Nr 565 Wk 6 Asthma

Nr565 Wk 6 Asthma

Nr565 Wk 6 Asthma

Complete the blanks in the following table to create an algorithm for asthma care using your textbook as well as GINA guidelines. Classify asthma and be familiar with step therapy for patients aged 12 years and older.

Step Asthma Classification Asthma symptoms and frequency as noted in textbook Controller and Preferred Reliever: (Drug Class and frequency if provided from GINA guidelines) Controller and Alternative Reliever: (Drug Class and frequency if provided from GINA guidelines) Step 1 Click or tap here to enter text. Daytime symptoms Click or tap here to enter text. Drug class: Click or tap here to enter text. Frequency: Click or tap here to enter text. Drug class: Click or tap here to enter text. Frequency: Click or tap here to enter text. Nighttime awakenings Click or tap here to enter text.

Step 2 Click or tap here to enter text. Daytime symptoms Click or tap here to enter text. Drug class: Click or tap here to enter text. Nighttime awakenings Click or tap here to enter text.

Step 3 Click or tap here to enter text. Daytime symptoms Click or tap here to enter text. Drug class: Click or tap here to enter text. Drug class: Click or tap here to enter text. Nighttime awakenings Click or tap here to enter text.

Step 4-5 Click or tap here to enter text. Daytime symptoms Click or tap here to enter text. Step 4: Drug class: Click or tap here to enter text. Drug class: Click or tap here to enter text. Nighttime awakenings Click or tap here to enter text. Step 5: Drug class: Click or tap here to enter text.

Refer for: Click or tap here to enter text. No change. Starting treatment: Complete this section using the GINA guidelines provided. First Assess: Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Fill in the blank: 1. Using Click or tap here to enter text.as reliever reduces the risk of Click or tap here to enter text.compared with using a Click or tap here to enter text.reliever. 2. Before considering a regimen with a Click or tap here to enter text.reliever, check if the patient is likely to be adherent with Click or tap here to enter text. Dosing: Low, Medium, High Low dose ICS provides most of the clinical benefit for most patients. However, ICS responsiveness varies between patients, so some patients may need medium dose ICS if asthma is uncontrolled despite good adherence and correct inhaler technique with low dose ICS. High dose ICS is needed by very few patients, and its long-term use is associated with an increased risk of local and systemic side-effects. Adults and adolescents Inhaled corticosteroid Total daily (24 hour) ICS dose (mcg) Low Medium High BDP (pMDI, HFA) > >1000 BDP (DPI or pMDI, extrafine particle, HFA) > >400 Budesonide (DPI or PMDI, HFA) Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Ciclesonide (pMDI, extrafine particle, HFA) 80-160 > >320 Fluticasone furoate Click or tap here to enter text. Click or tap here to enter text. Fluticasone propionate (DPI) Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Fluticasone propionate (pMDI, HFA) Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Mometasone furoate (pMDI, HFA) Treating Modifiable Risk Factors Exacerbation risk can be minimized by optimizing asthma medications and by identifying and treating modifiable risk factors. List the six modifiable risk factors identified in the GINA guidelines that show consistent high-quality evidence. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. 1. Click or tap here to enter text. Non-Pharmacological Strategies and Interventions In addition to medications, other therapies and strategies may be considered when relevant, to assist in symptom control and risk reduction. List the examples the GINA guidelines provide. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.

Paper For Above instruction

Asthma is a chronic respiratory condition characterized by airway inflammation, hyperresponsiveness, and airflow obstruction. Proper classification and stepwise management are essential for optimizing care, especially in adolescents and adults. The GINA (Global Initiative for Asthma) guidelines provide a comprehensive framework for assessing severity and stepping up or down therapy based on symptom control, as part of a personalized treatment plan.

Asthma Classification and Step Therapy

Based on the classification system outlined in textbooks, asthma can be categorized into intermittent, mild persistent, moderate persistent, and severe persistent. For adolescents aged 12 and older, intermittent asthma manifests as symptoms less than twice a week and nighttime awakenings fewer than twice a month. Mild persistent asthma involves symptoms more than twice a week but not daily, with nighttime symptoms occurring 3-4 times a month. Moderate persistent asthma presents with daily symptoms and nighttime awakenings more than once weekly, impacting daily activities. Severe persistent asthma is marked by continuous symptoms, frequent nighttime awakenings, and substantial activity limitations.

Step 1: Intermittent Asthma

In this stage, daytime symptoms are infrequent, occurring less than twice weekly, with nighttime awakenings fewer than twice monthly. Management involves as-needed inhaled short-acting beta-agonists (SABAs), such as albuterol, as a preferred reliever. Alternative relievers can include other short-acting bronchodilators but with less preference.

Step 2: Mild Persistent Asthma

Patients experience symptoms more than twice weekly but not daily, with nighttime symptoms occurring 3-4 times a month. Controller therapy should include low-dose inhaled corticosteroids (ICS), which are the mainstay for reducing airway inflammation. The preferred reliever remains a SABA taken as needed, with a possible addition of low-dose ICS-formoterol as a reliever in specific cases. Alternative options include leukotriene receptor antagonists if ICS is contraindicated or not tolerated.

Step 3: Moderate Persistent Asthma

Daily symptoms with nighttime awakenings more than once weekly characterize this step. The recommended controller involves medium-dose ICS to better control inflammation. A combination inhaler containing ICS and a long-acting beta-agonist (LABA), such as formoterol, should be considered for effective symptom management. The preferred reliever continues to be a SABA, with some guidelines suggesting as-needed low-dose ICS-formoterol for better outcomes.

Steps 4-5: Severe Persistent Asthma

For severe cases, frequent symptoms and activity limitations necessitate high-dose ICS therapy, possibly combined with additional controllers such as tiotropium or biologic agents depending on phenotype and eosinophil counts. The preferred reliever remains a SABA, but with careful assessment of the risks and benefits of long-term high-dose steroids.

Additional Considerations

Assessment of adherence, inhaler technique, and inhaler device selection are crucial. Inhaled corticosteroids like fluticasone and budesonide are most commonly used, with dosages adjusted according to severity. Formoterol is a LABA that offers rapid onset of action, facilitating its use as a reliever or in combination inhalers. Examples include Symbicort (budesonide/formoterol) and Dulera (mometasone/formoterol).

Modifiable Risk Factors

Identifying and managing risk factors can significantly decrease exacerbation risks. The six factors with high-quality evidence are:

  • Tobacco smoke exposure
  • Obesity
  • Allergen exposure (e.g., dust mites, pet dander)
  • Environmental pollutants
  • Poor adherence to medications
  • Inadequate inhaler technique

Non-Pharmacological Strategies

  • Environmental control measures to reduce exposure to triggers such as dust, pets, and tobacco smoke.
  • Patient education targeting inhaler technique and adherence.
  • Smoking cessation programs.
  • Weight management to reduce obesity-related exacerbations.
  • Allergen immunotherapy in selected cases.

Case Study Application

In the case of Haley, a 14-year-old girl with persistent asthma symptoms, classification based on symptoms suggests moderate persistent asthma because she experiences symptoms daily, including nighttime awakenings a few times weekly. According to GINA guidelines, her management should involve stepping up therapy from occasional rescue inhaler use to regular controller therapy—specifically, medium-dose ICS combined with a LABA like formoterol. Her current use of SABA alone is insufficient for control. Introducing an ICS-LABA combination inhaler such as budesonide/formoterol would provide both anti-inflammatory and bronchodilator effects, improving her symptom management and reducing nighttime awakenings.

Importance of LABA in Asthma Management

Inhaled LABAs, such as formoterol, play a vital role when combined with ICS because they improve symptom control, reduce exacerbation frequency, and enhance lung function. The combination inhaler assists in achieving rapid symptom relief while providing continuous anti-inflammatory effects. Moreover, LABAs like formoterol have a rapid onset of action, making them suitable as part of a reliever in some strategies, contrary to older LABAs that had sluggish onset and increased risks when used alone. This approach improves adherence and outcomes in adolescents with moderate to severe asthma.

Patient Education and Environmental Factors

Effective education for Haley and her parents should emphasize the distinction between rescue SABA use for immediate relief and maintenance therapy with ICS-LABA inhalers for controlling underlying inflammation. They must understand the importance of daily medication even when asymptomatic and recognize early signs of worsening asthma to seek prompt care. Environmental assessments should identify potential triggers such as pet dander and indoor allergens, which Haley may be exposed to during outdoor activities and at home, contributing to her exacerbations. Measures like keeping pets out of bedrooms and using allergen-proof covers can mitigate these factors.

Action Plans and Web Resources

The GINA guidelines strongly endorse personalized asthma action plans that provide clear instructions on daily management and steps to take during worsening symptoms. Providing Haley with an action plan enhances self-management and reduces emergency visits. A reputable example of an asthma action plan can be found at the CDC website or through reputable clinical resources, which can be adapted based on her specific needs and inhaler regimen.

Conclusion

Optimizing asthma management in adolescents requires meticulous assessment, classification, and tailored therapy following GINA guidelines. In Haley’s case, implementing a combination ICS-LABA inhaler regimen, addressing modifiable risk factors, and providing comprehensive education and action plans will likely improve her quality of life, reduce exacerbations, and promote long-term control.

References

  • Global Initiative for Asthma (GINA). (2023). Global Strategy for Asthma Management and Prevention. Retrieved from https://ginasthma.org
  • Baumann, M. H., & Larsen, G. (2020). Asthma management. In R. E. Rhoads (Ed.), Nelson Textbook of Pediatrics (21st ed., pp. 1015-1022). Elsevier.
  • National Heart, Lung, and Blood Institute (NHLBI). (2020). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. NIH Publication.
  • Price, D., et al. (2021). The importance of inhaler technique in asthma management. Therapeutic Advances in Respiratory Disease, 15, 17534666211024399.
  • Barnes, P. J. (2019). Inhaled corticosteroids in asthma: local and systemic effects. Current Opinion in Pharmacology, 45, 125-132.
  • Reddel, H. K., et al. (2020). An official American Thoracic Society/European Respiratory Society statement: Asthma control and management. American Journal of Respiratory and Critical Care Medicine, 202(4), e1–e39.
  • Bradding, P., et al. (2020). Biologic therapies in severe asthma. European Respiratory Journal, 55(1), 1900656.
  • Chung, K. F., et al. (2019). International ERS/ATS guidelines on the management of severe asthma. European Respiratory Journal, 54(4), 1901691.
  • Ostrom, M., et al. (2019). Environmental control in asthma management. Journal of Allergy and Clinical Immunology, 144(2), 377–386.
  • Madhur, R., et al. (2022). Digital tools and plans for asthma management. Journal of Medical Internet Research, 24(4), e31937.

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