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Assignment: Asthma and Stepwise Management

NURS 6521 Assignment: Asthma and Stepwise Management

Long-Term Control Treatment Options

Nurses should ensure patients with asthma do not suffer, or the disease ruins their quality of life. Long-term asthma medications for the patient are essential for preventing asthma symptoms and potential attacks (American College of Allergy, Asthma, & Immunology, 2023). The patient should take them daily as long-term control necessitates. The main options, also available for the patient, include inhaled corticosteroids, leukotriene modifiers, and long-acting beta-agonists (LABAs). The safety of inhaled corticosteroids makes them a highly effective option for long-term asthma control. Generally, health care providers recommend these control medications since they reduce airway inflammation to improve breathing. Besides, they improve asthma symptoms, which is critically needed for a better quality of life for the patient.

Quick-Relief Treatment Options

Effective asthma treatment requires health care providers to recommend treatment depending on the severity of the condition. Quick-relief options are necessary for intermittent asthma or at the first sign of the symptoms. They offer immediate relief, which the patient requires to continue with daily activities. Options for the patient include inhaled SABAs and anticholinergics. The American College of Allergy, Asthma, & Immunology (2023) categorize these options as bronchodilators since they expand air pathways into the lungs. Doing so improves breathing by allowing more free air movement into the lungs. Besides, quick-relief options clear mucus from the lungs, which can help the patient to breathe and cough better.

Potential Impacts of the Drugs

Both long-term control options and quick-relief treatments for asthma are effective depending on the severity of the condition. However, health care professionals should be wary of side effects of these medications and assess patients to assist them accordingly. For instance, the patient may experience headaches and nervousness when using SABAs. This necessitates a holistic evaluation of the condition to provide patient-centered care. Inhaled corticosteroids are associated with hoarseness, coughing problems, and oral thrush (Asthma Initiative of Michigan, 2023). Leukotriene modifiers may elevate liver enzymes levels while LABAs are linked with increased heart rate and occasional shakiness. As a result, health care providers should evaluate the possibility of these side effects through open communication with the patient and healthy interactions.

The Stepwise Approach to Asthma Treatment and Management

Like other health conditions, asthma treatment requires a patient-centered approach guided by symptoms, patients’ feelings, and health goals. In agreement with Papi et al. (2020), anti-inflammatory treatment is the cornerstone of asthma management, with the stepwise approach helping to meet the patients’ and health care providers’ goals. As the chart demonstrates, SABAs are recommended in the initial stages of asthma management for quick relief purposes. After that, asthma moves into long-term control steps where the patient should take daily medication. The dosage depends on the severity of the condition and, in most cases, requires a combination of different medications. The treatment may be adjusted as situations necessitate to ensure the best possible outcomes for the patient.

Assisting Health Care Providers and Patients

The stepwise approach enables health care providers and patients to collaborate for effective asthma control. As Wang et al. (2021) mentioned, the stepwise approach to asthma management is highly recommended since it leads to improved asthma control and helps care providers to prevent asthma exacerbations. The implication is that risk and potential impairment are significantly reduced since medication type and dosage are adjusted according to the patient needs. Risk reduction also reduces hospitalizations and emergency department visits, indicating health care providers’ ability to optimize the use of medications. The treatment through an iterative cycle of assessment and treatment adjustment further helps to maintain the patient’s normal activity and prevent troublesome symptoms. For improved outcomes, health care providers and patients should collaborate to ensure they work toward shared goals.


References

´American College of Allergy, Asthma, & Immunology. (2023). Medication. https://acaai.org/asthma/treatment/medication/

´Asthma Initiative of Michigan. (2023). Long term control medications used to treat asthma. https://getasthmahelp.org/ltc-medications

´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 Immunology16, 1-11. 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 Medicine4(4), 293-296. https://doi.org/10.1093/pcmedi/pbab028

 

