Feb 23, 2024 NURS 6521 Asthma and Stepwise Management
NURS 6521 Asthma and Stepwise Management
A Sample Answer For the Assignment: NURS 6521 Asthma and Stepwise Management
In asthma management there are several modes of treatment that can be used that can be classified into short-term and long-term treatment options. The major forms of treatment for this condition involve drugs such as bronchodilators and anti-inflammatory drugs.
ØBronchodilators consist of drugs such as muscarinic antagonists, leukotriene receptor blockers, beta 2 selective antagonists, anticholinergics and xanthine derivatives while anti-inflammatory drugs consist of mast cell stabilizers and corticosteroids.
From the mentioned management options there are long term drugs and they consist of methylxanthines, leukotriene receptor antagonists, long-acting beta-2 agonists (LABAs), cromolyn and inhaled corticosteroids
1.Methylxanthines mode of action occurs by inhibiting non-competitively the enzyme phosphodiesterase and it the most commonly known drug of this group is theophylline.
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₋It brings about a therapeutic effect through the treatment and prevention of chest tightness, dyspnea and wheezing due to asthma. However, there are associated side effects such as severe dysrhythmias and also contraindications to be considered with this drugs such as in patients with heart and liver conditions.
2.Leukotriene receptor antagonists consist of drugs such as montelukast whereby its mode of action involves preventing leukotriene from being released by eosinophils and mast cells
₋These drugs’ therapeutic effect is by ensuring open airways through preventing bronchoconstriction and mucus secretion. However, there are side effects with these drugs such as sore throat, fever and headache as well as contraindications such as in patients with hepatic impairment and hypersensitivity to these drugs.
(Rosenthal & Burchum, 2021).
Introduction
Asthma is a chronic, inflammatory disease which affects the airways. It is associated with various symptoms such as wheezing, difficulty in breathing, chest pain, and cyanosis in severe cases. It is very prevalent in America where 22 million people are affected. The situation raises hospitalization levels to more than 497,000 annually (Kirenga et al., 2018). With such a high number, the country is significantly affected both economically and socially. Many children missed school days due to asthma and some caregivers are also forced to leave work to take care of their sick children. As productivity of the country lowers, a lot of money is used in managing the disease (Rothe et al., 2018). However, treatment options have been improved to address the situation.
Treatment Options
Both quick-relief and long control medicines are used in treating asthma. Long-term control medicines (also called controller medicines or maintenance medicines). Long-acting beta-adrenergic (LABA) is one of the quick relief medication used. The LABAs help in providing long-term control of symptoms (Kirenga et al., 2018). Inhaled corticosteroids (ICS) are commonly used as anti-inflammatory drugs because they reduce inflammation caused by a vast diversity of inflammatory mediators (Yawn & Han, 2017). Rothe et al. (2018) highlight omalizumab (Xolair) as the most common Immuno-modulators used to prevent the binding of IgE to its receptor and in turn, inhibit IgE-mediated asthma from cascading before it begins.
Long-term control drugs
•There are several stated models of treatment of asthma. However, the major ones include bronchodilators and anti-inflammatory drugs. Bronchodilators include: beta 2 selective agonists, muscarinic antagonists, xanthine derivatives, leukotriene receptor blockers and anticholinergics. Anti- inflammatory drugs include: corticosteroids and mast cell stabilizers.
•These Long-term control drugs : Long acting beta-2 agonists (LABA), Methylxanthines, Inhaled corticosteroids, Leukotriene receptor antagonists and Cromolyn.
1. Long- acting beta-2 agonists (LABA) mode of action is by activating the pre-junctional β2-adrenoceptors and reduce acetylcholine release thereby prevent any functional competition by acetylcholine .
•They include drugs such as: Salmeterol, formoterol and olodaterol
•The therapeutic effects include: improving lung function, increase number of asthma symptom free days, reduce the asthma symptoms and reduce number of asthma attacks.
•However they include contraindications and adverse effects whereby in a drug such as salmeterol caution should be taken in use by African Americans and for (LABA) should be used with an oral glucocorticoid to minimize various risks and shouldn’t be used alone for prophylaxis as it can lead to increased risk of severe asthma attacks and asthma related deaths.
2. Methylxanthines mode of action is through non-competitive inhibition of the phosphodiesterase enzyme, methylxanthines cause an intracellular increase in levels of cyclic adenosine monophosphate and cyclic guanosine monophosphate.
•Here the most common drug used is theophylline.
•The therapeutic effects involve it preventing and treating wheezing, shortness of breath, and chest tightness caused by asthma.
•However it also has contraindications and adverse effects whereby caution should be taken in patients with heart disease, seizure disorders and liver dysfunction and its adverse effects involve toxicity, severe dysrhythmias and even death
Inhaled corticosteroids mode of action is by suppressing inflammation through decreasing inflammatory mediators, decreasing activity of inflammatory cells and decreasing edema of airway mucosa.
•The inhaled corticosteroids include drugs such as budesonide, fluticasone propionate, ciclesonide and beclomethasone.
•The therapeutic effects involve reducing inflammation, reducing production of mucus, improve response to bronchodilators and reduce potential of dyspnea.
•However there are contraindications and adverse effects involved such as caution should be observed in patients tested positive with candida albicans and its adverse effects involve it could lead to candidiasis development and decreased growth.
4. Leukotriene receptor antagonists mode of action is by preventing leukotriene release from mast cells and eosinophils or by blocking the specific leukotriene receptors on bronchial tissues it also reduces the influx of eosinophils, thus limiting inflammatory damage in the airway.
•The main drugs prescribed here are montelukast and zafirlukast.
•The therapeutic effects involve it prevents bronchoconstriction, mucus secretion and edema thus having open airways.
•However there are contraindications and adverse effects involved such as it shouldn’t be used in patients with a hypersensitivity to it or with hepatic impairment and its adverse effects involve it could lead to fever, headache, cough, sore throat and risk of upper respiratory infections.
Short-term control drugs
•These involves drugs such as: Short acting beta-2 agonists (SABA), Anticholinergics and Oral corticosteroids.
1. Short acting beta-2 agonists mode of action is through activates the beta-2 receptor, and this helps relax the bronchial tubes within five minutes.
•Drugs involved her include albuterol, levalbuterol, isoproterenol and terbutaline sulphate.
•The therapeutic effects include: relieving of symptoms of asthma attack such as dyspnea, wheezing and coughing.
•Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with heart disease, diabetes and hypertension then on the adverse effects there are usually no adverse effects as long as patient is compliant with the practitioner’s instruction though one may experience mild effects such as headaches, trembling and nervousness.
2. Anticholinergics mode of action is through activates the beta-2 receptor, and this helps relax the bronchial tubes within five minutes.
•Drugs involved her include alcidinium and ipratropium bromide.
•The therapeutic effects include: reducing inflammation, decrease mucus production in the airways and prevent bronchospasms.
•Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with heart disease, hypertension and myasthenia the adverse effects include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating.
•These involves drugs such as: Short acting beta-2 agonists (SABA), Anticholinergics and Oral corticosteroids.
3. Oral Corticosteroids mode of action is through binding to intracellular receptors which then act to modulate gene transcription in target tissues .
•Drugs involved her include: prednisone, prednisolone, methylprednisolone and dexamethasone.
•The therapeutic effects include: reduce inflammation and swelling in the airways they also relieve asthma related symptoms, such as body pain, swelling, and stiffness.Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with
Stepwise-approach to asthma treatment and management
•It involves six steps whereby in the first step a short acting beta-2 agonists (SABA) is used when necessary such as albuterol.
•In the second step when the asthma is persistent a low dose inhaled corticosteroid is used or alternatively a methylxanthine such as theophylline is used.
•In the third step preferably a low dose inhaled corticosteroid is used together with a long acting beta- 2 agonist or alternatively a low dose inhaled corticosteroid and either theophylline or leukotriene receptor antagonists .
•In the fourth step preferably a medium dose inhaled corticosteroid and a long acting beta-2 agonist or alternatively medium dose inhaled corticosteroid with theophylline.
•In the fifth step a high dose inhaled corticosteroid is used together with a long acting beta- 2 agonist is preferred and omalizumab can be considered for patients with allergies.
•In the sixth step a high dose inhaled corticosteroid with a long acting beta- 2 agonist and an oral corticosteroid is preferred and the same omalizumab should be considered for patients with allergies.
•The drugs used change depending on the category asthma condition they are in whether it is intermittent, mild persistent, moderate persistent or severe.
Stepwise management use in controlling the disease
•The six steps involved are used to benefit the patient in the phase of the patient’s asthma whether it is intermittent, mild persistent, moderate persistent or severe.
•One is able to step up or step down in the steps involved if relief is found and vice-versa and throughout one should have a short acting beta-2 agonist. The effectiveness of it should be assesses by the heard breath sounds.
•If relief is not heard one steps up. The stepwise approach helps to not the category of the condition of the patient and the effectivity of the medication. If the medication is not working it helps the practitioner determine what the next course of treatment is as it is indicated in the steps depending on the ,medication listed on that step.
•Then in the case of relief the drugs the patient to use as they are stepping down.
•It also aids healthcare providers in identifying alternatives that can be used if the preferred one can’t be used such as a low dose inhaled corticosteroid and either theophylline or leukotriene receptor antagonists in the third step.
