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    2.      Asthma and Stepwise Management
    Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening symptoms. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. One method that supports the clinical decision-making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
    To prepare:
    • Consider drugs used to treat asthmatic patients including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients including adults and children.
    • Review Chapter 25 of the Arcangelo and Peterson text. Reflect on using the stepwise approach to asthma treatment and management.
    • Consider how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
    To complete:
    Write a 2- to 3- page paper that addresses the following:
    • Describe long-term control and quick relief treatment options for asthma patients, as well as the impact these drugs might have on patients.
    • Explain the stepwise approach to asthma treatment and management.
    • Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

    Reminder: include a title page, introduction, summary, and references.
    Important Information for the Assignment

     please minimize the use of abbreviations. If you use them, please state at least once, what it stood for.
     Once again, do not use proprietary or trade names of the drugs, by itself. Use generic or drug names. Eg: it is metoprolol, not Toprol! Using trade or proprietary names is interpreted as you doing advertising for a drug company!
     I would like to see more pharmacology than pathophysiology, herbal remedies or information on medical procedures such as cardio-version or CABG! As an example, if the discussion is on HIV and AIDS, please make sure that you discuss the DRUGS used in the management of the virus and the disease as a part of your assignment, even if the question directly does not ask for drug information.
     Include pharmacodynamics (molecular mechanism of drugs mentioned), pharmacokinetics (absorption, distribution, metabolism & elimination) & pharmacogenetics (genetic pre-disposition to drug effects) in assignment. As an example, just mentioning that “tylenol” will be recommended in place of “motrin” is not advanced pharmacology! I need to see you describe how acetaminophen works and why acetaminophen could be of more benefit in a specific patient!


    . Virginia Poole Arcangelo & Andrew M. Peterson (2013). Pharmacotherapeutics for Advanced Practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins



Subject Nursing Pages 6 Style APA


Asthma and Stepwise Management

            Asthma is a long-term condition that has an unacceptably high mortality and morbidity rate. Many deaths and diseases are associated with the disease are due to inadequate treatment and the underuse of measures of severity reduction. Lack of supervision is also a factor that makes asthma fatal even when it was manageable. Therefore, asthma management is an important concept especially if it long-term controls (Wechsler, 2009).

Long-term control and quick relief treatments

            Quick-relief medications are also used in the treatment but are more likely to be used for the control of asthma attacks. Some of the examples of quick relief medication include short-acting Beta2 Agonists. These medications serve as bronchodilators and do not reduce inflammation or airway responsiveness. They relax and open the constricted airways during an acute asthma attack. The medications are used in isolation for patients that have intermittent and mild asthma. An example of the specific Beta2-agonists includes Albeterol also referred to as salbutamol or proventil Ventolin. There are also levabuterol that has fewer side effects. Antocholergic drugs include tiotropium and impratropium but are not very effective for acute asthma attacks. There are also oral corticosteroids that effectively reduce inflammation such as prednisolone, prednisone, and hydrocortisone. These are used for patients that do not respond to inhaler medications.

            Long-term medications are taken on a regular basis for the purpose of prevention and control of chronic symptoms associated with asthma. Some of the long-term medications are inhaled corticosteroids also called glucocorticoids. They do not work to reduce inflammation but reduce it over time preventing permanent lung damage. Some of them include budesonide, fluticasone, triamcinolone and ciclesonide. According to Virginia and Andrew (2013), they are considered safer and more effective since they don’t have most of the side effects associated with oral steroids. There are also long acting beta2-angonists and include formotrol mometasone and salmeterol-fluticasone. However, they are not used alone as they work better when paired with others. Leukotriene Antagomists are used in the blocking leukotrienes that are powerful immune system factors that can cause inflammation when in excess. They are thus useful in prevention n rather than treatment. The last category of long-term treatment is Omalizumab that target and block antibody immunoglobulin that is a chemical trigger for inflammation.

Impact these drugs might have on patients

            Depending on the medication taken there are various side effects that may be experienced by the patient. Both short term and long term relief options have their side effects. Short-acting beta2 agonists are known for side effects such as tremors, restlessness, headaches, anxiety and fast and irregular heartbeats. The medications should also not be mixed with other medications for people who have the previous history of heart disease, blood pressure, diabetes and hyperthydosim. Oral corticosteroids may also result in adverse effects. They include weight gain, wasting of muscles, fluid retention and even osteoporosis. Long term medications may also have various effects. Long term inhalation of steroids may result in throat irritation, rashes, fungal infections and throat bruising. In patients over forty, it is the most common cause of cataracts particularly due to high dosages. There is also an association of mental disturbances with the various drugs (Wechsler, 2009).

Stepwise Approach to Asthma Treatment and Management

            The approach is used in the management of asthma that aims to abolish the symptoms as soon as possible. The objective is to maintain and control the disease by stepping up the treatment when it is necessary. It also requires that treatment is stepped down when the control is established to be good. The step of care is determined by establishing if long-term treatment is being used for the first time or if therapy is being adjusted. At any stage care may be stepped up so as to regain control. If the patient is noted to be doing well for a length of time, then treatment may be stepped down as the minimal amount of medication is determined. The first step in this process is the assessment of asthma severity. After this, the right treatment that corresponds to the severity is selected. Depending on the results of a two to six weeks follow-up the process may be stepped up or down if the disease is under control.

Benefits of Stepwise approach to asthma treatment and management

            According to Halm, Mora and Leventhal (2006) Stepwise approach to the management and control of asthma is one of the most effective methods. It has various benefits that are associated with its use right from the point of diagnosis. The goal of using this treatment is to reduce impairment and risk associated with the disease. As such, it is effective in the prevention of troublesome and chronic symptoms such as breathlessness and coughing. Through proper monitoring, it helps to maintain the normal pulmonary function of the patient. The approach is essential in meetings the concerns especially when the condition of a [patient gets worse. It is also effective in the prevention of the loss of lung function in children.

            In summary, the use of both long term and short-term asthma drugs is beneficial to patients who experience severe symptoms. However, there are various side effects that may be experienced by the patient. These side effects may be cumbersome to the patient. The use of stepwise approach is necessary as it provides a lot of valid method for the control of symptoms and the disease at large.




Halm, E. A., Mora, P., & Leventhal, H. (2006). No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. CHEST Journal, 129(3), 573-580.

Virginia Poole Arcangelo & Andrew M. Peterson (2013). Pharmacotherapeutics for Advanced Practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins

Wechsler, M. E. (2009, August). Managing asthma in primary care: putting new guideline recommendations into context. In Mayo Clinic Proceedings (Vol. 84, No. 8, pp. 707-717). Elsevier.


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