Application: Asthma Management
Chronic asthma and acute asthma exacerbation are respiratory disorders that affect children and adults. Advanced practice nurses often assist physicians in providing treatment to patients with these disorders. Sometimes, patients require immediate treatment, making it is essential to recognize and distinguish minor asthma symptoms from serious, life-threatening symptoms. Since symptoms and attacks are often induced by a trigger, 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. Some approaches work better than others, 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.
Review “Asthma” in Chapter 26 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.
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 Poole 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.
Think about how to educate patients to develop a plan for medication adherence. Consider how the plan might differ based on the patient’s age.
Write a 2 page paper that addresses the following:
-Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Then, explain the changes in the arterial blood-gas patterns during an exacerbation.
-Describe long-term control and quick-relief drugs used to treat asthma in patients.
-Explain the impact these drugs might have on adults and children.
-Explain the stepwise approach to asthma treatment and management and how this approach assists health care providers and patients in gaining and maintaining control of the disease.
-Explain how you would help patients develop a plan for medication adherence, including how the plan might differ based on the patient’s age
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby
Poole Arcangelo, V., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
The Pathophysiological Mechanisms of Chronic Asthma and Acute Asthma Exacerbation
The pathophysiology of asthma is multifaceted and it involves inflammation of the airways, which in turn results to an increased contractibility of the surrounding smooth muscles. This leads to episodes of narrowing of the airway; in other words airflow obstruction: as a result, is the classic symptom of wheezing. In addition, there is the intermittent airflow obstruction, characterized by easily triggered bronchospasm (Smith, Cowan, Brassett, Herbison, & Taylor, 2005). Typically, the narrowing is combinable with or without treatment; they alter themselves. Characteristic changes include an amplification of eosinophils and congealing of the lamina recticularis.
Chronically the smooth muscles of the airways sometimes augment simultaneously with a rise of mucous glands T lymphocytes, neutrophils and macrophages are some of the cells involved in the process (Smith, et al., 2005).
The Changes in the Arterial Blood-Gas Patterns during an Exacerbation
At the onset of an asthma attack the regular PaO2 of 100 mm Hg and the PaCO2 of 40 mm Hg drops. Subsequently the pH of 7.40 rises. Progressively the PaCO2 and the PaO2 persist falling at the same time the pH continues to rise as the asthma exacerbates. Ultimately, it reaches a point where the lungs are not able to exhale carbon dioxide. When it reaches this point the PaCO2 begins to go up and the pH falls. However, the level of PaO2 progresses to drop. The progressive worsening of the asthma attack gets results in additional lowering of PaCO2. On the other hand, the high pH moves back to its normal values, pH of 7.40 and PaCO2 of 40 mm Hg.
For instance, the PaCO2 and the pH may drop to 30 mm Hg and 7.50 respectively. On the other hand the PaO2 possibly may drop, while the pH may become. However, the PaO2 steadily progresses to drop. Ultimately, the progression of the severity of the asthma attack results in a rise above 40 mm Hg of the PaCO2 or more and a fall of the pH below 7.40 or lower, while the PaO2 continues to fall steadily (Haahtela, 2012)..
Long-term Control and Quick-Relief Drugs Used To Treat Asthma in Patients
Asthma has no cure since it’s a long term disease. Therefore the ultimate goal in its treatment is to control the disease. Consequently, to control asthma, a patient has to partner with his/her doctor so as to manage or control it, both individually and for one’s child. If a child is above 10 years, he/she should actively be involved in their asthma care (Bateman et al., 2008). This involves: collaborating with the doctor to treat conditions that inhibit asthma control, avoiding asthma triggers except for physical activities and working with physicians or other healthcare providers to formulate an asthma action plan. Quick-relief drugs used to treat asthma include systemic corticosteroids, short-acting bronchodilators, and ipratropium (Atrovent). The table below gives additional facts on this.
Table 1: Long-term Asthma Medications
The quick-relief drugs used to treat asthma in patients are summarized in Table 2 below
Table 2: Quick-Relief Drugs Used to Treat Asthma
The Impact These Drugs on Adults and Children
|Drug||List/Examples||Impact on Adults||Impacts on Children|
|Inhaled corticosteroids||Ciclesonide (Alvesco), Fluticasone (Flovent Diskus), Beclomethasone (Qvar), Budesonide (Pulmicort), and Mometasone (Asmanex Twisthaler)||Throat and mouth irritation Oral yeast irritation||Slightly delay growth|
|Theophylline||Elixophyllin, and Theo-24||Reduces lung reaction to irritants gastroesophageal and insomnia flux||Reduces lung reaction to irritants gastroesophageal and insomnia flux|
|Long-acting beta agonists (LABAs)||brong-koh-DIE-lay-tur (bronchodilator)||Severe asthma attack|
|Leukotriene modifiers||Montelukast (Singulair), Zafirlukast (Accolate) and Zileuton (Zyflo)||Agitation, hallucination, aggression, depression and psychological reactions|
The Stepwise Approach to Asthma Treatment and Management
The goal of this an approach is to control asthma with minimal amount of medication, and this equally lowers the risk of adverse effects. The control of asthma under this is deliberated under risk and impairment. Reducing impairment involves prevention of troubles and chronic symptoms. Bateman et al. (2008) argued that:
Reducing risk involves: Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the daytime, in the night, or after exertion), require infrequent use (≤2 days a week) of SABA for quick relief of symptoms, Maintain (near) normal pulmonary function, Maintain normal activity levels (including exercise and other physical activity and attendance at work or school), and Meet patients’ and families’ expectations of and satisfaction with asthma care. Reducing risk, prevent recurrent exacerbations of asthma, and minimize the need for ED, visits or hospitalizations, prevent progressive loss of lung function; for youths, prevent reduced lung growth, and provide optimal pharmacotherapy with minimal or no adverse effects. (p. 144)
Patients Plan for Medication Adherence
The adults can be made to comprehend the legal implication of none-adherence, whereas children are considered innocent, and only dialogue and persuasion can work with them (Haahtela, 2012). Involving the immediate family is very beneficial in both the cases of an adult or a child (Smith, et al., 2005). Another applicable strategy is the use of technological reminders for adults.
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.
Haahtela, T. (2012). The disease management approach to controlling asthma. Respiratory medicine, 96, S1-S8.
Prevention, P. (2007). Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. The Journal of allergy and clinical immunology, 120(5 Suppl), S94.
Smith, A. D., Cowan, J. O., Brassett, K. P., Herbison, G. P., & Taylor, D. R. (2005). Use of exhaled nitric oxide measurements to guide treatment in chronic asthma. New England Journal of Medicine, 352(21), 2163-2173.