Managing Adult Asthma Exacerbations Discussion Paper

Clinical Guidelines/Research on Asthma Exacerbation in Adults

Asthma is a chronic disease characterized by airway inflammation and attacks accompanied by wheezing, shortness of breath, chest stiffness, and coughing. Asthma attacks or episodes increase these symptoms and cause a decline in the lung’s capacity to function, which needs appropriate treatment (Wagh et al., 2022). In primary care, awareness of asthma exacerbation management across the adult age span is essential in enhancing results and clients’ living standards. Such factors may include allergens, infections, pollution, and stress, leading to exacerbations. Asthma patients in this age group may have other coexisting conditions, such as cardiovascular diseases. Normal aging also affects the lungs and how the body reacts to medications; hence, treatment should be personalized.

They include the overall management of asthma from the onset to the identification and management of the worsening of the disease. This includes follow-up, patient awareness, and compliance with the recommended treatment regimens. The current clinical practices include a stepwise approach based on the severity of the diseases, as suggested by evidence-based practices. These guidelines include ICS as first-line therapy to reduce inflammation, LABAs added to ICS for better control, SABAs to relieve acute symptoms, and oral steroids for severe exacerbations. Managing Adult Asthma Exacerbations Discusssion Paper

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Regarding the exacerbations, the guidelines highlight the importance of early management, frequent follow-up, and patient counseling. The strategies that fall under the early intervention include administering rescue inhalers and oral corticosteroids if required. Lung function monitoring is done through tools like peak flow meters, while patient education involves triggers, inhaler use, and early signs of exacerbation. Patient education is a key component, empowering patients to take control of their condition and recognize early signs of exacerbation. The most frequent issues in asthma control are patients’ compliance, improper use of inhalers, and underestimated disease severity. The task is made more challenging by environmental aspects and other coexisting conditions. Primary care providers can only overcome these challenges by constantly reinforcing patients’ knowledge and encouragement.

Some measures that can be taken to promote health among asthmatic patients include managing triggers, changing lifestyle, immunizations, and follow-up checkups. Maintenance means avoiding factors known to cause the condition, such as allergens and other pollutants. Preventive measures are exercising, quitting smoking, and maintaining a proper diet. It is crucial to ensure patients get vaccinated for the flu and pneumonia to avoid flu and pneumonia cases. Follow-up visits are essential in reviewing asthma status and management changes.

 Hence, the treatment of exacerbations is based on pharmacological and non-pharmacological measures. Pharmacologically, it is necessary to change the dosage of the medications prescribed according to the current norms (ADA, 2020). Apart from pharmacological treatment, patient counseling about the proper usage of inhalers, compliance, and avoidance of triggers is highly effective in preventing exacerbations. The main points to remember in asthma management are individualized patient care, continuous patient enlightenment, and prevention. It is important to develop management plans according to the specific patient and their life cycle. Continued education on medication usage, triggers, and self-observation can improve results substantially. Exacerbations should be promptly diagnosed and treated to avoid adverse effects and hospital admissions. Managing Adult Asthma Exacerbations Discusssion Paper

 Asthma exacerbation is one of the crucial issues in primary care, and it should be managed systematically and patient-specifically. Therefore, by adhering to such guidelines, responding to healthcare issues, and advocating for health interventions, PCPs can enhance the QOL of asthma patients throughout their adult lives.

Case Summary: Asthma Exacerbation in a 54-Year-Old Female (J.D.)

1. D., a female 54-year-old patient with a history of asthma and headaches, has come with the worsening of her asthma symptoms, such as wheezing, shortness of breath, and nocturnal cough for three days. She has an albuterol inhaler, Advair 250/50 mcg, twice daily, and propranolol for migraines. Later, she was prescribed fluticasone/salmeterol 250/50mcg twice daily, and she took a five-day prednisolone burst, 50mg per day. Specifically, J. D. denies fever, chills, pain, changes in appetite, and weight changes, which suggests the requirement for assistance with coping strategies.

The most likely diagnosis is acute asthma, based on J. D.’s history of asthma, symptoms, and respiratory status at this time: oxygen saturation at 92%, expiratory wheezing, and increased respiratory rate. Management involves reviewing medications to increase their doses, counseling the patient regarding the appropriate use of the inhaler and ways of avoiding triggers, and a review appointment within seven days. Managing Adult Asthma Exacerbations Discusssion Paper

For healthcare providers, here are some key take-home messages: medication compliance, identifying features of relapse, and a holistic approach to management (Holland et al., 2020). It is, therefore, important to remind patients about the correct use of inhalers and compliance with the medications prescribed for asthma. An effective management strategy incorporating medicinal and non-medicinal approaches based on patients’ specific characteristics may be highly beneficial.

