Treatment of Asthma - Essay Example

Treatment of Asthma Introduction: Jane is a girl who has been suffering from asthma from a young age and therefore is likely to be already on treatment with steroids and inhalers for her condition. She is currently admitted into gp surgery with a severe asthma attack. Some emergency measures can be used to alleviate the severity of the attack, to bring the wheezing down, but the long term regimen and treatment plan must be targeted towards preventing wheezing, not merely taking care of the flare ups. Emergency measures that can be considered will include oxygen inhalation, ipratropium use in conjunction with other nebulisers and conmcomittant use of steroid therapy. Once the wheezing is controlled and the patient is brought home from the hospital, she must have follow up visits on a regular basis in order to minotor her condition. Emergency Treatment Options: Since Jane has been admitted on an emergency basis with severe difficulty in breathing, the first step is to dilate the airways. The lack of oxygen can be corrected through the use of high concentrations of inspired oxygen (40-60%) using a high flow mask such as the Hudson mask(BTS:6.3.1). ABG and PEF levels must be maintained at above 92% and 50% respectively. If PEF levels are not rising fast enough, continuous nebulisation may also be considered using B2 agonists (BTS:6.3.2). To provide instant relief in breathing the use of ipratropium in association with salbutamol or terbutaline may also be considered. This helps to release blocked airways and bring the asthma attack under control(Plotnick and Duchrame 2003). The combination of ipratropium with salbutamol or tetrabuline works faster since they go straight to the lungs (National Institute 2001:1-13). Long term treatment options: Once Jane is stabilized and out of the hospital, there is no need to continue the use of ipratropium, since it will not be beneficial. (Stoodley et al 1999:8-18). The main aim of the long term treatment is to bring some measure of control over the wheezing attacks, so that Jane can sleep well at night and engage in moderate levels of activity without getting an attack. Since anxiety also brings about an attack, the aim of long term treatment must be to provide a supportive psychological environment for Jane, so that she does not get easily stressed. Jane must be reassured that her condition is curable, even though she has had it for so long. Because of her long history with asthma, Jane is likely to consider herself as a sick child who cannot play or be active. But she must first be counseled that she can also lead a fairly normal life, with a proper regimen of medication and some good preventive measures. For the first few weeks after Jane is home, she may need a home nebulizer. A bronchodilator such as tetrabutaline or albuterol will be needed in metered doses about two or three times a day, so that the severity of the symptoms can be controlled. One dose will provide relief for even as long as four hours. Alternatively, in Jane’s case, the use of salmeterol (Serevent) can also be considered because it provides relief for as long as up to 12 hours and is a good preventive measure to prevent wheezing attacks. A home nebulizer will be useful in Jane’s case because she can inhale the medication by using the aerosol form through a face mask or a mouthpiece. Bronchodilators are similar to adrenaline in that they may cause the heart beat to speed up, which will only increase Jane’s anxiety. Therefore, she will need to be given this treatment in a calm reassuring way, so that she knows that any tremors or hurried heart rate are only temporary factors and as soon as the severity of her wheezing symptoms has gone down, the dose of bronchodilator can also be reduced accordingly and then stopped. A spacers can be used with all inhalers, so that Jane can be helped to coordinate her deep inhalation and actuation puffs on the inhaler with more effectiveness. Although Jane is fifteen years old, she will benefit from the presence of caring individuals to see to her care, such as her nurse and family members. She is at a critical stage in her adolescent years where she identifies closely with her peers and the fact that she has a disease which often sets her apart from the others may have a damaging effect on her self esteem. Therefore it is very important to prove Jane with the reassurance, that even though she may be different from the others, she is not necessarily inferior and with good treatment, she will soon be better and able to lead a more or less normal life. Emotional and psychological reassurance from a loving, caring network of people is very essential for Jane at this stage and will go a long way towards speeding up her complete recovery. Effective long term treatment will consist of phasing out the bronchodilators as soon as possible. Steroid inhalers can be used on a daily basis instead, at up to 2000 mcg per day. The steroid treatment will be very effective to address the underlying inflammation that causes the wheezing attacks. In Jane’s case, it may be necessary to use the inhaled steroids for a several weeks or months, so that the wheezing is brought fully under control in an effective way. But Jane’s condition must be carefully monitored because there is always the danger posed by the side effects of long term use of oral steroids. Therefore, while monitoring her conditions, if there is some good improvement and she is able to remain for longer periods with getting a wheezing attack, some alternate medications can be considered such as theophylline or Cromolym. Cromolyn especially, may be effective Jane, since she has a history of allergy associated with her wheezing which is why she has had it for so long. When the steroid therapy has brought Jane’s condition under control, she can be started on Cromolyn given as an inhaler and it will be effective for long term treatment and control. Theophylline in a time release formula may be helpful in a liquid or tablet form, in order to maintain a wheezing free condition. But there are also some side effects associated with this medication, such as nausea or vomiting, so the dose must be sufficient to bring relief but not so low that it is ineffective. Also, Jane must have follow up visits on a regular basis so that her asthmatic condition can be carefully monitored. A part of her regular regimen of treatment may also include antibiotics if Jane gets a bad cold. It will be better to give an antibiotic to arrest the inflammation rather than giving an antihistamine, which may interfere with the working of the other medicines. The dosage and timing of medication is the most important factor to be taken into account for Jane’s long term treatment. Once the severity of the condition that called for a particular dose has reduced, the dosage of the medicine must also be reduced accordingly, and the timing must be carefully coordinated so that there is effective relief for long periods. It is also important to monitor Jane’s PEF values every day in order to ensure that they do not drop to a value below 50-60%. Jane must also be advised to take care not to expose herself again to the allergen or trigger that set off the acute respiratory attack that brought her to the hospital. The best way to avoid recurrent asthma attacks is to eliminate the trigger that is known to have caused it and since Jane has been an asthma patient since her childhood, she is likely to be already under treatment and there is a good chance that she is aware of the causal triggers that aggravate her condition (Sherill et al, 1999). Therefore, the most likely cause of an attack that necessitated a visit to the hospital may have been an unknowing exposure to the allergen or trigger in question. Follow up visits must be scheduled every two weeks, since it is extremely important to monitor her condition and reduce or increase the dosage as necessary. References cited: BTS: British Thoracic Society, 2004. “British Guideline on the Management of Asthma”. [Online] Available athttp://www.brit- thoracic.org.uk/c2/uploads/qrgjan03.pdf; accessed 10/15/2005 Medicines for children, 1999. Royal College of Paediatrics and Child Health (London), p viii National Heart Lung and Blood Institute, 2001.  Guidelines for the diagnosis and management of asthma (Definition).   Expert Panel Report 2:1-13 Plotnick LH, Ducharme FM, 2003.  Combined inhaled anticholinergics and Beta2 agonists in the initial management of acute paediatric asthma. Cochrane Review. Resuscitation Council, U.K., 2005. ”The Emergency Medical Treatment of Anaphylactic reactions for First medical responders and for Community Nurses.” [Online] Available at: http://www.resus.org.uk/pages/reaction.htm Accessed 10/16/2005 Sherill D, Stein R, Kurzius- Spencer M et al. (1999). “Early sensitization to allergens and development of respiratory symptoms. Clinical Exp. Allergy, 29: 905-11 Stoodley, R.G. Aaron S.D. Dales R.E, 1999. “the role of Ipratropium bromide in the emergency management of acute asthma exacerbation : a metanalaysis of randomized clinical trials: Annual of Emergency Medicine. 34:8-18 Read More