Assignment: Asthma and Stepwise Management ppt Essay

Assignment: Asthma and Stepwise Management ppt Essay

Long-term asthma management

Inhaled corticosteroids (ICS) – anti-inflammatory drugs that hinder the late reaction to allergens and decrease airway sensitivity. They work by inhibiting the production of cytokines, activating adhesion proteins, preventing inflammatory cell migration and activation at the cellular level. Additionally, they reverse the down-regulation of beta2-receptors and prevent microvascular leakage. However, they may lead to side effects such as oropharyngeal candidiasis and delayed growth in children (Heffle, et al., 2018).

Oral corticosteroids – these medications function similarly to inhaled corticosteroids. Short-term usage may result in reversible abnormalities in sugar metabolism, mood swings, hypertension, and rarely, aseptic necrosis of the femur. On the other hand, long-term use can cause systemic effects.

Long-term asthma management includes medications taken daily to achieve and maintain control over persistent asthma. Leukotriene receptor antagonists (LTRAs) are suitable for patients aged over one year, while 5-lipoxygenase pathway inhibitors are prescribed for those above 12 years old. Long-acting beta-agonists (LABAs), such as salmeterol and formoterol, act as bronchodilators for at least 12 hours after a single dose. However, LABAs should not be used alone due to their short duration of action.

Short-term management

Quick-relief inhalers – these are fast-acting bronchodilators, like albuterol, that provide immediate relief from symptoms by opening inflamed airways.
Short-acting beta-agonists (SABAs) are the most common quick-relief medications for asthma attacks. They relax airway muscles within minutes and provide relief for several hours.
Oral steroids are used for frequent attacks but are not quick-relief medications.

Quick-relief drugs for asthma, also known as rescue drugs, are essential for rapidly controlling asthma attacks. They can be administered before exercise to dilate and relax airway muscles. SABAs, such as albuterol, levalbuterol, metaproterenol, and terbutaline, are the primary quick-relief medications. Oral steroids are reserved for symptom flare-ups but are not for immediate relief.

Importance of Stepwise Management

The stepwise approach to asthma management aims to prevent recurrent exacerbations, slow the loss of lung function, and provide optimal pharmacotherapy with minimal adverse effects. It helps reduce emergency department visits and hospitalizations, allowing both providers and patients to gain and maintain control over asthma. Additionally, it assists providers in making informed decisions tailored to individual patient needs, with alternative treatments available for unresponsive cases.

Step-wise management of Asthma

Step 1: Inhaled corticosteroids (ICS) with formoterol and short-acting beta-agonists (SABA)
Step 2: Low-dose ICS with formoterol or daily low-dose ICS with SABA
Step 3: Low-dose ICS with long-acting beta-agonist (LABA) and SABA
Step 4: Medium-dose ICS with LABA and SABA
Step 5: Higher-dose ICS with LABA or referral to a pulmonologist

The stepwise management of asthma provides a structured approach for tailoring treatment to individual patient needs. It involves a gradual increase in medication intensity as needed to achieve and maintain asthma control.

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.

Zachary LaFontaine Infant Well Visit Shadow health Objective Data

Assignment: Asthma and Stepwise Management ppt Essay

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 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 ones. 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. Assignment: Asthma and Stepwise Management ppt Essay

 

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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.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission. Assignment: Asthma and Stepwise Management ppt Essay
  • NOTE: SafeAssign does not accept files over 10MB in size. Please attempt to keep your files under 10MB.
Excellent Good Fair Poor
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.
27 (27%) – 30 (30%)
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.

24 (24%) – 26 (26%)
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. Assignment: Asthma and Stepwise Management ppt Essay

21 (21%) – 23 (23%)
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.

(0%) – 20 (20%)
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.

Explain the stepwise approach to asthma treatment and management for your patient.
27 (27%) – 30 (30%)
The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.
24 (24%) – 26 (26%)
The presentation accurately explains the stepwise approach to asthma treatment and management for their patient.
21 (21%) – 23 (23%)
The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.
(0%) – 20 (20%)
The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.
27 (27%) – 30 (30%)
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.

24 (24%) – 26 (26%)
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.

21 (21%) – 23 (23%)
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.

(0%) – 20 (20%)
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.

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%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. Assignment: Asthma and Stepwise Management ppt Essay
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
(4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors Assignment: Asthma and Stepwise Management ppt Essay
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100