Application: Asthma and Stepwise Management
Introduction
Asthma is a chronic inflammatory respiratory disease which is experienced by a large segment of the population of the US (McGonigle & Mastrian 2011, p. 346). Because of the differences in severity and persistence which vary from person to person, it is vital to consider the various treatment options for asthma patients. The best way to do this is with a stepwise approach; the following outlines a stepwise management approach to asthma treatment and management, as well as the advantages of stepwise management in controlling diseases and adverse medical conditions. Stepwise management is shown to be an effective means of addressing treatment options for asthma patients due to its incremental changes in dosage and treatment based on patient response to existing medications.
When treating asthma, the overall goals are to reduce the dependence of the patient on quick relief treatment medicines and allow patients to maintain a normal level of activity (Kaufman, 2012). There are several options for both long-term control and quick relief treatment of asthma symptoms. For long term control of asthma, the primary method of treatment is the administration of inhaled corticosteroids (ICS), which reduce the swelling and inflammation that can bring about an asthma attack (McGonigle & Mastrian 2011, p. 349). Mast cell stabilizers can also be used for long-term control, as they prevent calcium influx along mast cell membranes, suppressing inflammation (McGonigle & Mastrian 2011, p. 349). Despite the advantages of long-term medicines like ICS, they can also bring about side effects including increased risk for osteoporosis and cataracts (CITE). As for quick relief treatments, medications such as inhaled short-acting beta-2-agonists are often used to bring about fast relaxation of airway muscles during asthma attacks; this is often administered via quick-relief inhaler (McGonigle & Mastrian 2011, p. 354). Other quick-relief treatment solutions include immunomodulators and systemic corticosteroids, which bind IgE on the surface of mast cells and suppress inflammation, respectively (pp. 354-355). While quick-relief asthma medicines help to address immediate attacks, they do nothing to lower the rate of inflammation in asthma patients, so they should not be used as a substitute for long-term treatment (Pauwels et al., 2012).
Stepwise Approaches to Asthma Treatment/Management
The best way to treat and manage a condition such as asthma is with a stepwise approach, which involves starting out with small doses and only increasing the dosage and frequency of administration as needed (Kaufman, 2012). In order to administer a stepwise approach to treatment, nurses must assess the patient’s current and future risk for asthma attacks, determining the level of impairment the patient currently experiences as a result of their condition (Blakey et al., 2013). Nurses assessing asthma control must check for comorbid conditions, environmental control, and adherence to existing regimen before determining whether or not to step up or down in treatment (McGonigle & Mastrian 2011, p. 359). For example, if a patient shows mild impairment and low risk for asthma attacks, it is prudent to start at Step 1, administering merely a short-acting beta-2-agonist. However, if symptoms increase and further treatment is needed, practitioners may move up to Step 2, administering a low-dose ICS to the patient. This cycle may continue up to Step 6, in which high-dose ICS and long-acting beta-2-agonists are administered (p. 359). If the patient’s asthma is successfully controlled for a period 3 months or longer, stepping down in dosage may be possible (p. 359). Dosage is then increased or decreased according to the patient’s response to that level of treatment, until an adequate level of dosage is found.
Advantages of Stepwise Management
Stepwise management is perhaps the ideal strategy for treating asthma and similar diseases, for many reasons. Asthma is a heterogeneous disorder that expresses itself in varying levels of intensity depending on the patient; to that end, treatment must be tailored to the individual. The overall goal with asthma medications is to treat the condition with the least amount of medication, in order to reduce side effects; the stepwise approach provides an effective means of reaching that ideal dosage (Blaket et al., 2013). The side effects of long-term control medications such as ICS are severe if taken in inappropriately high doses; because of that, risk must be mitigated with the use of stepwise approaches that allow physicians and nurses to find the most efficient dosage for the patient (Pauwels et al., 2012). Stepwise management is also an ongoing and incremental process, permitting nurses to accommodate changes in symptom variability and maintain a consistent system of monitoring said symptoms (Thomas, Lemanske Jr., & Jackson, 2012).
Summary
When considering treatment for asthma patients, a stepwise approach must be considered. Current medications for asthma include ICS and mast cell stabilizers for long-term control, and inhaled short-acting beta-2-agonists for quick relief of exacerbated symptoms. With a stepwise approach, nurses are able to correctly assess the best dosage and medication for a patient by taking incremental steps to increase or decrease treatment as dictated by patient response. Stepwise approaches to diseases such as asthma permit the minimization of side effects from medication, as well as offer the best possible treatment regimen for patients.
References
Blakey, J. D., Woolnough, K., Fellows, J., Walker, S., Thomas, M., & Pavord, I. D. (2013).
Assessing the risk of attack in the management of asthma: a review and proposal for revision of the current control-centred paradigm. Primary Care Respiratory Journal, 22(3).
Kaufman, G. (2012). Asthma update: recommendations for diagnosis, treatment and
management. Primary Health Care, 22(5), 32-39.
McGonigle, D., & Mastrian K. (2011). Nursing informatics and the foundation of knowledge.
Jones & Bartlett Learning.
Pauwels, R. A., Buist, A. S., Calverley, P. M., Jenkins, C. R., & Hurd, S. S. (2012). Global
strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 163(5).
Thomas, A., Lemanske Jr, R. F., & Jackson, D. J. (2011). Approaches to stepping up and
stepping down care in asthmatic patients. Journal of Allergy and Clinical Immunology, 128(5), 915-924.
