NURS 6521 Week3 Assignment: Asthma and Stepwise Management

When it comes to managing asthma over an extended period, we rely on two types of medications, inhaled corticosteroids (ICS) and oral corticosteroids. These medications share a common goal: to reduce inflammation in the airways. They achieve this by inhibiting the production of cytokines, activating adhesion proteins, and limiting the movement and activation of inflammatory cells at the cellular level. Additionally, they can reverse the down-regulation of beta2-receptors and prevent microvascular leakage. However, it’s important to note that they do come with some side effects. For example, ICS can lead to oropharyngeal candidiasis and hinder growth in children. On the other hand, oral corticosteroids can temporarily disrupt sugar metabolism, affect mood, raise blood pressure, and, in rare cases, result in aseptic necrosis of the femur. For those who use oral corticosteroids over a long period, there can be systemic effects on various aspects of health.

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Long-term asthma management is about keeping the condition under control on a daily basis. In addition to ICS, other options include leukotriene modifiers (LTRAs) and 5-lipoxygenase inhibitors, which block the synthesis of leukotrienes at the cellular level. When considering LTRAs, it’s important to monitor liver enzyme levels as they may be affected. Moreover, in some cases, healthcare providers may recommend using LTRAs in combination with ICS for patients older than 12 years. Furthermore, immunomodulators can serve as an adjunctive therapy for the same age group.

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For those who require consistent control of their asthma, long-acting beta-agonists (LABAs) are an option. These medications work slowly but provide a lasting effect compared to short-acting beta-agonists (SABAs). They function by relaxing the smooth muscles in the bronchial airways, increasing cyclic AMP levels, and thereby opposing bronchoconstriction. However, it’s worth noting that LABAs can lead to side effects like an increased heart rate, tremors, and hypokalemia. There’s also a possibility of a reduced bronchoprotective effect after one week of chronic therapy.

Short-term asthma management, for addressing immediate symptoms and attacks, involves quick-relief inhalers. These fast-acting bronchodilators, such as albuterol, open up inflamed airways, providing rapid relief. Short-acting beta-agonists (SABAs) are commonly used as quick-relief medications, and they work within minutes to alleviate symptoms. In contrast, oral steroids are reserved for frequent attacks but aren’t considered quick-relief solutions.

When it comes to quick-relief options, short-acting beta-agonists (SABAs) act as bronchodilators that quickly relax airway muscles. They lead to increased airflow, making breathing easier and relieving symptoms within a few hours. However, it’s important to be aware of the potential adverse effects, such as tachycardia and tremors. The risk of arrhythmia is higher in cases of comorbidity and hypoxemia. These effects are related to the dose and potency of the medication. Additionally, SABAs can be influenced by non-pharmacological factors, like specific stimuli such as allergens and exercise, which can increase airway inflammation.

The step-wise management of asthma is crucial in preventing recurrent asthma exacerbations and progressive lung function loss. It aims to provide the most effective pharmacotherapy with minimal adverse effects, reducing the need for emergency department visits and hospitalizations. Both healthcare providers and patients use this approach to maintain control of asthma, and it complements decision-making regarding individual patient needs. In cases where the current treatment is unresponsive, alternative therapies can be explored. By following the step-wise approach, asthma can be effectively controlled and managed by both patients and healthcare providers.

The step-wise management of asthma involves several steps, each tailored to the patient’s condition. It starts with step 1, which includes ICS with formoterol and a short-acting beta-agonist (SABA). As asthma severity increases, the treatment steps progress, including low-dose ICS with or without a long-acting agonist and SABA (step 2), medium-dose ICS with LABA and SABA (step 4), and, in severe cases, higher-dose ICS with LABA or referral to a pulmonologist (step 5). These steps help in providing appropriate and effective asthma management based on the individual’s needs and the severity of their condition.

tep-wise management of ASTHMA

Step 1: ICS- formoterol+ SABA
Step 2: Low –dose ICS- formoterol or daily low-dose ICS + SABA
Step 3: Low-dose ICS long-acting agonist +SABA
Step 4: Medium dose ICS-LABA +SABA
Step 5: Higher dose ICS-LABA or refer to a pulmonologists.

References

Boulet, L. P., Reddel, H. K., Bateman, E., Pedersen, S., FitzGerald, J. M., & O’Byrne, P. M. (2019). The global initiative for asthma (GINA): 25 years later. European Respiratory Journal, 54(2).
Bernstein, J. A., & Mansfield, L. (2019). Step-up and step-down treatments for optimal asthma control in children and adolescents. Journal of Asthma, 56(7), 758-770.
Heffler, E., Madeira, L. N. G., Ferrando, M., Puggioni, F., Racca, F., Malvezzi, L., … &Canonica, G. W. (2018). Inhaled corticosteroids safety and adverse effects in patients with asthma. The Journal of Allergy and Clinical Immunology: In Practice, 6(3), 776-781.
Lenney, W., Bush, A., Fitzgerald, D. A., Fletcher, M., Ostrem, A., Pedersen, S., … & Zar, H. J. (2018). Improving the global diagnosis and management of asthma in children. Thorax, 73(7), 662-669.
Ramsahai, J. M., Hansbro, P. M., & Wark, P. A. (2019). Mechanisms and management of asthma exacerbations. American journal of respiratory and critical care medicine, 199(4), 423-432.
Zahran, H. S., Bailey, C. M., Qin, X., & Johnson, C. (2017). Long-term control medication use and asthma control status among children and adults with asthma. Journal of asthma, 54(10), 1065-10.

Assignment: 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 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.

Assignment: Asthma and Stepwise Management ppt Essay

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

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

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NURS 6521 Week3 Assignment: Asthma and Stepwise Management