Understanding Asthma From a Pharmacological Perspective Term Paper

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

Clinical practice guidelines have been set by the National Asthma Control Initiative and provide a solid foundation for standards of practice. There are four general components involved in the standards of practice, measuring and monitoring, education of patients, control of environmental factors, and pharmacologic therapy, which will be discussed in a later section. The first component of care is the assessment and monitoring of asthma in individuals. According to the report, "the functions of assessment and monitoring are closely linked to the concepts of severity, control, and responsiveness to treatment" (National Heart, Lung, and Blood Institute, 2007). The severity of an individual's expressed asthmatic symptoms is a baseline for future treatments and control measures. Often, severity needs to be measured before treatment can be decided upon and requires the patient to stop control therapy for a period in order to assess the level of asthma that then needs to be addressed, as the true severity is often masked through control therapies. Tests for severity include "spirometry, especially forced expiratory volume in 1 second (FEV1) expressed as a percent of the predicted value or as a proportion of the forced vital capacity (FVC) or FEV1/FVC" (National Heart, Lung, and Blood Institute, 2007). It is critical for healthcare professionals to understand the real severity in order to know the potential risk factors and then mitigate them appropriately with long-term control care. This leads to the notion of control factors in the standard practices for dealing with asthma. The report suggests that control relates to "the degree to which manifestations of asthma (symptoms, functional impairments, and risks of untoward events) are minimized and the goals of therapy are met" (National Heart, Lung, and Blood Institute, 2007). Physicians and healthcare professionals consistently monitor control factors in order to gauge the success and efficiency of particular treatments implemented within an individual's healthcare regiment. Finally, in the monitoring standard of care is the element of assessing responsiveness, which relates to how well a particular patient responds to treatments. Like control, this must be actively monitored on a consistent basis in order to detect any potential failures before they become major risk factors.

The next standard of practice that comes after diagnosis and maintenance is the education of patients. Within standard care practices, it is critical for healthcare professionals to evaluate how well a patient can manage asthma on their own, in order to then create the most tailored approach to asthma management. Essentially, "successful management of asthma requires that the patient or patient's caregiver have a fundamental understanding of and skills for following the therapeutic recommendations, including pharmacotherapy and measures to control factors that contribute to asthma severity" (National Heart, Lung, and Blood Institute, 2007). Physicians and healthcare professionals must assess how capable each individual patient is in regards to how they understand their asthma and how to manage it appropriately before setting a healthcare regiment. If a patient is unable to understand the scope and severity of their asthma, which is often the case for patients who are very young children or older seniors, it is critical that the healthcare team work with patient caregivers to educate them so that the can manage the asthma symptoms and controls in lieu of the patient. The Education for a Partnership in Asthma Care provides a great detailed assessment on how to evaluate a patient's capability and then educate them or their caregivers accordingly.

Finally, there is the component of controlling environmental factors. Physicians and healthcare professions are required to try to mitigate potential environmental factors that may augment a patient's asthmatic severity. This often requires allergy testing and lifestyle training on how to avoid certain activities or environmental stimuli that would trigger an asthma attack. Exposure to particular allergens, like pet dander and pollen, and other irritants, like tobacco smoke and industrial pollution, all contribute to the severity of a patient's asthma. Physicians must help patients evaluate their lifestyles in order to mitigate exposure to such environmental factors as a way to better control asthma symptoms and severity.

Pharmacological Treatments

There are a number of pharmacological treatments that are suggested by the accepted standards of care. According to the research, "the current concept of asthma therapy is based on a stepwise approach, depending on disease severity, and the aim is to reduce the symptoms that result from airway obstruction and inflammation to prevent exacerbations and to maintain normal lung functioning" (Rabe & Schmidt, 2001). There are a number of pharmacological treatments currently favored by physicians for the treatment and maintenance of asthma. Beta2-andrenoceptor agonists and glucocorticoids are commonly used in modern practice and are often thought to be one of the more effective drugs for treating inflamed airways in the lungs. Such regiments also include a second line of theophylline, leukotrien receptor atagonists, and anticholinergics to augment the beta2 treatments (Rabe & Schmidt, 2001). New treatments also gaining favor include inhaled steroids, "primarily with long-acting beta2-adrenoceptor agonists" (Rabe & Schmidt, 2001). Asthma is a serious condition, but one that can be controlled by following standard practices presented by some of the leading asthma researchers and advocates in the field. By utilizing such control methods, individuals with asthma "can stay active, sleep through the night, and avoid having their lives disrupted by asthma attacks" (National Heart, Lung, and Blood Institute, 2007).

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…