What are the appropriate pharmacological therapies to be prescribed for Johnathan?
Consistent with Sharma (2019), pharmacological therapies for Jonathan comprise of utilizing agents for relief and control. Agents of control incorporate inhaled nedocromil or cromolyn, inhaled corticosteroids, theophylline, long-acting bronchodilators, and modifiers of leukotriene. Also, other control agents that can be used include IL-4 receptor alpha monoclonal antibody (dupilumab), or IL-5 monoclonal antibodies (mepolizumab, benralizumab), or the anti-immunoglobulin E (IgE) antibody (omalizumab). Medications to induce relief include ipratropium, systemic corticosteroids, and short-acting bronchodilators.
What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?
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Jonathan's mother should be educated on information regarding the management of asthma exacerbations at home since it forms an essential part of the management of asthma. Jonathan’s mother ought to be enlightened on how to identify early signs of diminishing lung function to facilitate adjustment of medication as necessitated. To control asthma exacerbations, Johnathan’s mom should be enlightened regarding the Stepwise Approach. Moreover, a transient increase in anti-inflammatory medication may be needed to re-establish control. Asthma exacerbations may be typified by the elevated urge for oral steroids, heightened demand for short-acting bronchodilators, or lessening PEF (20% or higher), declined tolerance to physical activity, and elevated nocturnal symptoms (Miller, 2016). Other elements that influence maintaining management of asthma comprise contact to allergens, self-management factors, and financial-linked barriers to care. Referral of Jonathan to an allergy speciality may be indispensable to ensure management of symptoms of Asthma.
What is an appropriate clinical assessment tool to be used with Johnathan?
The most appropriate tool for assessing Jonathan is the Childhood Asthma Control Test (cACT) – The cACT was enacted in 2006 to evaluate asthma management in kids 4-11 years old (Alzahrani & Becker, 2016). cACT is an individually-administered tool that incorporates the caregiver's and the child's viewpoints on management asthma for four weeks.
What is the classification of asthma?
Exercise-induced asthma is the obstruction of the airway after the end of an exercise, even after short exercise periods (Polgar-Bailey, 2017). Symptoms appear 5-10 minutes after the cessation of the exercise and settle within 1-4 hours. Some types of exercise, such as skiing and running in the cold often induce airway obstruction.
Aspirin-exacerbated respiratory disease (AERD) happens in people with mild to severe asthma (Polgar-Bailey, 2017). AERD is typified by symptoms of mildly extreme obstruction of the airway, sneezing, dermal changes, tearing, rhinorrhea and gastrointestinal symptoms on coming to contact with Aspirin or any prostaglandin inhibitors (Polgar-Bailey, 2017). AERD onset often happens in patients in their 20s and 30s. Diagnosis of AERD is integral since drugs containing aspirin ought to be avoided because the drugs may trigger deadly asthma episode attacks.
Among children, the grouping of asthma is founded on gravity and frequency of warning sign (Miller, 2016): These comprise of Mild intermittent asthma : symptoms not more than twice in a week and asymptomatic in the middle of exacerbations. Children between the ages of 0-4 years' experience no nighttime symptoms. Kids between 5-11 years' experience nightmare symptoms not more than two times a month with PEF is greater than 80% predicted. Mild persistent asthma: symptoms appear more than two times in a week but not more than ones in a day, and exacerbations may influence physical activity. Children aged 0-4 ages undergo nighttime symptoms more than twice a month, while those aged 5-11 years have nigh time symptoms about 3-4 times in a month. Also, PEF of greater than 80% is postulated.
Moderate persistent asthma: Patients experience symptoms daily and depend on beta2 agonist. The exacerbations experienced affect regular physical activity. Children aged 4 and below have nighttime symptoms 3-4 times in a month. Children 5-11 years have nighttime indications beyond once in a week, however not every night. PEF exceeding 60% to less than 80% is predicted. Children experience exacerbations 2 or more times in a year. Severe persistent asthma: Patients experience the extent of symptoms persistently; severely constrained physical activity; recurrent nighttime symptoms, diminished lung function. PEF less than 60% predicted. Kids’ 5-11 ages experience exacerbations more than twice a year.
How would you as the NP address his mother’s concern regarding providing an inhaler at school?
Johnathan’s mom ought to be educated that it may be essential to control Jonathan’s symptoms when in school. The “Expert Panel Report 3: Guidelines” - NAEPP, 2007 endorses that the inscribed asthma action plan be distributed to the school (Miller, 2016). Because school going children are developmentally intrigued in learning and grasping new skills, children should be included in their therapy plans. Adolescents and school and school-aged children ought to have the aptitude to efficiently administer inhaled therapies. The healthcare practitioner should supervise how the child uses the inhaler and implement relevant adjustments and required. Because schools do not permit students to carry and administer self-medications, the NAEPP (2007) has recommended a resolution enabling students to carry and do self-administration if the parent and provider consider it relevant to do so. The plan to have Jonathan to bring to school and administer the inhaler should be consulted between the school, Jonathan's mother, and the healthcare practitioner.
What is an appropriate plan of care for Johnathan?
Contemporary guidelines four critical elements of asthma management, in this fashion (Sharma, 2019): Assessment and monitoring: After the condition of the patient has been classified and medication started continuous assessment is vital for control of the disease. Control of Asthma is defined by Sharma (2019) as “the degree to which the manifestations of asthma are minimized by therapeutic intervention, and the goals of therapy are met.” Education: education on self-management should aim at instructing patients on the benefits of identifying their level of control and indications of deteriorating symptoms. Educational approaches should major on environmental management and evasion stratagems and therapy use and compliance, for example, precise inhaler technique.
Management of environmental elements and comorbid situations: Exposure and irritants from the environment contribute immensely to symptom exacerbations. Utilization of in vitro and skin testing to evaluate sensitivity to persistent indoor allergens is crucial in patients with long-lasting asthma. After the offending allergens have been recognized, patients are counselled on avoidance. Patients need to be educated on the avoidance of tobacco smoke. Pharmacologic treatment: Pharmacologic control incorporates the employment of agents of management and relief. For most patients especially extremely affected patients, the final objective is to deter signs, reduce death from acute episode attacks, and avert psychological and functional morbidity to deliver a healthy lifestyle suitable to the child’s age.
Jonathan experiences Mild Intermittent Asthma. Jonathan falls in the age group of 5-11 years. Jonathan has been wheezing and coughing for more than 24 hours, and symptoms require him to use MDI in the past 24 hours. Jonathan tried using SABA, and this is his first exacerbation this year. Increased use of SABA did not ease his symptoms, meaning he required a step-up. Change in step calls for, assessing, educating, environmental management, and control of morbidities. In this period, a low-dose ICS can be recommended, a substitute to ICS: Cromolyn, Nedocromil, LTRA or Theophylline.
References
Alzahrani, Y. & Becker, E. (2016). Asthma control assessment tools. Respiratory Care, 61 (1) 106-116; DOI: https://doi.org/10.4187/respcare.04341
Miller, B. (2016). Asthma and Chronic Obstructive Pulmonary Diseases. In T.M. Woo & M. V. Robinson (4th Ed.), Pharmacotherapeutic for Advanced Practice Nurse Prescribers (pp. 913-941). Philadelphia, PA: F. A. Davis.
Polgar-Bailey, P. (2017). Asthma. In T. Mahan Buttaro, J. Joanne Sandberg, J. Trybulski, & P. Polgar-Bailey (5TH Ed.), Primary care. A collaborative practice (pp. 421-445). St. Louis, MI: Elsevier.
Sharma, G. (2019). Medscape. Pediatric asthma treatment & management. Retrieved from https://emedicine.medscape.com/article/1000997-treatment
Woo, T. (2016). Drugs Affecting the Respiratory System. In T.M. Woo & M. V. Robinson (4th Ed.), Pharmacotherapeutic for Advanced Practice Nurse Prescribers (pp. 360-412). Philadelphia, PA: F. A. Davis.