Introduction

uAsthma is a chronic respiratory disease

uAssociated with inflammation and bronchospasm

uActs as a source of disease burden

uLowers quality of life of patients

uManaged using pharmacological interventions

uStep-wise approach utilized in chronic cases

Asthma is one of the respiratory problems that can be either acute or chronic in nature. It arises from the exposure to environmental triggers such as allergens. Asthma is characterized by symptoms such as dyspnea,  tightness in the chest with wheezing ,  cough, and cyanosis due to increased bronchospasm, inflammation and production of mucus. Asthma often tends to be recurring in nature. The recurrence makes asthma a critical source of disease burden to the patients. The disease burden is seen from the increased need for frequent hospitalizations, loss of productivity, and high costs incurred in the treatment process. The effects of asthma have a negative effect on patients, hence, lowering their quality of life. Pharmacological interventions however exist for use in the management of asthma. The interventions are classified into those used for quick relief of symptoms or those used for long-term management of asthma. In addition, the step-wise approach has been developed to enhance the outcomes in chronic and recurrent asthma.

Long-Term Treatment

uLong-acting beta agonists (LABA)

uLeukotriene modifiers

uInhaled corticosteroids

uCromolyn

uAnti-IgE medications

The long-term treatment of asthma is achieved with a number of medications. One of them is the long-acting beta-2-agonists (LABA). LABA is a group of medications that work by getting attached to the beta-receptors of the respiratory system to cause extended bronchodilation. The bronchodilation enhances air-flow, dyspnea, chest pain, and minimizes resistance to air flow. The other category of long-term treatment of asthma is the use of inhaled corticosteroids. Inhaled corticosteroids work by suppressing the inflammation of the respiratory muscles. The drugs achieve this outcome by inhibiting histone activation and its correlates that include histone deacetylase 2 that is responsible for airway inflammation. The other category of drugs is leukotriene modifiers. Leukotriene modifiers work by inhibiting mucus production as well as the inflammation of airway muscle. The other category of medications is cromolynes that produce their work by blocking the opening of chloride channels by mast cells. The inhibition of chloride ion channels reverses mucus production and inflammation. The last category of long-term medications used in asthma is the anti-IgE medications. The Anti-IgE medications produce their effect by interfering with the binding of the antigens of the Fc sub-unit to the IgE molecule. The inhibition results in the stabilization of the mast cells as well as mucus production and inflammation of the airways (White et al., 2018). Cromolyn is used as prophylaxis, an inhaler drug that subdues bronchial inflammation

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Quick Treatment

uBeta-2-agonists

uTheophylline

uAnti-cholinergic medications

The treatment of asthma can also be achieved using medications that provide quick relief. The medications relief symptoms such as wheezing, chest pains, and difficulty in breathing in asthma patients. One of the categories of asthma medications with quick effect is theophylline. Theophylline produces its effects by relieving bronchospasms as well as the symptoms of asthma. The mechanism of action of theophylline includes the inhibition of phosphodiestarate, which leads to bronchodilation and suppressed hyper-responsiveness of the respiratory system to the allergen. The other group of medications that provide quick relief of asthma symptoms is beta-2-agonists. Beta-2-agonists produce their effect by dilating the  bronchioles. They act by activating the beta-adrenergic receptors of the lungs and bronchioles to open the airways. They include medications such as salbutamol and terbutaline. The last category of quick acting asthma medications are the anti-cholinergics. Anti-cholinergics work by preventing acetylcholine from binding to muscarinic receptors. The effect of the inhibition includes prevention of mucus production, bronchospasms, inflammation, and airway remodeling. An example of an anti-cholinergic is Ipatropium bromide (White et al., 2018).

Step-Wise Treatment

uStep 1: short-acting beta-agonist

uStep 2: low-dose inhaled corticosteroids; leukotriene blocker or cromolyn

uStep 3: low-dose inhaled corticosteroid + long-acting beta agonist or medium-dose inhaled steroid alt: low-dose inhaled steroid + leukotriene blocker

uStep 4: Medium-dose inhaled steroid + long-acting beta agonist Alt: medium-dose inhaled steroid + leukotriene blocker

uStep 5: High-dose inhaled steroid + long-acting beta agonist and omaluzimab if allergies

uStep 6: high-dose inhaled steroid + long-acting beta agonist + oral oral steroid plus omaluzimab if allergies

