Paper Example on Asthma: Evolving Pharmacotherapy and Pathophysiology

Introduction

Asthma has an evolving and complex pharmacotherapy ranging from natural substances to present-day pharmaceutical drugs. The contemporary pharmaceutical technology is responsible for the development of current effective asthma drug therapy. Understanding the pathophysiology of asthma is the basis of comprehending its pharmacotherapy and the foundation of the mechanism of actions of available drugs. According to Tay, Lee, and Hew (2018), pharmacotherapy of asthma is founded on two primary areas namely the prevention or reversal of the inflammation of the airways, and inhibition of the constriction of the bronchioles' smooth muscles. The roles of the drugs are to correct the narrowing of the airways because asthma triggers the production of excess mucus and swelling of the airways which leads to breath shortness, wheezing sound while breathing and general difficulties in breathing. Pharmacological management of asthma and general nursing care plan according to asthma patients such as Zachy have the ultimate objective of preventing symptoms and minimizing the resultant psychological, and functional morbidity caused by associated acute episodes of asthma, and provide a holistic plan for the patient to lead a healthy life.

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Asthma Drugs and Pathophysiology

Asthma's pharmacotherapy is heavily reliant on v2-Adrenoceptor agonists which are currently one of the most effective bronchodilators (Derendorf, Nave, Drollmann, Cerasoli, & Wurst, 2015). The second category of asthma drugs are the corticosteroids whose mechanism of action in relation to pathophysiology of asthma is to control the underlying inflammation of the airways. On the other hand, the working principles of v2-Adrenoceptor agonists are such that they trigger the dilation of the smooth muscles in the passages of the bronchioles and causes vasodilation the enhance the flow of air in the airways. According to Barnes (2013), the combined effect of v2-Adrenoceptor agonists and corticosteroids presently forms the basis of the gold-standard treatment of asthma as the inhalers were made from a combination of corticosteroid and long-acting v2-agonist to form an enhanced asthma drug therapy. In the case of Zachy, he was under ipratropium bromide which according to Barnes (2013) acts as parasympatholytic agents whose mechanism of actions is to block acetylcholine muscarinic receptor, the transmitter agent. The utilisation of ipratropium in Zachy's case was to prevent and control asthma symptoms like breathlessness and wheezing sound. The drug's working mechanism is to relax the muscles of the airways to makes breathing easily.

Pharmacological Care for Zachy

The general care accorded to Zachy was the control of chronic asthma symptoms and treat acute episodes of breathlessness, exercised-induced and nocturnal symptoms. Ipratropium was a quick relief solution but there are other available pharmacotherapy solutions that were appropriate in Zachy's case. These include theophylline drugs and leukotriene modifiers such as zileuton (Zyflo), montelukast (Singulair) and zafirlukast (Accolate) (Barnes, 2013). Others include long-acting bronchodilators such as anticholinergics and beta-agonists. There also most recent asthma drugs such as anti-IL-5 and anti-immunoglobulin E (IgE) antibodies (Gross, 2017). Asthma has complex pathophysiology involving bronchial hyperresponsiveness, intermittent obstruction of the airways and inflammation. These factors are responsible for the breathlessness, chest tightness, coughing and wheezing episodes among asthmatic people such as Zachy. The role of treatment and drugs such as ipratropium is to reverse the episodes linked with obstruction of the airflow.

Nursing Plan for Asthma

Nursing care upon arrival of the patient in the hospital is essential for positive health outcomes. Depending on the severity of asthma symptoms, the accorded nursing plan will first begin with an essential assessment by conducting the following immediate nursing activities. First, the nurses assess the severity of asthma symptoms by evaluating the respiratory status, the sounds of the breaths to examine the presence of the wheezing sound, and use a pulse oximeter to evaluate the degree of oxygen saturation to inform subsequent actions (Sundbom, Malinovschi, Lindberg, & Alving, 2015). Depending on gathered data on arrival at the hospital, the nurses conduct appropriate diagnosis encompassing the nature of the airway clearance and the amount of mucus produced, and the presence of bronchospasm which both signify ineffective clearance. Henceforth, the vital signs of the patients must be monitored closely to determine response to the planned medications. Nursing intervention concerning the assessment of respiratory status entails evaluating the nature of the respiratory system of the patients determining pulse oximetry, peak flow, breath sounds and the degree of symptoms severity (Scullion, 2018).

Additionally, nurses have the responsibility of identifying and assessing medications, administering them according to prescription and monitoring how the patients respond to treatment. Nurses also check the dehydration level of the patients and where necessary administer fluids. The nursing care plan must be effective and this can be determined by conducting an evaluation based on the key elements of asthma therapy and the functionality of the drugs (Kuethe, 2013). First, the airway patency should remain maintained at all time with effective assessment expectoration to ensure clear secretions. The nursing and pharmacological interventions are also effective within 24-hours of admission, the patient shows signs of reduced or absent chest congestion, enhanced oxygen exchange, noiseless respirations, and clear breathing sound. Within this period, nurses ought to determine possible complications and begin appropriate corrective or preventing measures.

Dieting and Patient Education

Nursing care plan in Zachy's case will not be holistic if it lacks dietary interventions and health education. First, Zachy and his mother must receive education about the medical condition and the concept of chronic inflammation, role and working mechanism of assigned drugs, allergens to avoid and probable ways of avoiding inflammation triggers. While Zachy was not recommended an inhalation device, it is important to provide education on proper inhalation techniques under the do-it-your-own concept to minimize hospitalizations and associated costs. Scullion (2018) recommends that patients and their families must receive instructions concerning peak flow and ways of monitoring. Nurses are tasked with providing patient education basing on the contemporary asthma pharmacology and depending on patients' cultural background and education level, causative factors, and diagnostic results. Before discharge, patient education should place more emphasis on compliance and adherence to prescribed medication and therapy (Kuethe, 2013). There should be a clear description of preventing measures at home such as the use of inhalation techniques and the need for regular follow-up appointments with medical specialists to keep track of the patient's health progression. The teaching should also concentrate on the asthma action plan, the do's and don'ts and more importantly a healthy diet regimen. Dietary intervention is important in the management of asthma considering research studies such as the one conducted by Xiao and Ma (2014) which outline a close and positive relationship between obesity and asthma. Zachy and his mother ought to learn the essence of healthy eating and its relevance to Zachy's condition. Healthy eating for asthmatic individuals has associated advantages such as improving digestion, lowering cholesterol and blood pressure which are all link with respiration (Guilleminault, Williams, Scott, & Berthon, 2017).

References

Barnes, P. (2013). Drugs for asthma. British Journal of Pharmacology, 152(Suppl 2): S297-S303. DOI: 10.1038/sj.bjp.0706437.

Derendorf, H., Nave, R., Drollmann, A., Cerasoli, F., & Wurst, W. (2015). The relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. European Respiratory Journal, 31(3), 1042-50. DOI: 10.1183/09031936.00074905.

Gross, K. (2017). New Strategies in the Medical Management of Asthma. American Family Journal, 62(1), 89-100.

Guilleminault, L., Williams, E. J., Scott, H. A., & Berthon, B. S. (2017). Diet and Asthma: Is It Time to Adapt Our Message? Nutrients, 9(11), 1227-1229. DOI: 10.3390/nu9111227.

Kuethe, M. (2013). Nurse versus physician-led care for the management of asthma. Cochrane Database of Systematic Reviews, 2(1), 13-19. DOI: 10.1002/14651858.CD009296.pub2.

Scullion, J. (2018). The Nurse Practitioners' Perspective on Inhaler Education in Asthma and Chronic Obstructive Pulmonary Disease. Canadian Respiratory Journal, 5(3), 113-128. DOI: 10.1155/2018/2525319.

Sundbom, F., Malinovschi, A., Lindberg, E., & Alving, K. (2015). Effects of poor asthma control, insomnia, anxiety, and depression on quality of life in young asthmatics. Journal of Asthma, 1(1), 3-17.

Tay, T. R., Lee, J. W.-Y., & Hew, M. (2018). Diagnosis of Severe Asthma. Medical Journal of Australia, 209 (2), S3-S10. DOI: 10.5694/mja18.00125.

Xiao, L., & Ma, J. (2014). Dietary pattern and asthma: a systematic review and meta-analysis. Journal of Asthma and Allergy, 7(1), 105-121. DOI: 10.2147/JAA.S49960.