Asthma Management with Beta Agonists - Term Paper Example

PHARMACOLOGICAL MANAGEMENT OF ASTHMA USING BETA-AGONIST AND NURSING IMPLICATIONS Written by Presented to [mentor’s In Partial Fulfilment of the Requirements of [Program Name] [Date] ABSTRACT The role of nursing is increasingly becoming complex and interdependent on many health care functions and domains. Today’s nursing requires deep integration with other health care systems. The nurses now have more autonomy and control on caring for their patients and taking clinical decisions related to their management, treatment and education. Asthma remains a widely prevalent chronic medical condition in the world, which requires quick and effective treatment to prevent morbidity and mortality. Nursing roles are becoming apparent and widely appreciated in creating health care systems that span communities to primary health care settings. Due to the unique positioning of the nurses, asthma care can be provided with ease. The article highlights the Beta agonists drugs in the management of asthma in context of nursing management principles. CONTENTS PHARMACOLOGICAL MANAGEMENT OF ASTHMA USING BETA-AGONIST AND NURSING IMPLICATIONS 1 ABSTRACT 1 PHARMACOLOGICAL MANAGEMENT OF ASTHMA USING BETA-AGONIST AND NURSING IMPLICATIONS 5 WHAT IS ASTHMA 5 MANAGEMENT OF ASTHMA 7 PHARMACOLOGICAL MANAGEMENT OF ASTHMA 8 BETA 2 AGONIST FOR ASTHMA MANAGEMENT 9 NURSING ROLE IN TREATING ASTHMATIC CASES 11 CLINICAL MANAGEMENT OF ASTHMA CASES 14 NURSING ROLE IN EMPOWERING PATIENTS FOR ASTHMA CONTROL 14 CONCLUSIONS 15 REFERENCES 16 PHARMACOLOGICAL MANAGEMENT OF ASTHMA USING BETA-AGONIST AND NURSING IMPLICATIONS WHAT IS ASTHMA Asthma is a complex medical condition encompassing varying degrees of severity and variation in the respiratory tract ability to respond to various allergens and irritants. There are many definitions available, yet all fail to provide the extremely complex nature and variations of asthma. Therefore, asthma can be more effectively defined by the processes that are involved in causing the condition and how it impacts the quality of life of the patient (Maddox and Schwartz, 2002, pp. 477). The pathological basis of asthma is bronchial inflammation where high numbers of eosinophils are present. This may be due to physiological changes that take place in lungs due to varying degrees of hyper-reactivity of bronchial tissues. The clinical presentation of asthma include cough, chest tightness and wheeze respectively (Douglas and Elward, 2010, pp. 10). Research also indicates a strong genetic component as part of aetiology of asthma. Other environmental factors that contribute to the development of asthma include environmental conditions (too much exposure to pollen or dust) and early childhood infections. The allergens cause a Th-2 Lymphocyte immune response which causes eosinophilic activation thereby leading to IgE Mediated inflammation (Maddox and Schwartz, 2002, pp. 488). These immune reactions cause damage to the immuneociliary escalator (Frigas and Gleich, 1986). The result is excessive shedding of the bronchial epithelium. Sputum tests can help confirm the presence of asthma with increased major basic protein concentrations (Frigas and Gleich, 1986). As a result, there are two main divisions of asthma, atopic and non-atopic asthma respectively. The atopic form of asthma emerges early in childhood with strong family history of atopy. Again, the high amount of IgE released leads to the strong inflammatory reaction, thus leading to atopic form of allergy (Kaufman, 2011). The non-atopic form of asthma is independent of IgE mediation. This form emerges later in life, and mostly is the result of viral infections (Kaufman, 2011). The prevalence of asthma has steadily increased due to pollution. In the USA alone, there are presently 16 million adults and 7 million children who are suffering from asthma (Douglas and Elward, 2010, pp. 66). Children constitute a major proportion of affected individuals taken to the hospital for asthma management. Around 103 children per 10,000 visit the emergency departments to relieve asthmatic conditions (Douglas and Elward, 2010, pp. 66). The management of asthma is critical and time bound, and can lead to significant morbidity and mortality if not handled immediately and accurately. Current guidelines for asthma treatment and management therefore now emphasize in preventing future asthma attacks in already diagnosed patients (Turner, Paton, Higgins and Douglas, 2011). The new health policies now emphasize creating patient education and awareness among the patients and their families about asthma, its causes, its exacerbating factors and ways to minimize the risk of having an acute asthma attack (Turner, Paton, Higgins and Douglas, 2011). MANAGEMENT OF ASTHMA Asthma is a chronic condition requiring continuous treatment and care before overt symptoms appear. There are four parts of full asthma care which include the following 1. To identify the asthma triggers for the patient and minimize exposure to it 2. To have medications prescribed and be taken at their prescribed times 3. Continuous monitoring asthma through signs and symptoms 4. Managing asthma when it worsens (British Guideline on the Management of Asthma, 2008) With these objectives in mind, clinicians undertake many diagnostic