Mrs. Cason Brings Her 10-Year-Old Child To The Clinic

Mrs Cason Brings Her 10 Year Old Child To The Clinic Stating My Son

Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this happens all the time.” Appearance of both mother and child is disheveled. The child’s wheezing can be heard across the room. When asked if her son is better at any certain time of the day, the mother responds: “It’s like this all the time and has been for the past year, we just don’t come to the doctor because we don’t have any money.” Mrs. Cason’s son was diagnosed with asthma.

Paper For Above instruction

Asthma is a chronic respiratory condition characterized by airway inflammation, hyperresponsiveness, and airflow obstruction, leading to episodes of wheezing, breathlessness, chest tightness, and coughing. Managing pediatric asthma, especially in resource-limited settings, requires a comprehensive approach that includes pharmacological treatment, patient education, and environmental control measures. The focus here is on the short-term and long-term use of inhaled beta2-adrenergic agonists and the associated educational plan tailored to the child's needs and circumstances.

Short and Long-Term Treatment Options Using Inhaled Beta2-Agonists

Inhaled beta2-adrenergic agonists are cornerstone medications in asthma management, providing rapid bronchodilation by stimulating beta2 receptors in airway smooth muscle. Their use can be categorized into quick-relief (rescue) and controller (long-term control) therapies.

Short-term (Rescue) Treatment:

Short-acting beta2-agonists (SABAs), such as albuterol (salbutamol), are the primary agents for immediate relief during asthma exacerbations or sudden symptom worsening. Administered via metered-dose inhalers (MDIs) with spacers, they provide rapid bronchodilation within minutes, alleviating wheezing and breathlessness (National Heart, Lung, and Blood Institute [NHLBI], 2020). These medication are essential for managing acute episodes and providing symptomatic relief, especially critical for children experiencing frequent symptoms as indicated in this case.

Long-term (Controller) Treatment:

Regular use of inhaled beta2-agonists alone is not recommended for long-term control due to potential tachyphylaxis and reduced efficacy with overuse. Instead, inhaled corticosteroids (ICS) are the preferred long-term controller agents. However, in cases where beta2-agonists are used frequently (more than twice weekly), adding a long-acting beta2-agonist (LABA), such as salmeterol or formoterol, in combination with ICS, is recommended to improve pulmonary function and reduce exacerbations (Global Initiative for Asthma [GINA], 2022).

Rationale:

The rationale for this approach is based on evidence indicating that tailored use of these medications reduces airway inflammation, prevents exacerbations, and improves quality of life. For a child with persistent symptoms like in this scenario, initiating an ICS-based controller therapy in combination with beta2-agonists can effectively manage ongoing airway inflammation, thereby reducing the frequency and severity of attacks (Reddel et al., 2019). It is crucial to educate the child and family about appropriate inhaler techniques to maximize medication efficacy and minimize side effects.

Educational Plan for the Child

Effective management of pediatric asthma is highly dependent on education tailored to both the child and the caregivers. The educational plan should focus on understanding the disease, recognizing early warning signs, correct inhaler techniques, adherence to medication, and environmental control.

Understanding the Disease:

Children should be taught in age-appropriate language that asthma is a condition that affects their lungs, causing difficulty breathing, wheezing, and coughing. Emphasizing that proper medication use can help them breathe better and participate in daily activities is vital.

Inhaler Technique:

Demonstration and supervised practice of proper inhaler use with a spacer are essential because incorrect technique diminishes medication effectiveness. Visual aids or models can be employed to enhance understanding (Rhee et al., 2018).

Adherence and Symptom Monitoring:

Children and caregivers should be instructed on the importance of adhering to prescribed medications daily, even when asymptomatic. They should also learn to monitor symptoms and recognize warning signs of exacerbations to seek timely medical intervention.

Environmental and Lifestyle Modifications:

Identifying and minimizing exposure to triggers such as tobacco smoke, dust mites, pet dander, and outdoor pollutants is essential. Schools and caregivers should be involved in creating a trigger-free environment to reduce exacerbations.

Action Plan Development:

A written asthma action plan tailored to the child's severity can empower the family to manage routine care and recognize when to seek emergency services. Regular follow-up appointments for reassessment are also integral to optimal management.

Conclusion

Managing pediatric asthma requires a multifaceted approach integrating appropriate medication use—primarily inhaled beta2-agonists for acute relief and inhaled corticosteroids for long-term control—with demonstrated efficacy—and comprehensive patient and family education. Addressing social determinants impacting healthcare access, as in this case, is vital, and health professionals should advocate for resources to ensure adherence and safety. With proper management and education, children with asthma can lead active, healthy lives, minimizing the disease's impact on their quality of life.

References

• Global Initiative for Asthma. (2022). Global Strategy for Asthma Management and Prevention. https://ginasthma.org
• National Heart, Lung, and Blood Institute. (2020). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program.
• Reddel, H. K., Takwoingi, Y., & Shepherd, S. (2019). Long-term management of asthma: A systematic review. American Journal of Respiratory and Critical Care Medicine, 199(5), 587–598.
• Rhee, H., Bender, B., & Williams, S. (2018). Improving inhaler technique to optimize asthma management. Respiratory Care, 63(11), 1464–1472.
• Martinez, F. D., & Vercauteren, J. (2017). Pediatric asthma management: Integrating pharmacology and education. Pediatric Pulmonology, 52(6), 732–739.
• Leung, D. Y. M., & Phipatanakul, W. (2018). Strategies for optimizing asthma control in children. Curr Opin Pediatr, 30(3), 284-290.
• Chung, K. F., et al. (2019). Global strategy for asthma management and prevention: GINA report, 2019. European Respiratory Journal, 53(3), 1901604.
• Gibson, P. G., et al. (2020). Pharmacological management of asthma. Annals of Allergy, Asthma & Immunology, 124(1), 74–80.
• O'Byrne, P. M., et al. (2018). Inhaled corticosteroids and long-acting beta-agonists in asthma therapy. Journal of Allergy and Clinical Immunology, 141(2), 479–488.
• Knox, K. L., & Clark, N. M. (2019). Patient education strategies for asthma control. Current Allergy and Asthma Reports, 19(8), 43.