Assignment: Asthma and Stepwise Management ppt Essay

Long-term Asthma Management

In the realm of long-term asthma management, Inhaled Corticosteroids (ICS) play a crucial role as anti-inflammatory agents. They function by blocking the late reaction to allergens, thereby reducing airway sensitivity. At a cellular level, ICS inhibits cytokine production, activation of adhesion proteins, and the migration and activation of inflammatory cells. Additionally, ICS reverses beta2-receptor down-regulation and inhibits microvascular leakage. However, it’s important to note potential side effects such as oropharyngeal candidiasis and delayed growth in children (Heffle, et al., 2018).

Oral corticosteroids share a similar mechanism of action with inhaled corticosteroids. Short-term use may result in reversible abnormalities in sugar metabolism, mood changes, and hypertension, while long-term use can lead to systemic effects, including growth suppression, dermal thinning, and impaired immune function.

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Long-term Treatment

Long-Acting Beta-Agonists (LABAs) provide sustained bronchodilation, outlasting Short-Acting Beta-Agonists (SABAs). They operate by relaxing bronchial smooth muscles, increasing cyclic AMP, and functionally antagonizing bronchoconstriction (Lenney, et al., 2018). LABAs, such as salmeterol and formoterol, can, however, cause side effects like increased heart rate, tremors, and hypokalemia. A diminished bronchoprotective effect may occur after a week of chronic therapy (Ramsahai, et al., 2018).

Leukotriene modifiers, including Leukotriene Receptor Antagonists (LTRAs) and 5-Lipoxygenase inhibitors, block the synthesis of leukotrienes at the cellular level. Although effective, LTRAs may elevate liver enzymes, necessitating monitoring (Zahran, et al., 2017). A combination of LTRAs and ICSs is used as adjunctive therapy for those over 12 years old. Immunomodulators also serve as adjunctive therapy for individuals in the same age group.

Short-Term Management

For short-term asthma management, quick-relief inhalers, or fast-acting bronchodilators like albuterol, offer rapid symptom relief. These inhalers act by opening inflamed airways, providing immediate relief. Short-acting Beta-Agonists (SABAs) are common quick-relief medications and are frequently used during asthma attacks. Oral steroids, while effective, are reserved for frequent attacks and are not classified as quick-relief medications.

Quick-Relievers

Short-acting Beta-Agonists (SABAs) act as potent bronchodilators, relaxing airway muscles within minutes and improving airflow, making breathing easier. They provide relief from symptoms within 3-6 hours. While they exhibit pharmacologically predictable dose-related and potency-related adverse effects like tachycardia and tremors, the potential for arrhythmia increases with comorbidities and hypoxemia (Lenney, et al., 2018). Non-pharmacologically predictable side effects involve responses to non-specific and specific stimuli, leading to increased airway inflammation.

Importance of Stepwise Management

The stepwise approach to asthma management is crucial for preventing recurrent asthma exacerbations, halting progressive loss of lung function, and providing optimal pharmacotherapy with minimal adverse effects. This approach aims to reduce emergency department visits and hospitalizations (Bernstein & Mansfield, 2019). It empowers both providers and patients to gain and maintain control over asthma, serving as an effective decision-making tool and offering alternative treatments in unresponsive cases. Effective control and management of asthma are paramount for the well-being of both patients and healthcare providers.

Long-term asthma management

• ICS – anti-inflammatory, blocks late reaction to allergen, reduce airway sensitivity.
• Inhibit cytokine production, adhesion protein activation, inflammatory cell migration and activation at cellular level.
• Reverse beta2-receptor down-regulation. Inhibit microvascular leakage.
• Side effects- oropharyngeal candidiasis, delayed growth in children (Heffle, et al., 2018).
• Oral corticosteroids- works the same as inhaled corticosteroids.
• Short-term use- reversible abnormalities in sugar metabolism, mood changes, hypertension, rare aseptic necrosis of femur.
• Long-term use- systemic effects

Inhaled and oral corticosteroids have the same mechanism of action. They are both anti-inflammatory medications which act by inhibiting cytokine production, activation of adhesion protein, inflammatory cell migration and activation at the cellular level. They also reverse beta2-receptor down-regulation and inhibit microvascular leakage. Oral corticosteroids may cause short-term and long term side effects. The long-term effects are systemic and may include growth suppression, dermal thinning, hypertension, muscle weakness, and impaired immune function.

• Long-term Treatment
• LABAs- work slowly and lasts longer than SABAs (Boulet, et al., 2019).
• Cause bronchodilation by relaxing bronchial smooth muscle, increases cyclic AMP producing functional antagonism of bronchoconstriction (Lenney, et al., 2018).
• LABAS can increase heart rate, tremors, hypokalaemia.
• A reduced Broncho protective effect may occur 1 week after chronic therapy (Ramsahai, et al., 2018).
• Leukotriene modifiers – LTRAs and 5-lipoxygenase inhibitor. Block synthesis of all leukotrienes at the cellular level.
• May elevate liver enzymes, thus monitoring is recommended (Zahran, et al., 2017).
• LRTAs +ICSs – used as adjunctive therapy for >12 years .
• Immunomodulators – adjunctive therapy for >12 years.