•It also aids the patient in knowing the level of symptoms and which category they are in whether it is intermittent, mild persistent, moderate persistent or severe.
•The patient is also able self- examine themselves and identify if symptoms are worsening to prevent from reaching that stage and use the medication in the step they are situated in such as if they are still in intermittent asthma they use medication as directed in the first step and don’t let it get to persistent asthma that requires another regimen that is daily medication. Having exercise induced bronchospasm is an indicator for inadequate asthma control.
•The patient benefits also by gaining relevant information on how to use the various drugs, the potential side effects and their management together with other significant health education such as chronic use of high dose inhaled corticosteroids could lead to osteoporosis.
Introduction
Asthma is one of the most common chronic respiratory conditions. It affects the airways, resulting in narrowing and reduced gaseous exchange. Asthma develops from exposure to triggers such as allergens, stress, or intensive exercises. The affected patients present with symptoms such as chest pain, difficulty in breathing, cough, wheezing, and cyanosis in extreme cases.
The frequent exacerbation of symptoms in asthma makes it a considerable source of disease burden. Asthma affects the quality of life of patients as well as health. The aim of asthma treatment is to control the symptoms and prevent recurrent attacks. Therefore, this presentation examines the treatment options for asthma and its stepwise management.
NURS 6521 Asthma and Stepwise Management
Long-Term Control for Asthma
Several drugs can be used for long-term control of asthma. One of them are the corticosteroids. Corticosteroids are drugs administered to reduce airway inflammation. They exist in forms such as inhaled and oral corticosteroids. Oral systemic corticosteroids and inhaled corticosteroids are indicated for severe persistent asthma. The other category of drugs is immunomodulators. Immunomodulators are medications that prevent the binding of IgE to its receptors.
Examples of these drugs include Omalizumab, which is used as a long-term drug of choice in asthma. The other category of drugs is leukotriene modifiers. This drugs are antagonists of leukotriene receptors and 5-lipoxygenase inhibitor. They can be used as an adjunctive treatment with inhaled corticosteroids. Zafirlukast and montelulast are examines of leukotriene modifiers. Long-acting beta agonists can also be used to control asthma in the long-term. These drugs dilate the bronchioles leading to reduced airway resistance. Examples of long-acting beta agonists include formoterol and salmeterol (Nanda et al., 2020).
Quick Relief Treatment for Asthma
Quick relief treatments are also available for acute asthma attacks. One of the classifications of these treatments are the short-acting beta agonists. Short-beta agonists are effective bronchodilators in asthma. They bind to beta receptors in the lungs to inhibit vasoconstriction of the bronchioles. The dilation improves respiratory exchange by lowering airflow resistance in asthma. Examples of short-acting beta agonists include albuterol. The other category of drugs are the anticholinergic agents.
Anticholinergic agents inhibit sympathetic effects associated with acetylcholine. This effect result in airway relaxation in asthma, improving airflow. Examples of anticholinergic include tiotropium and ipratropium. The last group of drugs is the oral and intravenous corticosteroids. These corticosteroids provide a quick relief by inhibiting inflammatory processes in asthma. Examples of drugs include prednisolone and methylprednisolone (Kaplan & Price, 2020; Matera et al., 2020).
Stepwise Approach
The stepwise approach is the recommended approach to treating patients with asthma. It comprises six steps that inform treatment decisions. In step 1, the recommended treatment entails the use of short-acting beta agonists as needed. In step 2, the treatment entails the use of low-dose inhaled corticosteroid plus long-acting beta agonist. The alternatives include Cromolyn, leukotriene receptor antagonist, nedocromil, or theophylline. In step 3, there is the preferred use of low-dose inhaled corticosteroid plus inhaled corticosteroid and long-acting beta agonist or medium-dose inhaled corticosteroid.
The alternative is low-dose inhaled corticosteroid plus either leukotriene receptor antagonist, theophylline, or Zileuton. In step 4, there is the preferred use of medium-dose inhaled corticosteroid with long-acting beta agonist. The alternative is the use of medium-dose inhaled corticosteroid with either leukotriene receptor antagonist, theophylline, or Zileuton.
In step 5, the preferred treatment is the use of high-dose inhaled corticosteroid with long-acting beta agonist and Omalizumab if the patient has allergies. In step 6, the preferred treatment entails the use of high-dose inhaled corticosteroid with long-acting beta agonist and oral corticosteroid. Omalizumab is included in case a patient has allergies (Beasley et al., 2020; Papi et al., 2020; Wang et al., 2021).
Impact of Stepwise Approach
The stepwise approach to asthma management assists health care providers and patients in gaining and
NURS 6521 Asthma and Stepwise Management
maintaining control of the disease. One of the ways is that it prevents and minimizes the risk of harm due to drug use for asthma treatment. The stepwise approach prevents providers from prescribing inappropriate drugs in the different stages of asthma. This minimizes the risk of adverse events. The stepwise approach also reduces the development of frequent asthma exacerbations.
The use of appropriate drug combinations minimize the frequent asthma attacks and frequent hospitalizations or visits to the emergency department. It also prevents the progressive loss of lung function among patients due to frequent attacks. Patients also benefit from reduced risk of impairment from chronic symptoms of asthma. The medications also maintain almost normal pulmonary function, which eliminate the potential of respiratory impairment syndromes (Beasley et al., 2020; Papi et al., 2020; Wang et al., 2021).
REFERENCES
Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., & Pavord, I. D. (2020). Optimal Asthma Control: Time for a New Target. American Journal of Respiratory and Critical Care Medicine, 201(12), 1480–1487. https://doi.org/10.1164/rccm.201910-1934CI
Kaplan, A., & Price, D. (2020). Treatment Adherence in Adolescents with Asthma. Journal of Asthma and Allergy, 13, 39–49. https://doi.org/10.2147/JAA.S233268
Matera, M. G., Page, C. P., Calzetta, L., Rogliani, P., & Cazzola, M. (2020). Pharmacology and Therapeutics of Bronchodilators Revisited. Pharmacological Reviews, 72(1), 218–252. https://doi.org/10.1124/pr.119.018150
Nanda, A., Baptist, A. P., Divekar, R., Parikh, N., Seggev, J. S., Yusin, J. S., & Nyenhuis, S. M. (2020). Asthma in the older adult. Journal of Asthma, 57(3), 241–252. https://doi.org/10.1080/02770903.2019.1565828
Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: Reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology, 16(1), 75. https://doi.org/10.1186/s13223-020-00472-8
Wang, G., McDonald, V. M., & Gibson, P. G. (2021). Management of severe asthma: From stepwise approach to therapy to treatable traits? Precision Clinical Medicine, 4(4), 293–296. https://doi.org/10.1093/pcmedi/pbab028
Asthma is a respiratory disorder characterized by swelling and inflammation of the airways making them narrow, and overproduction of mucus.
The age of onset of asthma is usually during the first 6 years of life accounting for 80% of the reported cases (Azmeh et al., 2020).
Some of the common side effects of asthma in both children and adults include:
Chest Tightness
Shortness of Breath
Wheezing
Coughing (Papi et al., 2020).
Asthma is a respiratory disorder characterized by swelling and inflammation of the airways making them narrow, and overproduction of mucus. In most patients, the age of onset of asthma is usually during the first 6 years of life accounting for 80% of the reported cases (Azmeh et al., 2020). However, diagnosis of this disorder among pediatric patients is usually very challenging due to the varied symptoms with age (Martin et al., 2022). Some of the common side effects of asthma in both children and adults include chest tightness, shortness of breath, wheezing, and coughing (Papi et al., 2020).
The treatment of asthma mainly involves the use of medication. The pharmacological approaches have been divided into two main categories, quick-relief medications and long-term control (Khurana & Jarjour, 2019). To determine which pharmacological approach to use for the patient, it is necessary to find out how severe the patient’s asthmatic condition is (Martin et al., 2022).
Several diagnostic tests have been proven to be effective in the diagnosis and grading of asthmatic patients. Such diagnostic tests include spirometry, lung function test, pulse oximetry, peak flow, and nitric oxide measurement (Witt et al., 2022).
For patients with an acute asthmatic attack, quick relief pharmacological management is recommended.
Drugs such as oral corticosteroids like prednisolone and short-acting beta blockers like salbutamol are recommended for quick relief management of asthma (Mauer & Taliercio, 2020).
Patients with severe and persistent asthma require long-term therapy, which involves the use of several drugs including:
Corticosteroids
Long-acting Beta-agonists (LABAs),
Leukotriene Modifiers
Immunomodulators for children above the age of 12 years (Beasley et al., 2020).
For patients with an acute asthmatic attack, quick relief pharmacological management is recommended. Drugs such as oral corticosteroids like prednisolone and short-acting beta blockers like salbutamol are recommended for quick relief management of asthma (Mauer & Taliercio, 2020).
However, patients with severe and persistent asthma require long-term therapy, which involves the use of several drugs including corticosteroids, long-acting beta-agonists (LABAs), leukotriene modifiers, and immunomodulators for children above the age of 12 years (Beasley et al., 2020). A stepwise approach is used to determine which medication to use at different stages of the disease.
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 ones.
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.
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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
Reflect on 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.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7 of Week 3
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