Advanced Practice Nurse Care of Asthma
“Asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment” (Kasper, Fauci, Hauser, Longo, Jameson, & Loscalzo, 2015.p. 2102). According to World Health Organization (2014), asthma is a non-communicable disease otherwise known clinically as a chronic disease, and it requires both long and short-term treatment.Advanced Practice Nurse Care of Asthma
Effective treatment of asthma requires the setting of goals because asthma is a chronic condition, “the goal of management should be to obtain and sustain complete control” (Colledge, Walker & Ralston, 2010. p.665). Asthma that is well controlled should show none of the characteristics like daytime symptoms, nocturnal symptoms, limitation of activities, need for rescue/ reliever treatment (Colledge, Walker & Ralston, 2010). Long-term control of asthma helps reduce airway inflammation and prevent symptoms (National Heart, Lung and Blood Institute, n/d). Quick-relief treatment is a rapid response to asthma flare-ups usually with drugs that help relax the airway of smooth muscles, these drugs are called bronchodilators (Kasper et al., 2015). Administering treatment to a patient with asthma depends on the severity of the condition, a quick relief treatment is administered to a patient that has good control of his/her asthma. The quick-relief drugs are either in tablets or inhaled form, but the more common ones are the inhalers. Bronchodilators are used as rapid relief drugs because they can immediately reverse asthma symptoms by directly relaxing the smooth muscles, although they have no effect on the underlying inflammatory process (Kasper et al.,2015). There are three types of bronchodilators, beta two agonists, theophylline, and anticholinergics, of these three beta two agonists are the most effective (Kasper et al., 2015). The beta two agonists have short-acting like albuterol and long-acting like Formoterol, and they last for 6 and 12 hours respectively, both these drugs are administered via inhalation to reduce side effects (Kasper et al., 2015).
Long-term control don’t give quick relief, instead they help prevent inflammation, inhaled corticosteroids are the most effective controller therapy for asthma patients, it helps reduce inflammatory cell numbers as well as their activation in the airways, they are usually given twice a day, but some can be given once daily (Kasper et al., 2015), examples of corticosteroids are prednisone, betamethasone. They are various side effects that can arise as a result of long-term intake of corticosteroids which include osteoporosis, immunosuppression, acne, abdominal striae as well hirsutism. Other controller drugs include cromolyn which is a mast cell stabilizer that prevents the release of inflammatory materials, leukotriene inhibitors.Advanced Practice Nurse Care of Asthma
The treatment of asthma requires a stepwise approach, according to guidelines which would help “achieve and maintain control of asthma” (Rance, 2011. p.300). Step one involves the occasional use of inhaled short-acting beta two agonist bronchodilators. For patients with mild intermittent asthma, i.e. “symptoms less than once a week for three months and fewer than two nocturnal episodes/month” (Colledge, Walker & Ralston, 2010. p.666), inhaled short-acting beta two agonist is sufficient for this patient. If asthma exacerbates, or the patient uses beta two agonists three times a week or more or is awakened by asthma one night a week, a step up in treatment is required which includes an addition of an inhaled corticosteroid to the beta two agonists (Colledge, Walker & Ralston, 2010). If asthma remains poorly controlled, another step up in treatment administered with the addition of large or medium dose inhaled corticosteroid with long-acting beta-agonist and short-acting beta agonist. After these steps if the patient fails to respond, step four is applied which includes long-acting beta agonist plus a medium dose inhaled corticosteroid plus a short-acting beta agonist. For step 5 they perform as follows: long-acting beta agonist plus high dose inhaled corticosteroid plus a short-acting beta agonist. For step 6 they perform as follows: oral corticosteroid mainly prednisone plus long-acting beta agonist plus high dose inhaled corticosteroid plus short-acting beta agonist. This step-up approach is carried out in case of persistent symptoms and comorbidities. A step-down approach is then carried out as the patient begins to respond to therapy, decreasing the dose inhaled corticosteroid to about 20-25 percent every three months is ideal (Colledge, Walker & Ralston, 2010).
It is important that health-care providers, as well as patients, understand when they need to step-up their therapy. In the case of the physician, the step-wise approach helps when meeting the patient for the first time, depending on the presenting symptoms the physician could decide which step to administer to the patient, that is, a step-up or a step-down. For the patient, it helps him/her adhere strictly to the medications prescribed, as a step-up could be lethal and a step-down could be ineffective.Advanced Practice Nurse Care of Asthma
References
Asthma – How Is Asthma Treated and Controlled? National Heart, Lung and Blood Institute. Retrieved from https://www.nhlbi.nih.gov/node/3894
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2015). Harrison’s principles of internal medicine, 19e.
Non-Communicable Diseases. World Health Organization (2014). Retrieved from http://www.who.int/topics/noncommunicable_diseases/en/
Rance, K. S. (2011). Helping patients attain and maintain asthma control: reviewing the role of the nurse practitioner. Journal of Multidisciplinary Healthcare, 4, 299–309. http://doi.org/10.2147/JMDH.S22966
Walker, B. R., Colledge, N. R, & Ralston S (2010). Davidson’s Principles and Practice of Medicine E-Book. Elsevier Health Sciences.Advanced Practice Nurse Care of Asthma