Assessing and Managing Asthma: a Global Initiative for Asthma Update by Pruitt and Lawson – Article Example
Assessing and Managing Asthma School: Number: Assessing and Managing Asthma Introduction The article attempts to study thetreatment and evaluation for asthma and to incorporate the latest evidences in the Global Asthma Initiatives (GINA) 2009 and also the Pocket Guide for Asthma Management 2010. Asthma is a condition which affects about 300 million across the world including both adults and children, and exacerbations of the disease can result in non-attendance at school or work. The medications required for asthma are particularly costly, inconvenient and need to be taken several times a day using complex devices. Exacerbations may require admission to inpatient wards, ICU and can cause sudden death. Hence there is a need to study the treatment and evaluation for the condition. The Guidelines provide certain measures required for nursing diagnosis related to asthma and based on the nursing diagnosis, a plan can be initiated by the nurses for effective treatment of the condition, besides, the nurses can play an important role in the education of a patient, better allergy management and helping the patient control the condition more effectively.
One of the requirements before treating asthma is to understand the severity of the condition based on the signs and symptoms of the disease. Using this, the disease can be classified and accordingly appropriate treatment can be initiated. In the year 1995 and 2002, the GINA Guidelines that were published were based on severity of the condition before starting treatment. However, the GINA 2006 guidelines began to focus began to also focus on the treatment received before the patient was actually being re-treated and re-assessed for the condition. Hence, based on control, the patient was re-classified as controlled, partly controlled or uncontrolled.
Several host factors and environmental factors are responsible for the development of asthma. Some of the hosts factors include genetic predisposition, gender, obesity, etc, and amongst environmental factors include allergens, infections, tobacco smoking, pollution, diet, etc, are responsible for the development of asthma. Asthma arises due to hyper-responsiveness and inflammation of airways that occurs as a complex interaction between inflammatory cells and mediators of inflammation. This results in airway edema, thickening of the airways, hyper-secretion of mucous, airway narrowing, resulting in acute exacerbation.
The diagnosis of asthma is made based on the history, symptoms, signs, allergic history and the results of various diagnostic test including pulmonary function tests. The GINA 2009 Guidelines considers the Peak Expiratory volume to help in the monitoring and the diagnosis of the condition as it acts as an indicator of the airflow limitation and response to treatment. To classify the patient’s condition, various other lung parameters are taken into consideration such as FVC, FEV1 and PEF.
As per the 2009 Guidelines, the medications used to treat asthma are classified either as controllers or relievers. Controllers help to control inflammation whereas relievers are taken on a need-basis and provide for bronchodilation and relieve of the symptoms. The controllers include corticosteroids, combination of corticosteroids and beta2-agonists, and leukotriene modifiers. The relievers include rapidly acting beta2-agonists, inhaled anticholinergics, etc. Most of the medications that are to be taken for asthma are given through the inhalation route as it is delivered to the most important portion of the body, quickly and immediately. The GINA 2009 guidelines also concentrate on treatment of asthma for children both for below 5 years and above 5 years. The right kind of device needs to be selected for the right based on the severity of the condition and the age of the patient.
Application to Practice
The GINA 2009 Guidelines have classified the management of asthma into 4 components:-
1. Develop a relationship between the patient and the healthcare provider – The healthcare provider and the patient should have a strong relationship and involve development of certain goals. The patient should be educated of various issues in asthma for better self-management of the condition. The nurse can play a vital role in educating the patient and ensuring that the patient’s treatment is closely followed.
2. Identifying and addressing of the risk factors for the condition – the effect of day-to-day allergens should be minimized. Exercises should be performed and medications to control the condition should be consumed. It also includes better management of dust and mites at home and annual influenza vaccination. A nurse can play a role in educating the patient about exercises, risk factors and medication, and the manner in which the same can be utilized.
3. Assess, treat and monitoring of asthma – The patient’s treatment can be monitored and stepped up or stepped down based on the level of control achieved by the patient. A good control of the condition for 3 months can be criteria to step down the treatment. Based on the step and the level of control, the nurse can play a role in monitoring, assessing or aiding in referring the patient for specialized care.
4. Management of exacerbations – As per the GINA 2009 Guidelines the exacerbations can be classified into 4 types, based on the severity of the symptoms. For each exacerbation type, the treatment would be different.
Based on 2009 GINA Guidelines, the nursing diagnosis and implementation of a nursing plan should be based on the nursing diagnosis; the associations include impaired exchange of gases, ineffective airway clearance, anxiety, contamination risks, intolerance activity, etc. If the nurses are able to follow the correct steps for the nursing diagnosis, the patient’s condition can improve and the nurse can help the patient to control the disease better. Nurses can also help in better education of the patient for effectively controlling the condition and preventing the development of exacerbations.
Pruitt, B., & Lawson, R. (2011), ‘Assessing and managing asthma: A Global Initiative for Asthma Update,’ Nursing 2011, 41(5): 46-52. http://www.nursingcenter.com/prodev/ce_article.asp?tid=1157674