Standard of Practice in Asthma Essay

Pathopharmacological Foundation

Asthma

Analyze the Pathophysiology of Asthma

The complex chronic inflammatory disease known as asthma, involves several inflammatory cells, more than a hundred distinct mediators of inflammation, and various inflammatory outcomes, such as plasma exudation, broncho-constriction, activation of the sensory nerves, and hyper-secretion of mucus. Mast cells contribute immensely to mediation of acute symptoms of asthma; on the other hand, T-helper 2 cells, eosinophils, and macrophages are factors that cause airway hyper responsiveness, by inducing chronic inflammation. It has been realized by an increasing number of researchers that structural airway cells, including smooth muscle and epithelial cells in airway, are a major inflammatory mediator source. Asthma involves several inflammatory mediators, such as growth factors, peptide and lipid mediators, chemokines, and cytokines. Chemokines have a crucial role to play in selective inflammatory cell recruitment from circulation, while cytokines coordinate chronic inflammation, which may cause structural airway modifications, including angiogenesis, sub-epithelial fibrosis, mucus hyperplasia, and airway smooth muscle hyperplasia/hypertrophy (Zaoutis, n.d).

Patients having persistent or aggravating respiratory trouble during asthma episodes require hospitalization, just like patients who need essential continuous asthma treatment, but it can't consistently be carried out, following discharge. Chronic or increasing asthma symptoms, in spite of bronchodilator treatment, are termed as status 'asthmaticus'. Hospitalization aims are described in varying perspectives: status asthmaticus control the stabilization and improvement of asthma-linked respiratory symptoms by suitable respiratory support de-escalation/escalation; monitoring and medication; investigating and managing asthma comorbidities or triggers; and planning patient discharge. Patients' asthma history should be examined, and post-discharge home-care plans for acute asthma exacerbation episodes and maintenance should be recommended with alterations made when required. The state has made it mandatory for family as well as patient to receive asthma education. Patients should meet with subspecialty or primary medical team and discuss proper follow-up after discharge (Zaoutis, n.d).

The Standard of Practice of Asthma

Discuss the Evidence-Based Pharmacological Treatments in Your State and How they Affect Management of the Selected Disease in Your Community

Magnesium Sulfate was recommended for use after 1 hour of treating both mild and life-threatening asthma, and administered in a period of more than 20 minutes. The drug is administered infrequently (Vincent, 2014). It has been proven that Magnesium sulfate inhibits the contraction of smooth muscle, decreasing the release of histamine in mast cells, and preventing the release of acetylcholine. Studies conducted in both children and adults show varying levels of improvement in patients that have severe limitation in airflow and unresponsive to conventional treatment using beta agonist, corticosteroid, and anti-cholinergic medications (Rowe & Camargo, 2008).

Clinical Guidelines for Assessment, Diagnosis and Patient Education of Asthma

Galveston relies on The National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3(EPR-3): Guidelines for the Diagnosis and Management of Asthma that promote comprehensive approach to management and control of asthma that include:

Avoidance of triggers from the environment;

Self-management education;

Proper use of daily medications to avoid attacks;

Partnering with the asthmatic individual, healthcare provider and family; and Using asthma action plan (AAP) that helps in daily management of asthma and when the condition symptoms worsen.

The two essential goals in asthma management are decreasing its risk and impairment (Texas Asthma Plan, 2012).

The gold standard associated with the asthma practice guidelines is 1997 Expert Panel Report (EPR) by national Heart, Lung and Blood Institute: these guidelines deal with asthma evaluation and treatment in a way that is comprehensive. Professionals interested in such issues in the guideline must familiarize themselves with EPR. The EPR highlights four levels associated with asthma severity distinguished by a number of factors, such as lung function, daytime symptom frequency, and nocturnal symptom frequency: mid-intermittent, moderate-persistent, severe-persistent and mild-persistent. Recommended treatment is algorithmically correlated to the degree of asthma severity, giving way to a stepped-care model in asthma treatment (Brown, 2003).

Asthma is diagnosed through the presence of chronic airway obstruction symptoms, on the basis of history (of cough, persistent breathing difficulties, persistent chest tightness and persistent wheezing) and examination. Symptoms transpire or aggravate during nighttime, while exercising, by irritant and allergen exposure, viral infection, stress, crying/laughing hard, weather changes, etc. Asthma assessment, with regard to its control, established action plan, appropriate treatment method, patient concerns, and compliance to plan and treatment is performed at every visit. In the assessment, spirometry measures lung function no less than once every two years; the test should be conducted more often for poorly-controlled asthma, to ascertain whether any adjustments should be made in therapy, or the same method needs to be maintained. If necessary, more advanced treatment techniques should be followed (Morris, 2015).

Patient asthma education is able to improve outcomes past symptom control. Various factors must be considered when planning to deliver asthma education to a patient, such as age, language differences and other communication barriers, cultural influences on health beliefs, access to care, health literacy, setting, psychosocial issues, and method of education (Jones, 2008).

Compare the Standard Practice for Managing Asthma within Your Community With State or National Practices.

The management of asthma in Galveston involves education. Asthma education encompasses pediatric asthma education, inpatient education program, outpatient asthma education, clinical guidelines, and school-based asthma clinics (The Growth Chart, 2000).

At the state level, on the other hand, the first plan to deal with issues affecting Texans with asthma came up in 2000 from the Asthma Coalition of Texas (ACT) and Texas Department of Health (TDH). Since then, the plan underwent several revisions that reflect current surveillance, developments in asthma knowledge and best practices. The 2011-2014 Texas Asthma Plan (TAP), which is data driven develops a continuous public health approach aimed at reducing the burden of asthma in Texas. The plan acts like a strategic blueprint, highlighting priority goals, objectives, and advocated activities, together with the promotion of action for increased and coordinated activities in asthma activities amongst partners and stakeholders (Texas Asthma Plan, 2012).

Discuss Characteristics of and Resources for a Patient Who Manages Asthma Well, Including Access to Care, Treatment Options, Life Expectancy, and Outcomes.

Access to Care

Effective asthma management necessitates the development of a partnership between the asthmatic individual and his or her healthcare team. With the help of health care teams, patients are able to learn how to:

Avoid risk factors

Take proper medication

Comprehend the differences between "reliever" and "controller" medications

Seek medical assistance when appropriate (Clark, 2002)

Treatment Options

The aim of asthma treatment involves achieving and maintaining clinical control that can be attained in many patients through constant cycle that entails:

Evaluating asthma control

Treating to Attain control

Observing to maintain control (Clark, 2002)

People who manage asthma properly comprehend the differences between "reliever" and "controller" medications, and are able to seek medical assistance when appropriate. Such people know that relievers help them treat symptoms of asthma, while controller medications assist in treating underlying inflammation in the airways (Clark, 2002).

Life Expectancy

Many people understand that a lot of asthma attacks can be deadly when left unmanaged. Although many people think that anyone who suffers from asthma should expect a shorter life expectancy; this assertion has not been proven to be true. The aim of asthma treatment involves achieving and maintaining clinical control that can be attained in many patients through constant cycle in trying to alleviate the deadly effects when left unmanaged (Clark, 2002).

Outcomes

Pharmacotherapy improvements lead to possible improvements in economic and clinical outcomes. Evidence shows that various adverse clinical results can be circumvented through delivery of proper medical care. Controller treatment helps improve symptoms, reduce acute resource use, enhance quality of life, and reduce medication costs (Luskin, 2005).

Analyze Disparities between Management of Asthma on a National and International Level

As asthma guidelines approached their 25th year in literature, they have positively affected the value and outcomes associated with care of asthma across the world. The U.S.' NAEPP (National Asthma Education and Prevention Program) guidelines and the GINA (Global Initiative for Asthma Guidelines) guidelines are often cited and endorsed by American clinicians. Both guidelines are evidence-based and use similar approaches because they originated from National Institutes of Health (Myers, 2008).

Since the GINA (Global Initiative for Asthma Guidelines) guidelines focus on international asthma, various financial statuses in different countries led GINA to generate comprehensive guidelines that focus on preferred treatment levels for chronic and acute asthma, but never focused on certain medications. Nevertheless, the guidelines highlighted acceptable therapies as well-referenced review of extra therapies (Myers, 2008).

On the contrary, the 1997 NAEPP guidelines can be abridged as follows:

1. Fresh appreciation of the core role airway plays in inflammation in pathogenesis of asthma

2. Effort focused on emphasizing therapy for anti-inflammatory maintenance

3. Attention center-tasked with establishing important risk factors associated with asthma development and identifying appropriate programs for its prevention and control

The NAEPP guidelines provide an outstanding vehicle for interpreting findings in research into clinical recommendations (Myers, 2008).

Discuss Three or Four Factors (E.G., Financial Resources, Access To Care, Insured/Uninsured, Medicare/Medicaid) that Contribute to a Patient Being Able to Manage Asthma

Financial Resources

Since costs can prohibit access to…