Application: Asthma and Stepwise Management
Instructions: 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.
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.
Asthma and Stepwise Management
Asthma is a condition where airway in the breathing tract narrow and swell to produce extra mucus that can lead to difficulty in breathing and prompt panting and coughing (Mims, 2015). Asthma as a long term condition has no cure. Therefore, it is advised that the condition must be prevented and managed properly. This literature will review the quick relief and long-term treatment of asthma, and also outline effects of these interventions on the patient. Also, an explanation of the how stepwise management helps healthcare personnel and patients benefit and maintain control of asthma.
Asthma is still the number one chronic disease in childhood (National Heart Lung and Blood Institute, 2012). Statistics suggest that Asthma has caused 3613 deaths, 1.7 million emergency section visits, 10.6 million physician office visits and approximately 500,000 hospitalizations (National Heart Lung and Blood Institute, 2012). On medication and control of asthma discussions, patients suffering from can be given long-term medication or quick-relief drugs that will help reduce the adverse effects of asthma.
First, most of the asthma medication are taken through pill form. Although, most of the patients prefer the use of inhalers. Long-term control medicines for asthma include inhaled corticosteroids. Inhaled steroids typically are well tolerated. The most common side effects these steroids are headaches, coughing, huskiness, dysphonia and oropharyngeal candidiasis (Arcangelo & Peterson, 2013, p. 349). Such effects on the patients only occur when high doses are administered. Another drug therapy for asthma patient is the use of mast cell stabilizers, which are effective as inhalants. They usually suppress the spread of the inflammatory cells and antigen-induced bronchial hyperactivity. Mast cell stabilizers exhibit side effects such as coughing, joint swelling and pain, unpleasant tastes, nasal irritation and dizziness among others (Arcangelo & Peterson, 2013, p. 351). Also, use of leukotriene modifiers and theophylline are employed in long-term control measures for asthma. These administered by mouth. Leukotriene modifiers are associated with weakness, dizziness, elevated liver enzyme levels, mild fever and back pains (Arcangelo & Peterson, 2013, p. 354). Secondly, there is also quick relief intervention in controlling asthma. Use of inhaled beta2-adrenergic agonists is one of the best-known rescue drug for controlling asthmatic patients. It mainly used before a patient engages in an activity to prevent exercise-induced bronchospasm. Its main side effects include skeletal muscle tremor, hyperglycemia, cardiac arrhythmia and dizziness (Arcangelo & Peterson, 2013, p. 354).
Treatment of asthma involves intensive assessment and monitoring that is focused on the frequency and intensity of its symptoms and their functional boundaries. One of the best way to manage asthmatic patient is using the stepwise management. This method is a pharmacologic therapy most nurses and physician use to control asthmatic patients. In stepwise management therapy, asthma severity and level of scrutiny are responsive to the type, amount, and schedule of medication.
Stepwise Management Stages
To gain control, treatment is administered at the step that is most suitable to the severity of symptoms of asthma. There will be a need for a step up if the indicators of asthma are uncontrolled. Below are steps that are taken in controlling asthma through stepwise management therapy.
- First Line Therapy
It is also called the mild-intermittent stage where symptoms are no more than two times a week. The recommended treatment at this stage is the use of quick-relief medication such as beta-adrenergic agonists.
- Second Line Therapy
At this stage, the patient experiences mild persistent asthma. Drug therapy involves a low dose of corticosteroids or theophylline. If the symptoms persist in this juncture, there is a need to move to step three.
- Third Line Therapy
It is known as the Initial add-on therapy. If the symptoms at stage 2 persist, the patient must check compliance and inhaler methods and eliminate trigger focus. The most effective therapy at this juncture is the use of LABA (beta-adrenergic agonists).
- Fourth Line Therapy
This stage involves persistent poor control. If the symptoms persist at step three, the dose is increased. Therefore, the patient can take leukotriene as a long-term control measure.
- Fifth Line Therapy
At this stage, Long-term control drugs are administered at high dose levels. For neonates (age of 4), high doses of inhaled corticosteroids and LABA are considered. If the symptoms persist patients move to step 6.
- Sixth line Therapy
If the symptoms are severe, high doses of corticosteroids and LABA are also administered to theophylline and leukotriene modifiers.
After all these medications in each stage, it is expected that the patient exhibits mild symptoms of asthma. If there are more difficulties in controlling asthma, the patient is advised to receive a specialist care. Also, specialist care is endorsed if a patient requires hospitalization during the therapy process.
When stepwise management is stepping down patient follow-up is important. This type of disease management is essential to patient and nurses in that it helps the physician understand the levels of symptoms occurring to the patient. Also, stepwise management is important to patients in that they can be able to self-examine themselves and avoid experiences the later stages of asthma. Stepwise management is also a tool in providing education to parents with asthmatic children (Bateman et al., 2008). The patient should learn to use the correct way in handling asthma.
Conclusively, asthma being an
incurable condition, it is fully advised
that patients must attend to a doctor to be
provided with an action plan in controlling asthma. With the current
invention of new drugs to control asthma, nurse practitioners must fully be
aware of the potential side effects of this
medication to patients be it adults or children. Stepwise management is an effective tool for efficient prevention of
asthma in healthcare (Bateman, et al., 2008). With full utilization and
educating nurses and patients on the procedure, asthma can be prevented, and we can save the upcoming
generation from the harshness of the condition.
Arcangelo, V. P., & Peterson, A. M. (2013). Asthma. In V. P. Arcangelo, A. M. Peterson, V. P. Arcangelo, & A. M. Peterson (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (3rd ed., pp. 346-364). Ambler, Pennsylvania, United States of America: Lippincott Williams & Wilkins.
Bateman, E., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., & Pizzichini, E. (2008). Global Strategy for Asthma Management and Prevention. GINA Eecutive Summary. European Respiratory Journal, 31(1), 143-178.
Mims, J. W. (2015, September). Asthma: Definitions and Pathophysiology. International Forum of Allergy & Rhinology, 5(1), pp. S2-S6.
National Heart Lung and Blood Institute. (2012, April). Expert Panel report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. Retrieved from National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm