The Pathophysiology Of Asthma
There has been some research done on asthma and genetics and this research is ongoing. Some research on this is pointing at a synergistic nature within the pathophysiology of asthma. “Polymorphisms in the gene that encodes platelet-activating factor hydrolase, an intrinsic neutralizing agent of platelet-activating factor in most humans, may play a role in susceptibility to asthma and asthma severity” (Morris & Pearson, 2016). There has been evidence which has suggested that the prevalence of asthma is reduced in association with certain infections and factors such as TB, measles, and Hepatitis A, rural living, exposure to other children or siblings in child care, and less frequent use of antibiotics. But the absence of these lifestyle
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events is associated with the persistence of a Th2 cytokine pattern and these conditions, the genetic background of the child, with a cytokine imbalance toward Th2, leads to the promotion of the production of immunoglobulin E antibody to main environmental antigens such as dust mites (Morris & Pearson, 2016). “Therefore, a gene-by-environment interaction occurs in which the susceptible host is exposed to environmental factors that are capable of generating IgE, and sensitization occurs” (Morris & Pearson, 2016). Some recent studies suggest that it is possible that the loss of normal immune balance presents as a result from a cytokine dysregulation in which Th1 activity in asthma is reduced and other studies point at the importance of genotypes in children's susceptibility to asthma and response to certain anti-asthma medications (Morris& Pearson, 2016).
The management of asthma involves different drug therapy and other factors. The right medication for each individual depends on their asthma severity, symptoms, age, as well as triggers. One of the options for treatment is a long term control medication and these include inhaled corticosteroids, leukotriene modifiers, long acting beta agonists, combination inhalers, theophylline, flovent HFA), budesonide, pulmocort, asmanex, qvar. Leukotriene modifiers are oral medications that help to relieve asthma symptoms for up to 24 hours and include montelukast (singulair), zafirlukast (accolate) and zileuton (zyflo). Long acting beta agonists are also inhaled medications which open up the airways and include salmeterol (serevent) and formoterol (foradil, ferforomist). Combination inhalers contain a long-acting beta agonist along with a corticosteroid and include fluticasone-salmeterol (advair diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (dulera). Theophylline is now rarely used but it’s a daily pill that helps to keep the airways open. Besides long term inhaler control medications, another option is the quick relief or rescue medications. These are used as needed for rapid, short-term symptom relief during an asthma attack, exacerbation or before exercise if recommended by the provider depending on the triggers. These can be taken through a nebulizer or a hand held inhaler and include albuterol (proAir HFA, Ventolin HFA, others) and levalbuterol (xopenex). Ipratropium is another quick relief option which acts quickly to immediately relax your airways but often used with emphysema or chronic bronchitis. And lastly in this category are oral or IV corticosteroids which include prednisone and methylprednisolone and are used to relieve airway inflammation caused by severe asthma. Allergy medications are another asthma medication option which may be taken to help if your asthma is triggered or worsened by allergies. “The best qualified physician in diagnosing and treating asthma. With the help of your allergist, you can take control of your condition and participate in normal activities” (AAAAI, 2016). With these medications, the provider may provide an asthma action to aid with coping with asthma. An asthma action plan outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms and may include a list of triggers and to avoid them (Mayo Clinic, 2016).
Lifestyle remedies are some things that can be done to help reduce triggering asthma and promote good health. Some of these remedies include maintaining a healthy weight, doing regular exercises, and avoiding possible triggers. Some of the ways to reduce these triggers are reducing dust in the household, prevent mold spores, reduce pet dander, keeping windows and doors closed during pollen season.
Patient education is very important with asthma patients because a patient who is well educated and instructed on this disease can improve their quality of life living with asthma. It’s important to educate these patients that they are at risk of developing complications from respiratory infections such as influenza and pneumonia and because of this, it is important for asthma patients to get their annual vaccinations (AAAAI, 2016).
Some clinical studies have been done on asthma and a number of these studies have been on asthma medications. One of the studies looked at inhaled corticosteroids. It states “a Cochrane review found that inhaled corticosteroids are superior to anti-leukotrienes when used as monotherapy in adults and children with persistent asthma. The superiority of inhaled corticosteroids is most pronounced in asthma patients with moderate airway obstruction” (Morris & Pearson, 2016). Another study looked at the routes of the medications and their effectiveness. “A study by Dhuper et al found no evidence that nebulizers were more effective than MDI/spacer beta agonist delivery in emergency management of acute asthma in an inner-city adult population” (Morris & Pearson, 2016).
Several essentials from the essentials of doctoral education can be applied with the topic of asthma.
One of the essentials that can be applied is essential I being the scientific underpinnings for practice. This is so because asthma is a disease and to fully understand it, one has to understand some of the biology and anatomy involved which is a science. Then the knowledge gained from this aids with providing patient with beneficial knowledge. Also with asthma, this essential states that having more knowledge of the disease provides “preparation to address current and future practice issues requires a strong scientific foundation for practice” (American Association of Colleges of Nursing, 2006). Another applicable essential is essential VI which is interprofessional collaboration for improving patient and population health outcomes. Asthma is a disease which sometimes requires a collaboration with other professionals in other specialties for optimal results such as allergy as there is a relationship and one can trigger the other. For example an asthma patient can be given a referral to an allergist or a pulmonologist etc. Essential VII being clinical prevention and population health for improving the nation’s health is another essential which applies to this topic because asthma affects an individuals’ overall health and as mentioned above, affects a large amount of the United States population. As this essential states, with adequate education on lifestyle remedies and avoiding triggers, an individuals’ well-being can be improved while living with asthma. And also applicable is essential VIII advanced nursing practice. As advance practice nurses (APN), we are to be able to have the skills and knowledge to better manage individuals with chronic illnesses such as asthma using best evidence based recommendations. “APNs assess, manage, and evaluate patients at the most independent level of clinical nursing practice” (American Association of Colleges of
Nursing, 2006).
Asthma is basically a chronic condition which affects your breathing and can interfere with activities of daily living. The studies show there is a genetic component to this condition and although it cannot be cured, it’s symptoms such as wheezing, coughing can be controlled with medications and lifestyle remedies. Being educated on the disease on ways to avoid triggers and staying healthy can contribute with keeping asthma symptoms and attacks under control and having a better quality of life with asthma.
events is associated with the persistence of a Th2 cytokine pattern and these conditions, the genetic background of the child, with a cytokine imbalance toward Th2, leads to the promotion of the production of immunoglobulin E antibody to main environmental antigens such as dust mites (Morris & Pearson, 2016). “Therefore, a gene-by-environment interaction occurs in which the susceptible host is exposed to environmental factors that are capable of generating IgE, and sensitization occurs” (Morris & Pearson, 2016). Some recent studies suggest that it is possible that the loss of normal immune balance presents as a result from a cytokine dysregulation in which Th1 activity in asthma is reduced and other studies point at the importance of genotypes in children's susceptibility to asthma and response to certain anti-asthma medications (Morris& Pearson, 2016).
The management of asthma involves different drug therapy and other factors. The right medication for each individual depends on their asthma severity, symptoms, age, as well as triggers. One of the options for treatment is a long term control medication and these include inhaled corticosteroids, leukotriene modifiers, long acting beta agonists, combination inhalers, theophylline, flovent HFA), budesonide, pulmocort, asmanex, qvar. Leukotriene modifiers are oral medications that help to relieve asthma symptoms for up to 24 hours and include montelukast (singulair), zafirlukast (accolate) and zileuton (zyflo). Long acting beta agonists are also inhaled medications which open up the airways and include salmeterol (serevent) and formoterol (foradil, ferforomist). Combination inhalers contain a long-acting beta agonist along with a corticosteroid and include fluticasone-salmeterol (advair diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (dulera). Theophylline is now rarely used but it’s a daily pill that helps to keep the airways open. Besides long term inhaler control medications, another option is the quick relief or rescue medications. These are used as needed for rapid, short-term symptom relief during an asthma attack, exacerbation or before exercise if recommended by the provider depending on the triggers. These can be taken through a nebulizer or a hand held inhaler and include albuterol (proAir HFA, Ventolin HFA, others) and levalbuterol (xopenex). Ipratropium is another quick relief option which acts quickly to immediately relax your airways but often used with emphysema or chronic bronchitis. And lastly in this category are oral or IV corticosteroids which include prednisone and methylprednisolone and are used to relieve airway inflammation caused by severe asthma. Allergy medications are another asthma medication option which may be taken to help if your asthma is triggered or worsened by allergies. “The best qualified physician in diagnosing and treating asthma. With the help of your allergist, you can take control of your condition and participate in normal activities” (AAAAI, 2016). With these medications, the provider may provide an asthma action to aid with coping with asthma. An asthma action plan outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms and may include a list of triggers and to avoid them (Mayo Clinic, 2016).
