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Asthma is a prevalent respiratory condition that affects individuals of all ages in the United States. Recent epidemiological data indicate a global rise in the prevalence of asthma, particularly among young populations (Quirt et al., 2018). Understanding the pathophysiology of asthma is crucial for healthcare professionals, including nurses, as it enhances their ability to diagnose and manage this condition effectively.
Asthma is characterized by acute reversible inflammation of the airways triggered by exposure to allergens. The pathophysiological cascade begins when an individual inhales an allergen, which could be cold air, pollen, smoke, or other triggers. In individuals with bronchial hypersensitivity, this exposure leads to airway inflammation and an increased production of mucus (Bush, 2019). Consequently, the airway resistance increases, primarily noticeable during exhalation. Airway obstruction is associated with the infiltration of inflammatory cells, excessive mucus secretion leading to the formation of mucus plugs, and the contraction of smooth muscles (Bush, 2019). Over time, these changes may become irreversible due to the thickening of the basement membrane, airway remodeling, hyperplasia, and hypertrophy.
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Based on the 2019 Global Initiative for Asthma (GINA) guidelines, the recommended approach for managing mild intermittent asthma involves the use of an inhaled corticosteroid (ICS) as a single maintenance therapy along with a short-acting beta-agonist (SABA) as needed (Elward, 2021). This approach is supported by research that suggests that relying solely on a SABA for mild intermittent asthma provides short-term symptom relief but does not effectively prevent exacerbations or hospitalizations (Elward, 2021). In contrast, combining a reliever therapy like a SABA with a single maintenance therapy like an ICS reduces the risk of potential adverse effects associated with long-term steroid use, decreases emergency department visits, and simplifies the medication regimen.
In Emily’s case, I would prescribe an ICS-formoterol combination along with a SABA as needed. It’s important to educate Emily about potential adverse effects, such as hives, swelling of the eyes, face, lips, and tongue, palpitations, and itching. Emily should also be advised to monitor her asthma by regularly measuring her peak flow using a peak flow meter. This monitoring will help assess the effectiveness of the prescribed medications (Elward, 2021). Additionally, patient education should encompass topics like medication adherence, correct inhaler technique, proper breathing techniques, and identifying and avoiding potential asthma triggers, which can include dust, mites, insects, pets, cold air, pollen, and dust, among others.
Regarding drug interactions, it’s essential to be cautious when prescribing formoterol in combination with medications like Lasix, which can lead to hypokalemia. Hypokalemia may result in breathing difficulties, muscle weakness, irregular heart rhythms, and even paralysis (Elward, 2021).
In summary, understanding the pathophysiology of asthma is essential for healthcare professionals, as it enables them to make informed decisions about treatment and patient education. A comprehensive approach to asthma management, including the use of ICS-formoterol, regular monitoring, and patient education, can significantly improve the quality of life for individuals like Emily who are living with this condition.
References
Bush A. (2019). Pathophysiological Mechanisms of Asthma. Frontiers in pediatrics, 7, 68. https://doi.org/10.3389/fped.2019.00068
Elward, K. S. (2021). Asthma Management Guidelines: Focused Updates for 2020. American family physician, 104(5), 446-447.
Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018). Asthma. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 50. https://doi.org/10.1186/s13223-018-0279-0
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