and monitoring tests to correctly manage the patient, as asthma has many variations and severity levels (Management of Asthma, 2013). The clinician usually takes the patient through a series of tests in the early phases. These tests help assess the lung function of the patient and the severity of the asthma condition, along with any damages that may have taken place. The tests include spirometry and peak flow expiratory flow rate (Management of Asthma, 2013). After the clinical diagnosis, the focus shifts on managing asthma. The medication therapy tries to reverse and prevent inflammation of asthma, and prevent further narrowing of the airways. The patients are educated and told of the potential asthma triggers, which should be avoided and the life style modifications needed to do so (Management of Asthma, 2013). Contributing factors that can cause exacerbation of asthma include infections of the upper respiratory tract, allergies to dust mites, pollens, animal dander, mould or mildew and cockroaches. Other factors include exercise and various kinds of food, irritants such as cigarettes or fine vapours of different kinds, air pollution and weather changes to name a few (Management of Asthma, 2013). In very severe cases, immunotherapy may also come into consideration. Finally, to ensure compliance with all the lifestyle and medication modifications the patients and their families must be educated and made aware of the potential severity of the condition (Management of Asthma, 2013). Management of asthma includes both non-pharmacological and pharmacological management. Non pharmacological management include primary prophylaxis, which are introduced before the asthma begins, or to reduce its impact. Secondary prophylaxis is those carried out soon after the diagnosis of asthma to reduce its impact. Primary prophylaxis includes avoiding contact from air pollutants and allergens. Certain foods are also likely to cause asthma development. PHARMACOLOGICAL MANAGEMENT OF ASTHMA Pharmacological management of asthma begins with the administration of steroids for relief of asthma. Steroids also help reduce the severity of asthma and prevent new episodes from occurring. The second line of treatment includes beta agonists. Although not indicated previously in acute asthma phases, now beta agonists are considered an essential component of acute asthma therapy (Douglas and Elward, 2010, pp. 66). Beta agonists however, are mostly administered in less critical conditions of asthma through large volume spacers, or with oxygen through a wet nebulizer, depending upon the clinician’s discretion. In recovery and maintenance phases, beta agonists are as useful as bolus nebulizations (Douglas and Elward, 2010, pp. 66). Some clinicians prefer using anti-cholinergics in conjunction with beta blockers, stating it to be highly effective method. Long acting inhaled B2 agonists however, are given to those patients who are not adequately responding to inhaled corticosteroids (British Guideline on the Management of Asthma, 2008). BETA 2 AGONIST FOR ASTHMA MANAGEMENT Beta agonists are now commonly used for the treatment of various forms and stages of asthma. These are considered as one of the most potent bronchodilators for asthma management (Lemanske, 2012). Beta Agonists are bronchodilating drugs, which activate the β-2 receptors on the smooth muscles which surround the bronchial airways. These are derivatives of epinephrine to allow interaction exclusively with Beta 1 and Beta 2 receptors on bronchial smooth muscles (Lemanske, 2012). Two categories of beta agonists exist. Short acting group of beta agonists consist of salbutamol and albuterol. The long acting groups include salmetrol and formoterol. Most of these molecules are variations in molecular structure to create differing levels of duration and onsets for bronchodilatation. This capacity makes beta agonists a good treatment option for obstructive lung disease (Lemanske, 2012). The short acting types work on the β 2 adrenergic receptors in the smooth muscle of bronchial tissue. This helps in creating bronchodilatation and relieves the symptoms of tightness around the chest and breathlessness (Kaufman, 2011). The long acting β2 agonists help in relaxing the airways, enhancing mucociliary clearance and decreasing vascular permeability respectively (Kaufman, 2011). Long acting agonists are used in conjunction with inhaled corticosteroids. The management protocol and mechanisms of action involved are described in table 1 (Kaufman, 2011) The use of beta agonists however, needs to be reviewed before prescribing due to the various side effects. The most common side effects are skeletal muscle tremor and tachycardia (Lulich, Goldie, Ryan and Paterson, 1986). Patients may look nervous, restless or trembling, may have a dry throat, palpitations, headaches, cough, and rashes or sleep problems (Lipworth and McDevitt, 2012). Among these, fenoterol causes higher beta 2 dose related response when compared to other similar drugs such as salbutamol and terbutaline (Lipworth and McDevitt, 2012). NURSING ROLE IN TREATING ASTHMATIC CASES The primary health care systems are now emphasizing on improving the quality of patients and societies lives through prevention, education, health literacy and self-management which has led to significant shifts in the treatment approaches and reductions in morbidity and mortality (McCarthy, Cornally, Moran and Courtney, 2012). Nursing profession has directly contributed towards this development of new primary health care system that takes a more proactive approach in treating the patients and identifying pathologies before they emerge (McCarthy, Cornally, Moran and Courtney, 2012). Nurses play a critical role in the prevention and control of asthma. Asthma being a widely prevalent and life threatening condition requires creating awareness within the community levels of how to manage and prevent them (McCloud and Papoutsakis, 2011). One study states that nutritional and dietary changes are one of the most important factors in contributing towards asthma. Nurses can play a key role in community awareness and telling patients the ways to improve the quality of nutritional (McCloud and Papoutsakis, 2011). This health literacy can significantly improve the quality of life for asthma patients, prevent and reduce the severity of asthma attacks and thereby reducing morbidity and mortality statistics (Wood and Bolyard, 2011). Although the nursing role has been acknowledged in the recent decades as fundamental towards managing chronic disease conditions, there are still barriers to the effective care models that can be successful in providing the level of care by the nursing professionals (Wilson, Brooks, Procter and Kendall, 2012). For example, those patients who mostly rely on the previous doctor perceptions of being the only diagnosticians and care providers find it difficult to communicate or trust the nursing staff (Wilson, Brooks, Procter and Kendall, 2012). Other patients however, may feel extremely comfortable and even welcome nursing interventions in management of their conditions such as asthma (Wilson, Brooks, Procter and Kendall, 2012). Most nursing professionals are now trained to administer first line treatments in asthma conditions. This is a method that is now applied to reduce the respiratory therapy time and the waiting time associated with it (Nurses, Partners in Asthma Care, 1995). Many protocols and clinical guidelines are now available regarding management of asthma cases of varying age groups. Nursing roles in asthma management and care include the following Maintain long term and on-going care to the asthma patients through regular monitoring and long term control Preventing acute asthma episodes by educating patients about asthma triggers Treatment of early asthma symptoms Management of the case include reducing inflammation of the airway to prevent asthma aggravation and relieving airway narrowing when needed (Nurses, Partners in Asthma Care, 1995). Nursing clinicians should first look for any physical signs and symptoms presented by the patient which are hallmark of asthma (Nurse Practitioner Clinical Practice Guidelines for Management of Asthma, 2005). These include assessing for general appearance of the patient, irritability and colour, the respiratory rate, nasal flaring and retractions, oxygen saturation, abdominal breathing, heart rates and sounds respectively. Other symptoms include wheezing, drooling, quality of voice and stridor respectively (Nurse Practitioner Clinical Practice Guidelines for Management of Asthma, 2005). Based on the symptoms present diagnostic tests carried out include PEFR or spirometry, chest x-ray to rule out any pathology other than asthma such as COPD (Nurse Practitioner Clinical Practice Guidelines for Management of Asthma, 2005). The nurses are responsible for educating patients about causes of asthma and how asthma can be triggered. They can help patients identify early signs and symptoms of asthma in order to seek prompt medical attention (Cornforthe, 2012). Nurses also need to understand and identify any psychosocial, financial and/or emotional problems which can affect asthma control and compliance (Cornforthe, 2012). CLINICAL MANAGEMENT OF ASTHMA CASES Asthma cases require prompt care and attention as the duration of time of the asthma attack may significantly cause destruction of the cells. Management of asthma cases require certain clinical steps which should be followed as part of protocol. Nurses must continue to maintain the respiratory function, provide bronchodilatation through medicines and nebulazations and try in expulsing the mucous plug (Nursing File, 2010). During the asthma attack, the nursing staff must not leave the patient’s side, provide reassurance, help him in relaxing, and place him in the semi-fowler position to allow diaphragmatic breathing. In acute asthma episodes, the key concern is the maintenance of arterial oxygen saturation (Nursing File, 2010). Oxygen administration is carried out through nasal cannulization, at the same time adjusting the oxygen concentration according to the ABG measurements and vital signs. In many acute cases, management of asthma requires administration of IV drugs (Nursing File, 2010). Having a good medical record present for asthmatic cases is invaluable. The nursing staff would be able to know the drugs or medications the patients are using and administer the drugs according to the prescribed dosages and therapeutic window frames. Intravenous fluids may also be required and administered (Nursing File, 2010). NURSING ROLE IN EMPOWERING