Manage Discussion by Lusine Mkhitaryan
Hi,
My discussion will be on Asthma.
Asthma is a chronic, inflammatory disease that affects the airways. It is marked by episodes of airway obstruction when a patient presents with symptoms like shortness of breath, wheezing, chest tightness, and severe dyspnea. These episodes are triggered by allergens, and are typically reversible, but can vary in severity and sometimes require hospitalization or ICU care (Sun & Wang 2023).
When a patient faces a severe asthma attack, an adrenergic agonist is a key treatment because it provides fast and effective bronchodilation. The role of NPs is crucial to determine the appropriate dosage and administration route.
Pathophysiology: During an asthma attack, allergens or irritants prompt immune responses that cause bronchoconstriction, mucus buildup, and airway swelling, leading to symptoms like wheezing, shortness of breath, and reduced oxygen levels.
Mechanism of action of adrenergic agonists: Adrenergic agonists, especially short-acting beta-2 agonists (SABAs) like albuterol, activate beta-2 receptors in bronchial smooth muscle, leading to muscle relaxation, airway dilation, and improved airflow to enhance oxygen delivery to the lungs.
Benefits and limitations of adrenergic agonist therapy: Short-acting beta-2 agonists (SABAs) provide rapid relief by beginning to work within minutes, making them effective for quickly managing asthma exacerbations. By dilating the airways, they improve oxygen intake and facilitate CO₂ elimination, which alleviates symptoms and prevents hypoxia. Additionally, SABAs are conveniently administered through inhalation, delivering the medication directly to the bronchial tissue for fast action. However, their effects are temporary and don’t address the underlying inflammation, which can cause symptoms to recur. Frequent or excessive use may also lead to tachyphylaxis, reducing the body’s responsiveness to these medications over time. Additionally, adrenergic agonists can cause side effects like tachycardia, palpitations, and tremors, which can be problematic at high doses or in patients with existing cardiac conditions.
Dosage and route of administration: The primary objectives of asthma treatment are to relieve symptoms, prevent exacerbations, and enable patients to lead normal lives. Nurses are essential in asthma management, requiring a deep understanding to provide treatment guidance; their roles involve diagnosing, managing acute attacks, guiding self-care, adjusting medications, and educating patients on inhaler use. It is important to assess the severity of the asthma attack and determine the correct dosage and route of administration (Sun & Wang 2023).
Short-acting beta-agonists (SABAs), such as albuterol, terbutaline, levalbuterol, and pirbuterol, are first-line treatments for acute asthma attacks and form the foundation of emergency asthma care. These bronchodilators act quickly by activating beta 2-adrenoreceptors on airway smooth muscle and some inflammatory cells, providing rapid relief while generally being well-tolerated even at higher doses. Despite their long-standing use, there is potential to enhance their selectivity to reduce side effects. All major asthma guidelines recommend SABAs as the primary therapy for severe acute asthma (Sun and Wang 2023). In primary care and emergency settings, repeated inhalation of SABAs via nebulizer is recommended for extreme situations, followed by continuous nebulization, but studies indicate no advantage of nebulizer (Sun and Wang 2023).
For patients unresponsive to standard bronchodilation, continuous intravenous beta 2-agonist infusions or subcutaneous terbutaline have been explored, though lacking supportive evidence, while current guidelines reserve epinephrine use primarily for acute asthma emergencies (Sun and Wang 2023).
In summary, SABAs play a critical role in managing acute asthma exacerbations by rapidly reversing bronchoconstriction, though they must be used with an understanding of their limitations and potential side effects. By adjusting the dose and route according to the patient’s condition and response, the Nurse Practitioner can effectively stabilize the patient while preparing for additional interventions, like corticosteroids, to address the underlying inflammation.
Sun, D., Sun, P., & Wang, Z. (2023). Assessment and therapeutic management of acute asthma: The approaches of nursing staff in patient care. Advances in clinical and experimental medicine: official organ Wroclaw Medical University, 32(10), 1167–1178. https://doi.org/10.17219/acem/161156