Assignment: Asthma and Stepwise Management

Assignment: Asthma and Stepwise Management

Stepwise Approach for Asthma Treatment

Assignment: Asthma and Stepwise Management Introduction

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Asthma is a chronic respiratory condition

Stepwise approach includes a long-term control framework

Stepwise approach also outlines contingencies for quick relief

Pharmacology seeks to optimize the impacts of drugs used

Stepwise approach involves customizing treatment for the patient

The approach effectively manages asthma in most patients

It is a step by step process of determining most suitable treatment

Asthma is a respiratory condition in which the airway is obstructed due to spasm, mucus, swelling, or a combination of these, causing difficulty in breathing (McCance & Huether, 2019). Asthma affects both children and adults. Millions of Americans are affected by asthma (CDC, 2020). Asthma does not have a cure. It can, however, be managed using medications and lifestyle modifications. Management of asthma is dependent on its severity (McCance & Huether, 2019) Assignment: Asthma and Stepwise Management. The purpose of this presentation is to describe a stepwise approach to the treatment of asthma and how the stepwise approach will help both health care providers and patients manage the condition.

Long term control of Asthma

Treatments are taken daily to treat persistent asthma and provide long-term control (Zahran et al., 2017)

Corticosteroids: acts by decreasing inflammatory response that supports or cause airway obstruction (Zahran et al., 2017)

Leukotriene modifiers: modifies  inflammatory effects of leukotrienes in the airway (Zahran et al., 2017)

Immunomodulators:  helps regulate immune responses that promote airway inflammation and obstruction (Zahran et al., 2017)

Medications are taken even in the absence of symptoms to maintain control

Managing asthma aims to prevent exposure to triggers, reduce patient symptoms, and decrease complications (McCance & Huether, 2019). For long term control (LTC), certain medications are administered daily to help manage the condition (Zahran et al., 2017). LTC drugs include glucocorticoids, monoclonal antibodies, leukotriene modifiers, and long-acting beta-agonists (LABA) (Maine Line Health, 2020). Assignment: Asthma and Stepwise Management

Examples of LTC medications

Corticosteroids; prednisone, betamethasone

Leukotriene modifiers; montelukast sodium, zafirlukast

Immunomodulators; omalizumab, mepolizumab

Quick relief options for Asthma patient

Bronchodilators: prevents occlusion by dilating the bronchi

Beta 2 agonists : provides immediate relief by relaxing smooth muscles in the airway

Anticholinergics: inhibits acetylcholine to prevent airway obstruction

Can be bought over the counter (without prescription)

Are quick acting but can’t replace prescribed long-term treatments

Has more side effects such as increased heart rate

FDA approval is for 12 years and older (Onge et al., 2019)

Leading drugs used include Albuterol, Xopenex and Ipratropium (MedlinePlus, 2020)

Can be used before exercising to prevent an asthma attack (MedlinePlus, 2020)

Although asthma can be controlled, certain things may trigger a flare up thus causing acute symptoms that needs immediate treatment. Quick relief medications also known as rescue drugs are fast acting medications that can be used to provide immediate relief of symptoms when there is an asthma attack (Rosenthal & Burchum, 2018).

Short term medication examples

Bronchodilators; Theophylline

Short acting Beta 2 agonists; Albuterol, levalbuterol

Anticholinergics; Ipratropium

Impact Asthma drugs may have on the patient

Positive effects

uPrevents troublesome and chronic symptoms

uSustain close to normal pulmonary function

uMinimize the need for hospitalization

uImproves lung function and decrease inflammation

Adverse effects

uBronchodilators may cause dysrhythmias, convulsion

uCorticosteroids may cause adrenal insufficiency and weaken the immune system

uShort term beta agonists may cause tachycardia, angina, and tremors (Rosenthal & Burchum, 2018).

Generally, the impact of asthma quick relief drugs on the patient includes tachycardia, angina, low lung function, and bronchial hyper-responsiveness (Medlineplus, 2020).

The impact of long-term medications used in treating asthma varies based on the medications used. However, most long-term medications such as inhaled glucocorticoids and leukotriene modifiers also suppress the immune system therefore causing symptoms associated with a suppressed immune system such as adrenal suppression, respiratory infection (Zahran et al., 2019). Also long acting beta agonists have an increased risks of causing asthma-associated deaths especially when used alone (Rosenthal & Burchum, 2018). Leukotriene modifiers may also cause psychiatric related effects such as depression, suicidal thoughts (Rosenthal & Burchum, 2018).

uStepwise approach treatment to the patient

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

uStepwise approach treatment to the patient

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

uMerits of Stepwise approach to HCWs and patients

uStepwise approach prevents recurrent exacerbations

uThe method is flexible allowing optimal care (Zahran et al., 2017)

uPharmacological parameters are established uniquely

ucustomizes treatment according to age of the patient

uProvides best possible treatment while minimizing side effects

uHealthcare providers have clear guidelines for different scenarios

uPatients are educated on how to  manage asthma  crisis effectively

The stepwise approach assists the healthcare provider in ensuring the provision of individualized care and allows for continuous monitoring of the intensity of the disease, treatment with the appropriate medications, and therapy (Falk & Hughes, 2016). This eliminates the possibility of treating patients with the wrong dose or class of drugs.

This approach also enables patients to participate in their plan of care. Patients or families can identify when symptoms have improved or worsened, thus assisting the provider in adjusting medications and controlling the disease effectively.

uConclusion

uBoth long term treatment and quick relief are incorporated

uPharmacokinetic and pharmacodynamics factors are considered

uStepwise approach establishes the best treatment for a specific patient

uDrugs with adverse effect are minimized in this approach

Assignment: Asthma and Stepwise Management

uThe approach helps maintain close to normal pulmonary function

uStepwise approach is inherently adjustable to condition of the patient

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uReferences

Beasley, R. Braithwaite, I., Semprini, A. Kearns, C., Weatherall, M. & Pavord, I. D. (2019). Optimal Asthma Control: Time for a new target. American Journal of Respiratory and Critical Care Medicine, 201(12): 1480–1487. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31905013/

Falk, N. P., & Hughes, S. W. (2016). Medications for Chronic Asthma. American Family Physician, 94(6), 454-462. Retrieved from https://www.aafp.org/afp/2016/0915/p454.html#:~:text=Step%2Ddown%20therapy%20starts%20with,control%20is%20not%20initially%20attained

Onge, I., McDowell, K. M., & Guilbert, T. W. (2019). stepwise pharmacological approach to severe childhood asthma. Severe Asthma in Children and Adolescents: 113–131. Retrieved from http://link-springer-com-443.webvpn.fjmu.edu.cn/chapter/10.1007%2F978-3-030-27431-3_6

Maine Line Health. (2020). Long-term Control Medications for Asthma. Retrieved from https://www.mainlinehealth.org/conditions-and-treatments/treatments/asthma-long-term-control-medications

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. St Louis, MO: Mosby/Elsevier.

MedlinePlus. (2020). Asthma – quick-relief drugs. Retrieved from https://medlineplus.gov/ency/patientinstructions/000008.htm

Rosenthal, L. D. & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advance practice providers. St. Louis: MO: Elsevier

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) 1065–1072. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28282217/

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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. Assignment: Asthma and Stepwise Management

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