PATIENTS FOR ASTHMA CONTROL With an increase in medical and health care needs and consequent pressures on the medical and hospital resources in providing care, health professionals now agree to empower the patients. This concept of empowered patient allows the patients to take a more active role in managing their own condition, rather than relying on various health care providers. The nursing professionals play a crucial role in carrying out this aspect of health care awareness education (McCarthy et al, 2002). Their superior reach both clinically and in the community allows them more frequent interactions than clinicians (McCarthy et al, 2002). Therefore, the nursing staff is well suited to address patient concerns and understand the complex family setups and cultural barriers that may be affecting the quality of health care provided to the patients. This is easier said than done, for empowerment of patient must be done conscientiously, with strong solutions to any kind of problems that may emerge directly as a result of patient care (McCarthy et al, 2002). Nurses can create the link and break down communication barriers between the health care providers and entities and patients, which can lead to further education and awareness of the patients about the health care systems and the services available to them (McCarthy et al, 2002). CONCLUSIONS Nurses are now an important component of primary care and management of asthma. These professionals are now taking an active role in the management of asthma. With the help of guidelines and up to date asthma standards, nurses will perform a very strong role in management of asthma issues (Cornforthe, 2012). There is need to integrate the nursing role further into the health care system in both primary, emergency, and community care to handle cases of asthma from all three domains in a more effective manner. This method will help further reduce the prevalence of asthma related attacks and episodes reduce recovery time and help prevent future asthma attacks for the patients. Asthma patients can be educated through nursing professionals about improving the quality of their lives. Nursing leadership can help reduce the gap between the necessary care structure needed for the asthma patients and the demand for accurate, efficient and timely care for asthma management and prevention. REFERENCES British Guideline on the Management of Asthma: A National Clinical Guideline, 2008. Health Care Improvement Scotland, Scottish Intercollegiate Guidelines Network. Site last accessed on March 10th, 2013 from http://www.sign.ac.uk/pdf/sign101.pdf Cornforthe A, 2012. Management of Asthma Care. Independent Nurse. Site last accessed on March 10th, 2013 from http://www.independentnurse.co.uk/cgi-bin/go.pl/library/articlehtml.cgi?uid=89811;type=Clinical Douglas J G and Elward K S, 2010. Asthma: Clinician’s Desk Reference. Manson Publishing, 2010. Frigas E and Gleich G J, 1986. The Eosinophil and the Pathophysiology of Asthma. Journal of Allergy and Clinical Immunology Vol 77, Issue 4, pp. 527-537. Kaufman G, 2011. NS613 Asthma: Pathophysiology, Diagnosis and Management. Nursing Standard. 26, 5, 48-56. Available at: http://nursingstandard.rcnpublishing.co.uk/archive/article-asthma-pathophysiology-diagnosis-and-management Lemanske R F, 2008. Beta Agonists in Asthma: Acute Administration and Prophylactic Use. Wolters Kluwer Health Up To Date. Available at http://www.uptodate.com/contents/beta-agonists-in-asthma-acute-administration-and-prophylactic-use Last accessed on 10th March, 2013. Lipworth B J and McDevitt D G, 2012. Inhaled Beta 2-adrenoceptor Agonists in Asthma: Help or Hindrance? British Journal of Clinical Pharmacology Vol. 33, Issue 2, Pages 129-138. Lulich KM, Goldie RG, Ryan G, Paterson JW, 1986. Adverse Reactions to Beta 2-agonist Bronchodilators. Med Toxicology Jul-Aug; 1(4): 286-99. Management of Asthma, 2013. Wexner Medical Centre. Accessed on: March 20th, 2013. Available at: http://medicalcenter.osu.edu/patientcare/healthcare_services/allergy_asthma/about_asthma/asthma_management/Pages/index.aspx McCarthy G, Cornally N, Moran J and Courtney M, 2012. Practice Nurses and General Practitioners: Perspectives on the Role and Future Development of Practice Nursing in Ireland. Journal of Clinical Nursing vol. 21, issue 15-16, pp. 2286-2295. McCloud E and Papoutsakis C, 2011. A Medical Nutrition Therapy Primer for Childhood Asthma: Current and Emerging Perspectives. Journal of the American Dietetic Association Vol. 111, Issue 7, pp. 1052-1064. Nursing Files, Nursing Interventions for Asthma, 2010. Nursing Files. Last accessed on March 23rd, 2013. Available at http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-asthma.html Nurses, Partners in Asthma Care, 1995. National Institutes of Health NIH Publication no. 95-3308 Oct 1995. Last accessed on March 20th, 2013. Available at: http://www.nhlbi.nih.gov/health/prof/lung/asthma/nurs_gde.pdf Nurse Practitioner Clinical Practice Guidelines for Management of Asthma, 2005. Nurse Practitioner Guidelines.Sydney West Area Health Service. Accessed on March 20th, 2013. Available at: http://www0.health.nsw.gov.au/resources/nursing/practitioner/pdf/ab_np_guidelines_asthma.pdf Turner S, Paton J, Higgins B and Douglas G, 2011. 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