asthma
• https://www.nhlbi.nih.gov/health/asthma

Rheumatology – Chronic Inflammatory Disease 

Ankylosing Spondylitis (AS), Gout, Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Systemic Juvenile Idiopathic Arthritis (sJIA)

Disease State Overview

Chronic inflammatory diseases cause long-lasting inflammation in the body. This inflammation can damage healthy cells and tissues over time.  Many areas of the body can be affected including, but not limited to, the digestive system, joints, skin, and respiratory system. Researchers believe that these conditions may be related to an overactive immune system, but more research is needed to understand what triggers this disruption of the immune system. 

The term rheumatism is used to describe many conditions that cause inflammation in the joints, muscles, and connective tissues.  It includes a wide range of diseases such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE).

The most common symptom of rheumatologic inflammatory diseases is joint pain. Joints may also feel warm, tender, stiff, or swollen. Other symptoms may include feeling unusually tired, having low energy, occasional fevers, loss of appetite, skin rashes and vision changes.  In most cases, these conditions can be cyclical.  There are periods where symptoms are worse, called flares.  When symptoms ease and feel better, it is called remission.

Related Symptoms and Health Concerns

If left untreated,

• Inflammation can lead to permanent joint damage or deformity
• physical disability, making everyday activities and work more difficult
• negative impact on mental and social well-being
• patients may be at an increased risk of heart, lung and kidney problems
• patients may be at an increased risk of uveitis, which can cause eye pain, sensitivy to light, and blurry vision

Treatment

Most chronic inflammatory diseases have no cure. Lifestyle changes and early treatment may help manage and prevent complications. Treatment largely depends on the severity of symptoms. Research shows that people with rheumatoid arthritis who are diagnosed early and treated aggressively do better over the long-term.

Topical creams or ointments, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), may help with pain and reduce inflammation. If symptoms are widespread, more aggressive treatment may be required. Depending on the diagnosis, treatment options may include immunosuppressive therapies, such as steroids, disease-modifying antirheumatic drugs (DMARDs), or immunomodulators.  Immunomodulators may help decrease the body’s hyperactive immune response in the skin, joints and other organs.  Suppressing inflammation not only offers relief from common symptoms, but it also allows the tissues to heal.

Specialty medications used to treat chronic inflammatory rheumatologic conditions include, but are not limited to:

• Oral immunomodulators
• Injectable immunomodulator therapies

Treatment Goals

The primary goals of treating inflammatory rheumatic conditions are to:

• Reduce or eliminate symptomatic disease activity
• Manage exacerbating conditions, such as depression, anxiety, or sleep loss due to disease symptoms
• Prevent flares (maintain remission)
• Reduce risk of long-term complications, such as bone deformities
• Maintain as normal a lifestyle as possible.

Strategies to Achieve Treatment Goals

• Adhere to therapy
• Keep appointments, and follow-up with physician
• Report side effects or unmanaged symptoms to your pharmacist, or healthcare team
• Avoid known triggers, such as cigarette smoke, heavy alcohol consumption, and food sensitivities
• Practice stress management and relaxation techniques
• Participate in regular exercise and physical activity programs
• Eat a healthy diet, and maintain a healthy weight

Sources

• https://www.cdc.gov/arthritis/rheumatoid-arthritis/
• https://www.niams.nih.gov/health-topics/rheumatoid-arthritis
• https://www.niams.nih.gov/health-topics/ankylosing-spondylitis
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/ankylosing-spondylitis
• https://www.niams.nih.gov/health-topics/psoriatic-arthritis
• https://www.niams.nih.gov/health-topics/juvenile-arthritis
• https://www.cdc.gov/lupus/about/index.html