The step-wise treatment is an evidence-based approach used in the management of asthma. The management begins at step 1 and ends in step 6. The management is in ascending manner in case of unresponsiveness to treatment and descending if the patient improves in symptoms. Step 1 of the stepwise treatment of asthma entails the use of short-acting beta-agonists. The use of short-acting beta-agonists is recommended for patients of all ages. Step 2 of the management entails the use of low-dose inhaled steroid as a preferred treatment. An alternative is the use of leukotriene blockers or cromolyn. For children aged 0-4 years, the management entails referring the patient especially in cases when one is doubting the diagnosis. In step 3, the management of children aged 12 years and above entails the use of low-dose inhaled steroid with long-acting beta agonist or medium-dose inhaled steroid. The alternative entails the use of low-dose inhaled steroid + leukotriene blocker. The management of children aged 5-11 years in this step entails the use of low-dose inhaled steroid + long-acting beta agonist or leukotriene blocker or medium-dose inhaled steroid. For children aged 0-4 years, the management entails medium-dose inhaled steroid plus referral (Beasley et al., 2020).

The management in step 4 in 12 year old and above entails the use of medium-dose inhaled steroid + long-acting beta agonist as the preferred treatment. The alternative entails the use of medium-dose inhaled steroid + leukotriene blockers. Similar management is used in children aged 5-11 years. For 0-4 year-olds, the treatment entails the use of medium-dose inhaled steroid + either long-acting beta-agonist or leukotriene blocker. The step 5 management of 12 year olds and above entails the use of high-dose inhaled steroid + long-acting beta agonist and consideration of omaluzimab in case of allergies. For 5-11 year olds, the preferred treatment entails the use of high-dose inhaled steroid + long-acting beta agonist. The alternative entails the use of high-dose inhaled steroid + leukotriene blocker. For 0-4 year-olds, the management entails the use of high-dose inhaled steroid + long-acting beta-agonist or leukotriene blocker.  For step 6, 12 year-olds and above are managed using high-dose inhaled steroid + long-acting beta agonist+ oral steroid and consideration of omaluzimab in case of allergies. For those aged 5-11 years, the preferred treatment is high-dose inhaled steroid + long-acting beta agonist with the alternatives being high-dose inhaled steroid + leukotriene blocker + oral steroid. For 0-4 year-olds, the treatment entails the use of high-dose inhaled steroid + either long-acting beta-agonist or leukotriene blocker + oral steroid (Bernstein & Mansfield, 2019).

Impact of Step-Wise Treatment

uPrevent and reduce impairment

uPrevent recurrent exacerbations

uImproves quality of life

u Promote optimal pulmonary functioning

uPrevents loss of lung function

uMinimize side effects of treatment

The step-wise treatment is associated with a number of benefits to healthcare providers and patients. One of the benefits is that it prevents and reduces the risk of impairment of the airways due to asthma. The effective management of asthma symptoms such as remodeling of the airway prevents impairment, hence, optimal pulmonary functioning. The other benefit is the prevention of recurrent exacerbations. Asthma may be associated with recurrent exacerbations, which affect the integrity of the airways. The step-wise treatment optimizes the management of symptoms and exacerbations to enhance the pulmonary functioning as well as the quality of life for patients. The step-wise treatment also minimizes complications that would otherwise lead to loss of lung function. The stepwise treatment also provides systematic approaches to asthma treatment, which minimizes the side effects of the adopted treatments (Bernstein & Mansfield, 2019).

Conclusion

uAsthma is a chronic respiratory disease

uHas severe impacts on patients

uIncreases the risk of reduced lung function

uStep-wise management is an effective approach

uMinimizes complications of asthma

uImproves quality of life of patients

References

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.

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.

STEP 1. Step one and two are recommended for all ages. In asthma treatment, 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). STEP 2. Referrals can be considered for ages between 0-4 (White et al., 2018). This treatment is recommended for patients who show no improvement in step one. The intensity of the medications are increased, and other treatment options are introduced to address the problem. According to Yawn & Han (2017), leukotriene receptor antagonists (LTRAs) are introduced as the alternative category of drugs because they help in blocking leukotrienes from binding to the proinflammatory cells in the airways. Most commonly used LTRAs are montelukast, which is effective in allergic asthma.

