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Running head: ASTHMA

Asthma

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ASTHMA

Asthma

The pathophysiology mechanisms of chronic asthma and acute asthma exacerbation is

complex and recurrent and it is caused by a variety of changes in the airway. These changes include

air inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. Air

inflammation may be categorized as acute, subacute or chronic. The presence of airway edema,

and mucus secretion, contributes to airflow obstruction as well as bronchial reactivity (Madsen,

2014). Airflow obstruction is as a result of several alterations which include acute

bronchoconstriction, airway edema, chronic mucus plug formation as well as airway remodeling

(Madsen, 2014). Hyperinflation provides some level of compensation for airflow obstruction.

There is a limitation of this compensation, however, when the tidal volume approaches the volume

of the pulmonary dead space hence resulting in alveolar hypoventilation (Madsen, 2014).

When an asthma attack occurs, the normal PaO2 of 100mm Hg falls, the PaCo2 of 40mm

Hg also falls while the pH of 7.40 rises. As the disease worsens, there is a persistent fall in PaO2

and PaCO2 while the pH continues rising. The lungs are unable to blow off more carbon dioxide

leading to a rise in PaCo2 and a fall in both pH and PaO2. As the asthma attack progress, the low

PaCo2 and high pH are gradually restored back to their normal values. As the situation progress,

the level of PaCO2 rises above 40 mm Hg while the pH falls below 7.40. PaO2, on the other hand,

continues to fall and may reach 20mm Hg (Zahran, Bailey, Qin & Johnson, 2017).

The most effective ways of stopping asthma attacks is prevention and long-term control.

Preventive long-term medications play a crucial role by reducing the inflammation in your airways

that leads to symptoms. Quick-relief inhalers on the other hand, provide a quick way of opening

swollen airways that curtail breathing. Allergy medications are essential in some cases (Madsen,

2014).

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Long-term asthma medication is the most important form of asthma treatment. They help

in keeping asthma in check on a daily basis hence reducing the probability of asthma attacks

significantly. They include inhaled corticosteroids, leukotriene modifiers, long-acting beta

agonists, combination inhalers, and theophylline

Quick-relief medications on the other hand, are used when necessary and their role is to

provide a short term symptom relief in case someone suffers an asthma attack. (James, 2015). They

can also be used before exercise as per the recommendation of a doctor. They include short-acting

beta agonists, ipratropium as well as oral and intravenous corticosteroids-

Asthma treatments medications are associated with several side effects. Although the drugs

are tolerated and the benefits outweigh the side effects, sometimes the side effects may be more

severe leading leads to jarring and consequently the person may quit drugs altogether. The side

effects differ from one type of medication to another (Madsen, 2014). For instance, inhaled

corticosteroids cause both local and systematic side effects. Systematic side effects are often more

severe and are associated with long-term use. Some of the side effects include oral candidiasis,

sore mouth, decreased bone density in adults, dysphonia, increased pressure in the eye, eye

bruising as well as clouding of the eye. These side effects can be relieved by the use of a spacer

(James, 2015).

Short and long-acting beta antagonists are associated with side effects such as increased

heart rate, dizziness, headache, anxiety, rash as well as nervousness (Madsen, 2014). The side

effects of oral steroids include weight gain, fluid retention, high-blood pressure, and elevated blood

sugar, osteoporosis in children, muscle weakness, diabetes as well as cataracts and glaucoma

(James, 2015). Leukotriene modifiers are well tolerated, but they are also associated with side

effects such as stomach upset, flu-like symptoms, headache, nervousness, nausea, rash as well as

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nasal congestion. Lastly, the common side effects of immunomodulatory (Xolair) include swelling

and pain at the injection site, viral illness, upper respiratory tract infection, headache, sinusitis,

sore throat as well as anaphylaxis which occurs rarely (James, 2015).

After diagnosis and assessment of the severity of the disease, the stepwise approach is

applied to decide which step therapy coincides with the proper level of asthma severity. Stepwise

approach is recommended for implementation as well as adjustment of asthma management. The

stepwise management aims at initiating a more intensive therapy to attain control before stepping

down to the least possible therapy (Madsen, 2014). The guidelines for initiating therapy for

patients who are no longer taking long-term control medication is provided by the classification of

asthma severity, which puts into consideration the severity of not only impairment but also risk

domains (James, 2015). A patient is considered to be medication adherent if they are taking up to

80 percent of their prescription.

In helping patients develop a plan for medication adherence, I would start by taking on the

responsibility for educating them on the benefits and the side effects of the medication. Besides, I

would allow the patient enough time to discuss their medication effects and concerns as well as

promote patients aid such as medication that may help the patient manage their medication

regimen. Lastly, I would tailor the medication adherence plan to individual patient and ensure i

involve the patient in developing their treatment plan.

Medication adherence differs between ages for several reasons. In children, medication

adherence is affected due to their dependence on an adult caregiver. As such, the plan would

involve encouraging the caregiver to ensure that medication is administered appropriately

(Madsen, 2014). In adults, noncompliance is mainly attributed to higher patient-physician

discordance which reduces the satisfaction of the client. As such, the plan would involve creating

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awareness as well as providing sufficient information on the medication the patient is taking

(James, 2015).

References

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James, J. (2015). Mismatch Between Asthma Symptoms and Spirometry: Implications for

Managing Asthma in Children. PEDIATRICS, 136(Supplement), S264-S264.

http://dx.doi.org/10.1542/peds.2015-2776ffff

Madsen, H. (2014). Adherence to Maintenance Medication in Asthma in Patients Admitted with

Acute Asthma. Journal Of Lung, Pulmonary & Respiratory Research, 1(1).

http://dx.doi.org/10.15406/jlprr.2014.01.00004

Zahran, H., Bailey, C., Qin, X., & Johnson, C. (2017). Long-term control medication use and

asthma control status among children and adults with asthma. Journal Of Asthma, 1-8.

http://dx.doi.org/10.1080/02770903.2017.1290105

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