Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses
often provide treatment to patients with these disorders. Sometimes patients require
immediate treatment making it essential that you recognize and distinguish minor asthma
symptoms from serious, life-threatening symptoms. Since symptoms and attacks are often
induced by a trigger, advanced practice nurses must also help patients identify their
triggers and recommend appropriate management options. Like many other disorders,
there are various approaches to treating and managing care for asthmatic patients
depending on individual patient factors. One method that supports the clinical decision-
making of drug therapy plans for asthmatic patients is the stepwise approach, which you
explore in this Assignment
To prepare:
Consider drugs used to treat asthmatic patients including long-term control and quick
relief treatment options for patients. Think about the impact these drugs might have on
patients including adults and children.
Review Chapter 25 of the Arcangelo and Peterson text. Reflect on using the stepwise
approach to asthma treatment and management.
Consider how stepwise management assists health care providers and patients in gaining
and maintaining control of the disease.
To complete:
Write a 2- to 3- page paper that addresses the following:
Describe long-term control and quick relief treatment options for asthma patients, as well
as the impact these drugs might have on patients.
Explain the stepwise approach to asthma treatment and management.
Explain how stepwise management assists health care providers and patients in gaining
and maintaining control of the disease.
To complete:
Write a 2- to 3- page paper that addresses the following:
Describe long-term control and quick relief treatment options for asthma patients, as well
as the impact these drugs might have on patients.
Explain the stepwise approach to asthma treatment and management.
Explain how stepwise management assists health care providers and patients in gaining
and maintaining control of the disease.

ASTHMA AND STEPWISE MANAGEMENT 2

Use scholarly references including course text (Arcangelo& Peterson, chapter 25) and
National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines
for the diagnosis and management of asthma.

Asthma and Stepwise Management

Introduction

Asthma results from airways’ inflammation. It is a long-term respiratory disease that is
accompanied by symptoms such as coughing, breathlessness, and wheezing. These symptoms’
severity varies depending on individuals but the condition can be managed effectively in most
cases. So as to be able to treat the condition immediately, it is imperative for professionals to be
able to differentiate and identify between critical, life-threatening and minor symptoms
(Arcangelo & Peterson, 2013). Usually, symptoms and triggers are triggered by a particular
factor, which calls for the need to help patients identify their triggers. As a result, management
strategies are made based on the individual cases. Personal patient factors establish the
appropriate approaches for the treatment and management of disease. This paper aims at
discussing the stepwise approach in the management of asthma.
Long-term control
According to Arcangelo and Peterson (2013), long-term control medications have to be
taken every day in order to achieve and maintain control in persistent cases. Currently,
corticosteroids are considered the most potent and efficient anti-flammatory medications.
Corticosteroids prevent the migration and activation of inflammatory cells. Moreover, they
reduce airway hyper- responsiveness. Omalizumab is recommendable for patients aged > 12

ASTHMA AND STEPWISE MANAGEMENT 3

years and those with allergies and severe persistent conditions (Leuppi et al., 2001). Salmeterol
and formoterol are long-acting beta-agonists that control and prevent symptoms in moderate and
severe persistent cases. Inhaled corticosteroids help in managing persistent cases regardless of
the level of severity, which improves the symptoms and functions of the pulmonary system.

Quick relief treatment options
These ‘rescue drugs’ are extremely effective in controlling symptoms. An individual can
take them when wheezing, having trouble breathing, coughing, or during an attack. Owing to the
fact that they are useful in relaxing airway muscles, they are also referred to as ‘bronchodilators.’
The medical professional and patient can work out a plan regarding the time and amount of drugs
that should be taken (Bousquet, 2000). A patient should always carry adequate amounts of the
drugs so as to ensure that they have sufficient stocks while on a journey. Short-acting beta-
agonists are useful for treating attacks, for instance before an exercise, as they help in relaxing
the airway muscles. These include Metaproterenol, Pirbuterol, Bitolterol, Terbutaline,
Levalbterol, and Albuterol. Oral steroids are taken if an individual has ongoing attacks.
Implications of the drugs on patients
In adults and children, short-acting Beta-agonists cause tremor, headache, anxiety,
restlessness, and fast and uneven heartbeats (Arcangelo & Peterson, 2013). Inhaled
corticosteroids’ side effects include adrenal suppression, oral thrush, coughing, hoarseness,
osteoporosis, and easy bruising. Following consumption by children, inhaled corticosteroids lead
to delayed or suppressed growth. Oral corticosteroids lead to diabetes, cataracts, hypertension,
weakness, muscle weakness, impaired immune function, mood changes, weight gain, and peptic
cancer (Warner et al., 1989).

ASTHMA AND STEPWISE MANAGEMENT 4

The stepwise approach to asthma treatment and management
With the stepwise approach, the aim is escalating the number of medications,
administration frequency, and dose and minimizing them when necessary. Initially, treatment is
administered based on the condition’s severity but later, it is based on current asthma control.
There is a need to consider omalizumab and immunotherapy. Multiple variables should be
assessed simultaneously when checking on recent and current impairment. Short-term and more
universal assessments ought to be considered (Bateman et al., 2008).
During the first step, SABA PRN is preferred for treating intermittent asthma. Steps 2- 6
involves treating persistent asthma using daily medication. The following doses are preferred for
these steps; step 2- low-dose ICS, 3- medium-dose ICS or low-dose LABA + ICS, 4- LABA and
medium-dose ICS, 5- LABA and high-dose ICS, 6- oral corticosteroid+ LABA+ high-dose ICS.
A specialist should be consulted at step 4 while an individual should consider consultation during
the 3 rd stage. Every step should be accompanied by comorbidities management, environmental
control, and patient education.
How the stepwise management helps patients and healthcare providers in maintaining and
gaining control of asthma
Both providers and patients benefit from the stepwise approach. The validated
questionnaires help patients and clinicians in determining the level of control a patient has
achieved on a short-term basis (Osman et al., 1993). Therefore, current treatments are made
beneficial to patients and there is a focus on minimal risks. The disease’s frequency and severity
is easy to trace among the clinicians and patients. The stepwise management also helps in that
medications are prescribed depending on the stage of the disease and there are alternative
medications if the main ones are not available. in addition, every stage is accompanied by

ASTHMA AND STEPWISE MANAGEMENT 5

comorbidities management, environmental control, and patient education, which go a long way
in managing the disease.
Summary
Both the stepwise approach and drugs can manage asthma effectively. However, it is vital that
the providers and patients have a close collaboration so as to identify patient needs early enough.
Individual triggers should be identified for easier management of the management. Long-term
control involves the use of Corticosteroids, Omalizumab, Salmeterol and formoterol, Inhaled
corticosteroids. The stepwise management of the disease has 6 vital steps and through them,
providers and patients are able to manage the disease easily.

ASTHMA AND STEPWISE MANAGEMENT 6

References

Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice: A
practical approach (3 rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Bateman, E. D., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., & Zar, H.
J. (2008). Global strategy for asthma management and prevention: GINA executive
summary. European Respiratory Journal, 31(1), 143-178.
Bousquet, J. (2000). Global initiative for asthma (GINA) and its objectives. Clinical and
Experimental Allergy, 30(6; SUPP/1), 2-5.
Leuppi, J. D., Salome, C. M., Jenkins, C. R., Anderson, S. D., Xuan, W. E. I., Marks, G. B., &
Woolcock, A. J. (2001). Predictive markers of asthma exacerbation during stepwise dose
reduction of inhaled corticosteroids. American journal of respiratory and critical care
medicine, 163(2), 406-412.
Osman, L. M., Russell, I. T., Friend, J. A., Legge, J. S., & Douglas, J. G. (1993). Predicting
patient attitudes to asthma medication. Thorax, 48(8), 827-830.
Warner, J. O., Götz, M., Landau, L. I., Levison, H., Milner, A. D., Pedersen, S., & Silverman, M.
(1989). Management of asthma: a consensus statement. Archives of disease in childhood,
64(7), 1065-1079.

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