STEP 3. According to Yawn and Han (2017), this step applies for ages above 12 years. At this stage, either the ICS dose is increased, or a long-acting beta-adrenergic (LABA) is added. The LABAs help in providing long-term control of symptoms (Kirenga et al., 2018). Some of the most commonly used combinations of LABAs and ICS (ICS/LABA) are fluticasone + salmeterol (available as a dry powder inhaler) and formoterol + budesonide (available as an HFA inhaler) (Yawn & Han, 2017). STEP 4. Applies for ages above 12 years. Also, patients who experience recurring severe exacerbations requiring ED visits, oral prednisone, or hospitalizations should be considered for this step. The same applies for patient of ages between 5 and 11.

STEP 5. Applies for ages above 12 years. For ages between 5-11 years, Rothe et al. (2018) recommends a High-dose inhaled steroid plus long-acting beta-agonist. Alternative can be a High-dose inhaled steroid plus leukotriene blocker. 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. STEP 6. Applies for ages above 12 years. For age 5-11 years, a High-dose inhaled steroid plus long-acting beta-agonist are preferred. A combination of High-dose inhaled steroid, either long-acting beta-agonist or leukotriene blocker, oral steroid is preferred for age 0-4.

In 2007, the National Asthma Education and Prevention Program (NAEPP) published its third report, which reinforced the guidelines for the Diagnosis and Management of Asthma. According to Rothe et al. (2018), the Expert Panel recommends that asthma therapy should be aimed at maintaining control of the disease with the least amount of medication which, in turn, minimizes the risks for adverse effects. The stepwise approach increases or decreases the dose administered and also changes them and their frequency till the best medication and with its best amount and frequency of dosage is established. Efforts are focused on suppressing inflammation over the long term and preventing exacerbations (Yokoyama & Yokoyama, 2019).

References

uKirenga, B. J., Schwartz, J. I., de Jong, C., van der Molen, T., & Okot-Nwang, M. (2015). Guidance on the diagnosis and management of asthma among adults in resource limited settings. African health sciences, 15(4), 1189-1199.

uRothe, T., Spagnolo, P., Bridevaux, P. O., Clarenbach, C., Eich-Wanger, C., Meyer, F., & Sauty, A. (2018). Diagnosis and management of asthma–the swiss guidelines. Respiration, 95(5), 364-380.

uYawn, B. P., & Han, M. K. (2017, November). Practical considerations for the diagnosis and management of asthma in older adults. In Mayo Clinic Proceedings (Vol. 92, No. 11, pp. 1697-1705). Elsevier.

uWhite, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 73(3), 293-297.

Rubric

NURS_6521_Week3_Assignment_Rubric
NURS_6521_Week3_Assignment_Rubric
Criteria Ratings Pts

Describe the 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.

30 to >26.7 pts

Excellent
The presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice. … The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.

26.7 to >23.7 pts

Good
The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation accurately describes the impact these drugs might have on their patient.

23.7 to >20.7 pts

Fair
The presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.

20.7 to >0 pts

Poor
The presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing. … The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.
30 pts

Explain the stepwise approach to asthma treatment and management for your patient.

30 to >26.7 pts

Excellent
The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.

26.7 to >23.7 pts

Good
The presentation accurately explains the stepwise approach to asthma treatment and management for their patient.

23.7 to >20.7 pts

Fair
The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.

20.7 to >0 pts

Poor
The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.
30 pts

Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

30 to >26.7 pts

Excellent
The presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides accurate and detailed examples to support the explanation provided.

26.7 to >23.7 pts

Good
The presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides accurate examples to support the explanation provided.

23.7 to >20.7 pts

Fair
The presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides inaccurate or vague examples to support the explanation provided.

20.7 to >0 pts

Poor
The presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing. … The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.
30 pts

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 to >4.45 pts

Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4.45 to >3.95 pts

Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent
Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good
Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair
Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts