Assignment: Asthma and Stepwise Management

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 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. By Day 7 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. Dear Class, Here is some information that will be helpful to you when writing your Week 4 formal paper. If you have already written a paper about asthma in one of your other classes (Walden University classes or undergraduate classes at a different institution of higher learning), you will not be able to “re-use” or “recycle” this paper. Even though the paper you would be using is your intellectual property, reusing the paper in this (or any class) is considered to be “self-plagiarism” and is prohibited by Walden University. **Here are some hints for you about the Week 4 writing assignment** There is a chart on page 348 in the Arcangelo and Peterson textbook third edition (Table 25.1) and fourth edition (Tablet 25.1, 25.2 and 25.3) that is titled “Classification of Asthma”. These tables may lead you to think this is the “stepwise” approach referred to in the assignment. Assignment: Asthma and Stepwise Management. These tables are useful in the classification of asthma, not the stepwise treatment plan. There is information further along in the chapter that may be something you would want to look over closely. **HINT #1** If you are utilizing the fourth edition of the textbook, you may want to look over Tables 25.5, 25.6 and 25.7. **HINT #2** Since the title of this paper is the “Stepwise approach to asthma”, you will need to include a BRIEF description about each of the different steps. Include information not only how a patient is assigned to a step, but how the patient can step down a level in the treatment algorithm. **HINT #3** As a future Nurse Practitioner, you will be prescribing medications for the short term and long term management of asthma. If for example, a patient needed an inhaled short-acting beta2 agonist, you would want to know at least example of a drug from this classification. So that I can assess your understanding of the subject matter for this section of the paper, you will need to include an example of each of the different drug classifications you discuss in this section of your paper. If you are utilizing the textbook for the stepwise approach, there are six (6) steps in the treatment algorithm. There are other reference sources that discuss five (5) steps in the treatment algorithm. Both are correct depending on the source that you reference in your paper.

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Asthma and Stepwise Management

Long-term Control and Quick Relief Medications for Asthma Patients

Long-term control asthma medications are used to decrease and prevent swelling within the airways and hence prevent triggering asthma attacks. They also prevent inflammation of the airway and prevent asthma symptoms. Long-control medications are appropriate for individuals having asthmatic symptoms three or above weekly or at night three or more times monthly (Laforent et al, 2016). Long-term control medications include:

Anti-inflammatory medications: They are useful in reduction and prevention of swelling within the airways and they consist of: inhaled corticosteroids these prevent airway swelling after exposure to asthma triggers. They also decrease mucus within the lungs and reduce mucus within the lungs (Alangari, 2014).  Examples include flunisolide, fluticasone and beclomethasone. On the other hand, inhaled cromolyn and nedocromil are mostly utilized in preventing asthma attacks. Examples include nedocromil sodium and cromolyn sodium. Bronchodilators are also long-term control asthma medications that are effective in muscle relaxation within and around the airways; this opens-up the airways (Lampkin et al, 2016). Assignment: Asthma and Stepwise Management. They include inhaled long-acting beta₂-agonists used in preventing nighttime symptoms by relaxing muscles in the tightened airways to reopen airways. Other examples of bronchodilators are sustained-release beta₂-agonist tablets and sustained-release theophylline. These prevent nighttime asthma symptoms. Tiotropium (inhaled) is an example of bronchodilator (Lampkin et al, 2016).

Leukotriene modifiers are long-term control asthma medications used in preventing asthma attacks. They are mostly used to prevent asthma symptoms triggered by aspirin allergic reactions. Examples include zileuton and zafirlukast. Lastly,  anti-IgE (omalizumab) are also long-term control asthma medications that decrease allergic reactions by removing free IgE; this prevents attachment of free IgE to allergens (Tashkin, 2016).

Quick-relief medications quickly relieve asthma symptoms by fast relaxing muscles within and around the airways; this opens-up airways. Quick-relief asthma drugs include inhaled anticholinergics and inhaled short-acting beta₂-agonists (Alangari, 2014). Inhaled anticholinergics work by blocking acetylcholine a chemical that stimulates contractions of muscles and increase mouth and lung secretions during an asthmatic attack. An example is ipratropium bromide. Short-acting beta₂-agonists work by helping relaxing of muscles within and around the tightened airways to reopen the airways. Examples include terbutaline, albuterol and pirbuterol (Alangari, 2014).

Long-term effects of both long-term and short-term corticosteroids include systemic effects like hypertension, suppression of growth especially in children, dermal thinning and diabetes. On the other hand, inhaled long-acting beta2-agonists have been shown to cause shakiness, increased heart beat and hypokalemia (Laforent et al, 2016).