The long-term medications for asthma control are taken on daily basis to achieve and maintain control of persistent asthma. Leukotriene receptor antagonists (LTRAs) is for patients aged more than one while 5-lipoxygenase pathway inhibitors are used for more than 12 years. Long-acting beta-agonists such as salmeterol and formoterol act as bronchodilators for at least 12 hours after a single-dose. LABAS cannot be used as monotherapy due to short duration of acting.

Short-Term management – Assignment: Asthma and Stepwise Management ppt Essay

• Quick-relieve inhalers – fast acting bronchodilators e.g albuterol.
• Provide short-term relieve of symptoms –rescue inhalers
• Act by opening inflamed airways and relieving asthma symptoms.
• Short-acting Beta-agonists- most common quick relieve drugs for asthma attacks.
• Oral steroids – for frequent attacks, not quick-relief medications.

Asthma quick-relief drugs are used for fast control of asthma attacks. Also called rescue drugs. They can be used before exercise to dilate and relax muscles of the airways. Short-acting Beta-agonists are the most common quick relievers for asthma attacks. They include albuterol, levalbuterol, metaproterenol, and terutaline.  Oral steroids can also be administered although not for quick relieve. They are given 7 to 14 days during symptom flare-ups.

Quick-relievers –Assignment: Asthma and Stepwise Management ppt Essay

• Short-acting beta-agonists act as bronchodilators – relax airway muscles within 5 minutes.
• Increase airflow and make breathing easier.
• Relieve symptoms within 3-6 hours.
• Pharmacologically predictable dose-related and potency related adverse effects.
• Cause tachycardia and tremors.
• The potential for arrhythmia increases with comorbidity and hypoxemia (Lenney, et al., 2018).
• Non-pharmacologic predictable side effects – non-specific and specific stimuli.
• Increased airway inflammation.

SABAs are bronchodilators which relax the airway muscles within 5 minutes and relieve asthma symptoms within 3 to 6 hours. Research shows pharmacologically predictable dose-related and potency related adverse effects of SABAs including tachycardia, tremors, and effects on potassium and glucose levels. However, the effects resolve with increased exposure to the medications. Also, there is potential for arrhythmia in comorbidity and hypoxemia. Non-pharmacologically predictable effects include nonspecific and specific stimuli including allergen and exercise, and increased airway inflammation.

Importance of Step-wise management – Assignment: Asthma and Stepwise Management ppt Essay

• Prevent recurrent asthma exacerbations.
• Prevent progressive loss of lung function.
• Provide optimal pharmacotherapy with minimal or no adverse effects.
• Reduce ED visits and hospitalization (Bernstein & Mansfield, 2019).
• Providers and patients gain and maintain control of asthma.
• Providers use the approach to complement decision making in meeting patient needs.
• Alternative treatment in unresponsive cases available.
• Effective control and management of asthma for both patients and providers.

The step-wise approach to asthma management helps patients and providers to gain and maintain asthma control. It helps prevent recurrent asthma exacerbation , improve lung function, and improve the quality of life. The approach does not replace decision-making in asthma management but is used by providers as an alternative in decision-making regarding meeting patient’s individual needs. Alternative treatment are used in unresponsive cases . Alternatives therapies can be discontinued and the preferred treatment used before stepping up. The step-wise approach helps providers and patients control and manage asthma effectively.

Step-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, a respiratory disorder affecting both children and adults, frequently necessitates treatment from advanced practice nurses. Recognizing and distinguishing between minor asthma symptoms and serious, life-threatening ones is crucial, especially when immediate treatment is required. Triggers often induce symptoms and attacks, emphasizing the need for advanced practice nurses to assist patients in identifying triggers and recommending suitable management options. Like many other disorders, various approaches to treating and managing care for asthmatic patients exist, contingent upon individual patient factors.

*Photo Credit: Photo Library / Getty Images*

One effective method that supports clinical decision-making for drug therapy plans in asthmatic patients is the stepwise approach, a focal point of exploration in this assignment.

To Prepare:
Reflect on drugs utilized in treating asthmatic patients, encompassing both long-term control and quick relief options for adults and children. Contemplate the potential impact these drugs might have on patients.

Consider how the stepwise approach could be applied to address the health needs of a patient in your practice. Reflect on how stepwise management contributes to health care providers and patients gaining and maintaining control over the disease.

By Day 7 of Week 3:

Create a 5- to 6-slide PowerPoint presentation suitable for a staff development meeting, elucidating various approaches for implementing the stepwise approach in asthma treatment. Address the following key points:

– Describe long-term control and quick relief treatment options for an asthma patient in your practice and elaborate on the potential impact of these drugs on your patient.

– Explain the stepwise approach to asthma treatment and management tailored to your patient, detailing each step in the process.

– Clarify how stepwise management assists health care providers and patients in gaining precise and effective control over the disease. Provide specific examples and insights into the benefits of this approach.

Assignment: Asthma and Stepwise Management

To Prepare

By Day 7 of Week 3

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