Lifestyle remedies are some things that can be done to help reduce triggering asthma and promote good health. Some of these remedies include maintaining a healthy weight, doing regular exercises, and avoiding possible triggers. Some of the ways to reduce these triggers are reducing dust in the household, prevent mold spores, reduce pet dander, keeping windows and doors closed during pollen season.
Patient education is very important with asthma patients because a patient who is well educated and instructed on this disease can improve their quality of life living with asthma. It’s important to educate these patients that they are at risk of developing complications from respiratory infections such as influenza and pneumonia and because of this, it is important for asthma patients to get their annual vaccinations (AAAAI, 2016).
Some clinical studies have been done on asthma and a number of these studies have been on asthma medications. One of the studies looked at inhaled corticosteroids. It states “a Cochrane review found that inhaled corticosteroids are superior to anti-leukotrienes when used as monotherapy in adults and children with persistent asthma. The superiority of inhaled corticosteroids is most pronounced in asthma patients with moderate airway obstruction” (Morris & Pearson, 2016). Another study looked at the routes of the medications and their effectiveness. “A study by Dhuper et al found no evidence that nebulizers were more effective than MDI/spacer beta agonist delivery in emergency management of acute asthma in an inner-city adult population” (Morris & Pearson, 2016).
Several essentials from the essentials of doctoral education can be applied with the topic of asthma.
One of the essentials that can be applied is essential I being the scientific underpinnings for practice. This is so because asthma is a disease and to fully understand it, one has to understand some of the biology and anatomy involved which is a science. Then the knowledge gained from this aids with providing patient with beneficial knowledge. Also with asthma, this essential states that having more knowledge of the disease provides “preparation to address current and future practice issues requires a strong scientific foundation for practice” (American Association of Colleges of Nursing, 2006). Another applicable essential is essential VI which is interprofessional collaboration for improving patient and population health outcomes. Asthma is a disease which sometimes requires a collaboration with other professionals in other specialties for optimal results such as allergy as there is a relationship and one can trigger the other. For example an asthma patient can be given a referral to an allergist or a pulmonologist etc. Essential VII being clinical prevention and population health for improving the nation’s health is another essential which applies to this topic because asthma affects an individuals’ overall health and as mentioned above, affects a large amount of the United States population. As this essential states, with adequate education on lifestyle remedies and avoiding triggers, an individuals’ well-being can be improved while living with asthma. And also applicable is essential VIII advanced nursing practice. As advance practice nurses (APN), we are to be able to have the skills and knowledge to better manage individuals with chronic illnesses such as asthma using best evidence based recommendations. “APNs assess, manage, and evaluate patients at the most independent level of clinical nursing practice” (American Association of Colleges of
Nursing, 2006).
Asthma is basically a chronic condition which affects your breathing and can interfere with activities of daily living. The studies show there is a genetic component to this condition and although it cannot be cured, it’s symptoms such as wheezing, coughing can be controlled with medications and lifestyle remedies. Being educated on the disease on ways to avoid triggers and staying healthy can contribute with keeping asthma symptoms and attacks under control and having a better quality of life with asthma.