Understanding Asthma And Treatment Options

Asthma is a breathing complication that affects adults and children, characterized by the swelling and narrowing of the airways, causing them to produce mucus. This results in coughing, shortness of breath, wheezing while breathing and chest complications (Gans, & Gavrilova, 2020). The symptoms differ from one person to another and are intermittent depending on the prevailing environmental conditions. Under normal circumstances, when a person breathes in, air moves through airways, from the mouth and through the trachea or the windpipe down to the lungs. The tracheal system is divided into bronchial tubes, which pass through the lungs through bronchioles which are smaller air spaces. At the end of bronchioles, there are tiny air sacs called the alveoli, which upon breathing in, are filled up with air and, in this case, oxygen used in the body for respiration (Santacroce et al., 2020). When there is an asthma attack, the walls of the tracheal system contract leading to the inflammation and swelling of the airways or bronchoconstriction (Sinyor, & Perez, 2019). The overall effect is narrowing of the airways due to squeezing and swelling with increased mucus secretions on the lining membranes blocking the air sacs. This obstructs airflow channels leading to difficulty in breathing, coughing, wheezing, and chest complications (Carpaij et al., 2019). Allira Nantuwara clinical history presents a high respiratory rate of 28, heart rate of 130, blood pressure at 140/85, the temperature of 36.8⁰c, wheezing while breathing, coughing and shortness of breath, this is manifested in the way she responds to Dr. Ling in short sentences as she struggles to catch up with her breathing. These signs can be attributed to the swelling, irritation, constriction and mucus secretion in the airways causing blockage of unrestricted airflow into the lungs. Causative agents for Asthma include heredity or related biological causes, infections, neonatal exposure to conditions that affect lung development, allergens like dust, pollen, and perfumes, industrial emissions like smoke, and finally, weather changes. Asthma has an overall impact on sleep disturbance, fatigue, poor concentration, academic and financial implications.  Symptoms Of Asthma Essay Paper

Salbutamol is a beta-2 adrenergic receptor agonist used to treat and relieve symptoms associated with Asthma and chronic obstructive pulmonary disease like wheezing while breathing, coughing and difficulty in breathing. Its effect is to relax airways muscles that run from the tracheal system all the way to the lungs to relieve breathing complications, thus making breathing easier. It is presented as a tablet, puffer syrup or a nebulizer that helps an asthmatic patient to breathe in the medicine inform of mist with the help of a mask or a mouthpiece. Mode of action involves the activation of beta-adrenergic receptors on the airways smooth muscles leading to the activation of the adenyl cyclase leading to an increased intracellular concentration of cyclic-3’,5’-adenosine monophosphate. The increased concentration levels of cyclic adenosine monophosphates result in protein kinase A activation that works by inhibiting myosin phosphorylation and decrease in intracellular concentrations of calcium ions leading to relaxation of the airways from the tracheal system through the bronchioles. Salbutamol acts antagonistically in the relaxation of the airways channels regardless of the involved spasms to buffer all challenges associated with bronchoconstriction. The increase in cyclic concentrations can also be attributed to the restriction in the release of mast cell mediators along the airways channels. Upon use, changes in airway relaxation can be achieved within 5 to 15 minutes, 60 to 90 minutes range for normal pulmonary processes and 3 to 6 hours for bronchondial activities, respectively. The side effects include; increased heart rate, increased blood pressure, headaches and dizziness. Nursing considerations for salbutamol nebulizer use include; monitoring oxygen saturation levels, respiratory rates, lung movements and sounds before and after use and the recommended use of spacer devices. Salbutamol is safe at pregnancy and breastfeeding stages for adults and children. However, consultation with the doctor in cases of allergies and side effects is advised.

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Causes Of Asthma

A metered-dose inhaler is a canister of medicine that is pressurized with a plastic holder and a mouthpiece. Priming is essential as it ensures that the dosing chamber of the metered inhaler fills with the required medication doses when one is ready to use it and the medicine goes directly through the airways to the lungs (Rodriguez?Martinez et al., 2020). A spacer makes the inhaler more effective and user-friendly, and it prevents irritation of the mouth for patients taking inhaled steroids.

Diagram (Cho-Reyes et al., 2019)

• Priming; remove the cap and shake the inhaler well.
• Getting started, remove the cap of the inhaler and the spacer. Shake well and attach the inhaler to the spacer. Breathe out gently by removing as much air as possible.
• Breathing in slowly, gently place the spacer in between the teeth and the lips tightly by holding your chin up. A person should use mouth to start breathing slowly while pressing the inhaler in order to spray a puff into the spacer. Maintain breathing.
• Holding your breath, remove the spacer from your mouth and hold your breath to allow the medicine to reach the lungs. Release your lips to allow breathing from the mouth. Return the caps back to the inhaler and spacer and rinse your mouth with water and spit.
• Cleaning your inhaler; upon spotting a white powder around the hole of the inhaler, remove the canister, use warm running water to rinse the inhaler and cap and dry overnight. The mouthpiece should be washed twice a week with a soap and running water, rinse and dry off.
• Storing your inhaler; store under room temperature as the medicine in the canister is pressurized.
• Replacing your inhaler; maintain a close monitor on the counter and replace the inhaler (Wrench et al., 2019)

Asthma is a chronic complication, if left untreated, it poses a potential health challenge to the patient in various ways. They include; Airways remodeling: this occurs when Asthma is left untreated, drugs become ineffective and less air finds its way into the airways (Langton et al., 2020). Asthma attack results in the swelling and the inflammation of the inner linings of the respiratory system, constricting the smooth muscles of the airways leading to narrower airways and decreased oxygen supply to the lungs. Persisted swelling of the bronchial lining damages the mucus membranes along the airways, thus reducing their ability to filter foreign bodies that significantly affect the lungs. Bronchospasms narrow the airways and substantially affect the whole respiratory process (Sinyor, & Perez, 2019). Changes over the airways can result in lung failure, increased mucus secretion, increased blood flow, airway thickening and coughing. Respiratory failure occurs due to insufficient oxygen levels from the lungs into the blood system. If not treated early can lead to death. Hospitalization; severe asthma attacks can require hospitalization where steroid medication is administered and oxygen is availed through nasal tubes or breathing tubes inserted onto the airways to facilitate oxygen flow (Goorsenberg et al., 2018).

Fluticasone propionate is the active medicine in Flixtoxide accuhaler preventor medication and belongs to the corticosteroids family. Its main action is to provide a measured amount of steroids into the lungs. When used regularly, it reduces the inflammation or swelling and irritations in the airways of the tracheal system into the lungs, thus easing breathing patterns (Deeks et a., 2018). It contains a preventor and does not give results immediately on an asthma attack, however, the results can be realised in a week. Relievers are used in cases where there are sudden asthma attack symptoms like wheezing, coughing, challenges in breathing and chest complications as fast-acting medications. They act by relaxing the airway muscles to open it and enhance sufficient airflow along with the tracheal system into the lungs. They are in the form of inhaler puffer and their side effects include; anxiety and shaking hands. On the other hand, preventors are used in the prophylactic management of mild Asthma where patients need a bronchodilator for treatment on a daily base, moderate Asthma in unstable patients under prophylactic therapy, severe Asthma in patients on steroid medication to manage asthma symptoms and in children under all categories that require prophylactic asthma medication. The side effects include; a soar throat, soar oesophagus, a slow growth rate in the child, rounded face and loss of vision. Nursing considerations include; allergic reactions like hay fever, wheezing, lumpy rash, swelling of lips, fainting and challenges in breathing; sore throat as a result of thrush or candida infection; loss of vision complications like glaucoma and cataract and finally, consult your doctor when you want to change the medications or changes in physiological state (Larsson et al., 2020).

Treatment Options

Teach-Back is a communication tool that enables patients to remember, conceptualise and understand crucial information regarding their disease diagnosis, medication and treatment processes. It involves interactive sessions between the practitioner and the patient where the patient is frequently asked to remember and explain crucial information discussed with the practitioner over the previous sessions (Talevski et al., 2020). Repeated discussions improve the chances of the patient to grasp every crucial information in detail. It is a tool used as a result of communication breakdown and ineffectiveness due to health practitioner factors like limited time for discussion, bulk information and complex medical terms or patient factors like poor understanding due to complexity of medical terms, age, language, nervousness and lack of focus. To conduct Allira’s Teach-Back session, I will simply follow the steps below;

• Explaining; I will expeditionary explain to Allira using simple language and approach about Asthma as the core disease she is suffering from, what causes it, medication and treatment dimension and process and subsequently recommended plan on how to take her medications without failure.
• Teach-Back; over the session, I would ask Allira to demonstrate to me how she will execute the recommended disease symptoms monitoring, treatments and the laid medications.
• Assessing; I will keenly listen to her version of what she understood about the discussion and take notes. Suppose she fails to attain at least the minimum threshold for understanding the whole concept. In that case, I will repeat the entire process but now with a simpler approach and language, allow room for interactive questions on the areas she does not understand, break complex words and terms into simpler versions with examples and finally reassess for the second time until she is confident enough on what to do while she is away.

Allira is presenting a case of chronic Asthma. During the normal respiration process, air inhaled is moistened by the nasal passages. When people are exercising, they tend to breathe through the mouth, which means that they take in colder and drier air. In response, muscle linings around the airways are sensitive to changes in external conditions of temperature and humidity; thus, they will respond by contracting and subsequent tightening of the airways, thus presenting asthma-related complications like shortness of breath. Allira experiences this while exercising so she has to take her medication. In terms of muscle cramping, it is relatively attributed to asthma bronchodilators medication. Bronchodilators are beta-agonists which are in the form of steroids. Once taken, their action takes place in the lungs by relaxing the tightened muscles of the airways. Upon action, the residual drug acting component must make its way outside the patient’s body. This, in turn, affects the body’s electrolyte levels as they unnecessarily cause unwarranted muscle spasms resulting in generalised muscle cramps, as in the case with Allira. The recommended solution for muscle cramps includes; taking reliever drugs, stretching and massage, warming before the exercise, adhering to asthma plans and taking more electrolytes to meet electrolyte imbalance (Corren, 2019).

References

Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology & Therapeutics, 201, 8-24.

Cho-Reyes, S., Celli, B. R., Dembek, C., Yeh, K., & Navaie, M. (2019). Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of US studies. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 6(3), 267.

Corren, J. (2019). New targeted therapies for uncontrolled Asthma. The Journal of Allergy and Clinical Immunology: In Practice, 7(5), 1394-1403.

Deeks, L. S., Kosari, S., Boom, K., Peterson, G. M., Maina, A., Sharma, R., & Naunton, M. (2018). The role of pharmacists in general practice in asthma management: a pilot study. Pharmacy, 6(4), 114.

Gans, M. D., & Gavrilova, T. (2020). Understanding the immunology of Asthma: pathophysiology, biomarkers, and treatments for asthma endotypes. Paediatric respiratory reviews, 36, 118-127.

Goorsenberg, A. W., d’Hooghe, J. N., de Bruin, D. M., van den Berk, I. A., Annema, J. T., & Bonta, P. I. (2018). Bronchial thermoplasty-induced acute airway effects assessed with optical coherence tomography in severe Asthma. Respiration, 96(6), 564-570.

Langton, D., Bennetts, K., Noble, P., Plummer, V., & Thien, F. (2020). Bronchial thermoplasty reduces airway resistance. Respiratory Research, 21(1), 1-8.

Larsson, K., Kankaanranta, H., Janson, C., Lehtimäki, L., Ställberg, B., Løkke, A., … & Ulrik, C. S. (2020). Bringing asthma care into the twenty-first century. NPJ primary care respiratory medicine, 30(1), 1-11.

Rodriguez?Martinez, C. E., Sossa?Briceño, M. P., & Castro?Rodriguez, J. A. (2020). Metered?dose inhalers vs nebulization for the delivery of albuterol in pediatric asthma exacerbations: a cost?effectiveness analysis in a middle?income country. Pediatric pulmonology, 55(4), 866-873.

Santacroce, L., Charitos, I. A., Ballini, A., Inchingolo, F., Luperto, P., De Nitto, E., & Topi, S. (2020). The human respiratory system and its microbiome at a glimpse. Biology, 9(10), 318.

Sinyor, B., & Perez, C. (2019). Pathophysiology of Asthma.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLoS One, 15(4), e0231350.

Wrench, W., Van Dyk, L., Srinivas, S., & Dowse, R. (2019). Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler. African Journal of Primary Health Care & Family Medicine, 11(1), 1-9.  Symptoms Of Asthma Essay Paper