Stepwise Approach to Asthma Treatment and Management

This form of approach integrates different care elements that include: assessment of severity to start treatment or assessment of control for therapy monitoring and adjustment; patient education; environmental control strategies and managing comorbid during each step; as well as medication selection (Dunn et al, 2017). The severity and asthma control determines the kind, quantity, as well as scheduling of medication. Treatment is increased (stepping up) as essential and reduced (stepping down) when possible. Stepwise approach aims to gain control as fast as possible and then reduce therapy to the least medication essential in maintaining control. It is recommended to begin with a more intensive therapy to ensure a more quick suppression of airway inflammation and therefore gain control promptly. Corticosteroids are the most reliably effective anti-inflammatory treatment for all age-groups at all care steps for persistent asthma. Corticosteroids are also the ideal first-line therapy that leads to improved asthma control (Bateman et al, 2015). Assignment: Asthma and Stepwise Management.

Step 1 is recommended for treatment of intermittent symptoms of asthma and is appropriate for all age-groups. The recommended medications include short-acting beta-agonist, for example albuterol prn. If the patient used the treatment over two days weekly, the therapy should be taken as inadequate control and stepped up (Dima et al, 2016).

Step 2 is recommended for treatment of mild persistent asthma. The recommended therapies for all ages include low-dose inhaled corticosteroids and leukotriene blocker or cromolyn as the alternatives. However, for children aged between 0-4 years, a referral should be considered particularly if the diagnosis is uncertain. The alternative therapy should only be prescribed when the patient fails to tolerate the first-line treatment choice (Dima et al, 2016).

Step 3 is recommended for moderate and severe asthma. For individuals aged 2 years and above, the recommended therapy is low-dose inhaled corticosteroid combined with long-acting beta agonist or single therapy of medium-dose inhaled steroid. For children aged between 5-11 years, the recommended therapy is low-dose inhaled corticosteroid together with long-acting beta agonist. For children aged between 0-4 years, the recommended therapy is medium-dose inhaled steroid and a referral to a specialist. In step 4, the therapy is used in moderate and severe asthma (Dima et al, 2016). In this step, just like in step 3, the dosage of inhaled steroids is elevated or LABA added or both depended on the asthma severity. For step 5 and 6, the patients are prescribed increased and high-dose of inhaled corticosteroids combined with long-acting beta agonist. In step 5 and 6, omalizumab is considered if allergies for patients aged above 12 years. In step 6, oral or chronic corticosteroids (normally prednisone) are deliberated (Dima et al, 2016).

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For all ages, from step 4 to 6 an asthma specialist should be consulted. If allergic asthma, immunotherapy should be recommended.  For rescue medication, short-acting beta-agonist like albuterol should be administered depending on the symptom severity. Regular or using rescue medication increasingly may be an indication of an inadequate control and the necessity for stepping up treatment. For all steps, patient education and environmental controls should be provided (Dunn et al, 2017).  Assignment: Asthma and Stepwise Management.

Significance of Stepwise Asthma Management to Disease Control

Stepwise approach to asthma management enables patients and healthcare providers to utilize written action plans in guiding patients on effective control asthma attacks or asthma exacerbations. Stepwise approach also enables healthcare providers to provide individualized care depending on the patient; therefore, the patients are able to handle any changes in their conditions and have treatment adjusted accordingly (Bateman et al, 2015). The capacity of patients to regulate their stepwise medication depending on their asthma severity enables patients to gain and maintain control of the disease process. Finally, stepwise approach in asthma management has been shown to be effective in prevention and management of asthma exacerbations (Bateman et al, 2015).

References

Alangari A. (2014). Corticosteroids in the treatment of acute asthma. Ann Thorac Med. 9(4), 187–192.

Bateman R, Becker A, Wong G, Soto M et al. (2015). A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal. 1(2).

Dunn N, Neff L & Maurer D. (2017). A stepwise approach to pediatric asthma. J Fam Pract. 66(5):280,282-286

Dima A, Bruin M & Ganse E. (2016). Mapping the Asthma Care Process: Implications for

Research and Practice. J Allergy Clin Immunol Pract. 4(5).

Laforent L, Manon B, Didier A, Ganse E & Marine G. (2016). Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence. J Allergy Clin Immunol Pract. 4(5), 890–899.

Lampkin S, Cheryl M, Maish W & John B. (2016). Asthma Review for Pharmacists Providing Asthma Education. J Pediatr Pharmacol Ther. 21(5), 444–471.

Tashkin D. (2016). A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 1(11), 2585–2596.     Assignment: Asthma and Stepwise Management.