References

American Diabetes Association. (2020). 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2020. Diabetes care, 43(Supplement_1), S98-S110. https://diabetesjournals.org/care/article-abstract/43/Supplement_1/S98/30822

Holland, T. J., Penm, J., Johnson, J., Sarantou, M., & Chaar, B. B. (2020). Stakeholders’ perceptions of factors influencing the use of take-home-naloxone. Pharmacy, 8(4), 232. https://www.mdpi.com/2226-4787/8/4/232

Wagh, M. R. D., Khade, M. P., & Ld, H. (2022). Asthma: A comprehensive outlook. International Journal for Research in Applied Science and Engineering Technology, 10(1), 691-698. https://www.academia.edu/download/78967095/Asthma_A_Comprehensive_Outlook.pdf

Case Summary

J.D. is a 54-year-old female client with a history of asthma diagnosed at the age of 20 and also has had Migraines without aura. She presents with increased wheezing, shortness of breath, and nocturnal cough, which suggest worsening asthma for the last three days. She has been using her albuterol inhaler, which she initially reported was effective in managing her symptoms but currently provides limited relief of features. Her current medications include an albuterol inhaler as needed for asthma exacerbations and Advair 250/50mcg twice daily for asthma maintenance. She also uses propranolol for migraines, and her fluticasone/Salmeterol has been increased to 500/50mcg twice daily with oral corticosteroids (prednisone) and 50mg orally for five days. However, she denies constitutional features such as fever, chills, pain, changes in appetite, and weight gain/loss. Other than asthma and her migraines, she denies other health concerns and indicates the need for support to enhance her coping measures. Managing Adult Asthma Exacerbations Discusssion Paper

Differential Diagnoses

Asthma exacerbation: Given that J.D. has had asthma for a very long time and has been on follow-up care, acute asthma exacerbations are a likely diagnosis that should be evaluated. The condition occurs due to hyperresponsiveness, bronchospasms, mucus spasms, and decreased airway patency (Levy et al., 2023). Therefore, the client presents with features of decreased airway patency, including wheezing, shortness of breath, and cough. The presence of these features in the client’s case suggests asthma exacerbation is the most likely diagnosis for this case.

Chronic Obstructive Pulmonary Disease (COPD): This condition presents with similar manifestations, resulting in decreased airway compliance and restricted gaseous exchange. It occurs due to chronic irritation of the airway following exposure to noxious agents such as cigarette smoke (McCance & Huether, 2019). Although the client does not have a history of cigarette smoke, COPD should be evaluated due to increased shortness of breath and wheezing.

Viral Respiratory Infections: Viral infectious agents also trigger inflammatory responses, resulting in airway problems. The client has had wheezing and non-responsive asthma shortness of breath for the past three days. These infectious agents are known to provoke the airway, resulting in acute manifestations of asthma exacerbations (National Heart, Lung, and Blood Institute, 2020).

Heart Failure: Heart failure occurs when the heart cannot pump blood to achieve adequate peripheral perfusion and venous return. This process results in fluid accumulation in tissues such as the lungs, resulting in pulmonary manifestations such as wheezing, chest discomfort, and dyspnea that exacerbate with slight activity (McCance & Huether, 2019). Despite the absence of some of these manifestations, heart failure should be considered to help identify or rule out cardiovascular causes. Managing Adult Asthma Exacerbations Discusssion Paper

The Definitive/Most Likely Diagnosis

Ms. J. D.’s most probable diagnosis is an asthma exacerbation (flare) due to the described symptoms, history of asthma, and use of the rescue inhaler. Pathophysiologically, asthma exacerbation occurs due to airway inflammation, broncho constrictions, and increased mucus secretion, resulting in airway obstruction. Self-rating by Ms. J. D. Has complained of shortness of breath, wheezing, and coughing that increased at night over the last three days with the albuterol inhaler not as effective as it used to be rarely used. During the physical examination, the patient had expiratory wheezes on both sides, increased respiratory effort, and a prolonged expiratory cycle, which indicates respiratory distress (Holst et al., 2023). On the vital signs assessment, the patient’s oxygen saturation is 92%, which indicates hypoxemia. Diagnostic actions encompass the peak flow measurement and spirometry to measure the degree of obstruction during treatment and evaluate effectiveness or outcomes. Managing Adult Asthma Exacerbations Discusssion Paper

Asthma Management Guidelines

J.D.’s current stage is moderate persistent asthma that requires a combination of inhaled corticosteroids, long-acting beta-agonists, short-acting beta-agonists for quick relief, and a short course of oral corticosteroids (Holst et al., 2023).  According to the current clinical practice guidelines for managing an asthma exacerbation, the following changes would be made to Ms. J. D.’s current treatment plan: increasing her fluticasone/salmeterol dosing to 500/50 mcg twice daily and beginning a five-day course of oral steroids with prednisone, 50 mg per day. Further use of her albuterol inhaler PRN for irregular, intermittent use is recommended. The asthma education phase includes teaching the patient about trigger factors and the need to avoid them, proper inhaler usage, and ensuring that she follows her asthma management plan (Global Initiative for Asthma, 2023). A one-week follow-up is vital as it involves reassessment of symptoms and a response to treatment with spirometry if symptoms persist. If follow-up evaluation indicates non-improvement or worsening disease state, the nurse practitioner should consider referring the pulmonologist to establish a further course of action.

Comprehensive management plan

Medication Adjustments

The treatment plan will include several key components to manage J.D.’s condition. For instance, the medications will be adjusted by increasing the dose of Advair to 500/50 mcg twice daily to better control inflammation and bronchoconstriction. In addition, J.D. will continue using her albuterol inhaler as needed for acute symptom relief, and she will also start a five-day course of prednisone, 50 mg daily, to address severe inflammation during the exacerbation. Combining these medications will help improve general health and reduce exacerbation of the conditions.

Non-Pharmacological Therapies

Non-pharmacological therapies are also crucial for J.D. First, she will receive education on avoiding common asthma triggers such as allergens and irritants and proper inhaler techniques to ensure maximum medication delivery. Further, developing a personalized asthma action plan will help her manage symptoms and exacerbations effectively. Also, it is essential to inform her of the need and when to seek medical help. Managing Adult Asthma Exacerbations Discusssion Paper

Monitoring and Follow-Up

Monitoring and follow-up are essential components of the treatment plan. J.D. will have a follow-up appointment within a week to reassess her symptoms and response to the assigned adjusted treatment. During the follow-up visit, spirometry will be conducted to measure lung function and evaluate the degree of airway obstruction. If symptoms persist or worsen, it will be essential to give a referral to a pulmonologist.

Patient Education

Patient education will play a significant role in the management plan. First, J.D. will receive materials about asthma, proper inhaler use, and the importance of adhering to the prescribed treatment. Also, discussions will include lifestyle modifications, such as regular physical activity and a balanced diet, essential in improving asthma management. Addressing potential barriers to adherence, such as medication costs and forgetfulness, and proposing strategies like medication reminders will also form part of the educational effort.

Migraine Management

In terms of her migraine management, J.D. will continue taking propranolol to reduce the frequency and severity of migraine attacks. Also, non-pharmacological approaches, such as stress management techniques such as relaxation exercises, meditation, stress management, cognitive therapy, and adequate sleep, will be emphasized, given that they play a big role in migraine management (Haghdoost & Togha, 2022). The effectiveness of her current migraine management will be assessed during follow-up visits, and appropriate adjustments will be made.

Initial Presentation and Treatment

J.D.’s initial presentation indicated worsening asthma symptoms, which warranted adjustments in her treatment plan. The initial adjustment was to increase the dose of fluticasone/salmeterol and a course of oral prednisone. The follow-up visit will help document her response to this treatment, noting any improvements or persistent symptoms. A comparison between the actual treatment course and the recommended management plan shows close alignment. Further, it should be noted that the adjustments were made based on her current condition.

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Strategies for Future Management

To improve future management, ongoing education about asthma management and regular monitoring through follow-up appointments will be emphasized. In addition, it will be essential to involve other healthcare professionals, such as a pulmonologist or asthma educator. The objective of the comprehensive approach is to achieve better control of asthma, reduce the frequency of exacerbations, and improve the overall quality of life.

** Use attached work to make one final paper**

Clinical Case Report
Learning Objectives
Define a clinical case presentation
List the typical information included in a clinical case presentation
Describe the usual format and organization of a clinical case presentation
Discuss the use of critical thinking and communication skills to successfully present a patient case
What is a Clinical Case Presentation?
A clinical case presentation is a demonstration of a learner’s knowledge and skills related to the management of disease states and drug therapies through application to an actual patient case. This assignment aims to incorporate subjective and objective findings to formulate an evidence-based plan using a previously identified disease process. Use a discussion from this course where you completed a SOAP Note of a disease process to prepare a clinical case report and presentation. Managing Adult Asthma Exacerbations Discusssion Paper

The following should be included in your Clinical Case Report:
Patient Information
Disease State and Management Summary
Assessment
Plan of Care
Patient’s Treatment Course and Outcome(s)
Clinical Guidelines and Research
Case Summary Managing Adult Asthma Exacerbations Discusssion Paper