Asthma: Implications and Nursing Interventions

By Annie Collins, RN, MSN

The author of this article, Annie Collins describes the importance of applying better treatment management and nursing interventions in order to obtain more substantial outcomes in the health of clients with asthma. This disease is characterized by inflammation and hyper-responsiveness, with narrowing of the airways resulting in airway constriction and reducing oxygen supply. These symptoms can be mild but can also be life threatening in certain cases and result in a decline of their quality of life. When the disease is not well controlled, the patients activities and daily routine are limited and children can even miss school days and adults can miss days of work. Asthma prevalence increased from 2001 to 2010: An estimated 25.7 million persons had asthma in 2010. Certain demographic groups have higher asthma prevalence, like children aged 017 years, females, black people, people of multiple race, Puerto Rican people, and people with a family income below the poverty level. Increasing necessity of medical attention means also increasing on healthcare costs. The author mentions different interventions including accurate diagnosis, ongoing education for clients and their families, and the use of inhaled corticosteroids to reduce inflammatory response, to make the management of asthma more effective. The patients need to know the proper use of short and long-term medications, and the environmental triggers that exacerbate their asthma. The nursing intervention of education should include improving symptom identification by the clients and the use of peak flow meter to set a baseline for assessing lung function. The author states that increased asthma emergency room visits, hospitalizations, mortality and morbidity are associated with delay treatment and the inability of the client, or their families to identify accurately the severity of their symptoms. The writer also mentions that is necessary to adhere to daily medication regimens and daily adjustments if lung function changes, in order to obtain positive health outcomes. The client must be able to determine the level of lung function in order to accurately medicate and use interventions to reduce and prevent acute exacerbations of asthma. Nurses and patients or the patients families need to be aware and have information about the effects of chronic inflammation on the airways. These effects result in airway remodeling characterized by thickening of the sub-epithelial layers in the bronchial tree, and this can be prevented with appropriate therapy and frequent follow-up with a nurse trained in asthma management. The client or parents must understand the role of triggers and how to avoid them, the difference between rescue drugs and control drugs, the importance of inhaled corticosteroids in reducing inflammation and maintenance of the airway mucosa integrity. The routine use of inhaled corticosteroids has been shown to reduce the number of emergency room visits by 80% and the risk of death by 21%.

Despite the fact that there have been national guidelines for asthma management in existence for years, not all nurses or physicians follow them and there is little follow-up and education of the client regarding their individual medication protocols. Asthma remains undertreated by physicians with little use of inhaled corticosteroids, and the consequence of this is that patients in emergency room respond less to bronchodilators because there is airway remodeling resulting from chronic airway narrowing. Community based interventions for children with asthma should encourage all school districts to adopt protocols that include assessment, referral and education to students. School nurses should include not only screening for hearing, vision and other diseases, but also asthma screening. The author says that when asthma is properly managed it can achieve minimal or no chronic symptoms or exacerbations and normal or near normal pulmonary function, and the client can improve their quality of life. It is important to keep a trustful relationship and open communication between the health care provider, parents and children with asthma, and the nurse needs to be current in their knowledge of resources on asthma in order to be able to share them with the families and patients. This will promote reduction in the loss of school days, greater engagement in physical activity, less visits to emergency room, and improved quality of life. Nurses acting as patient advocates have to promote assessment, diagnosis and patients education. Early assessment to prevent airway remodeling, incorporation of national asthma guidelines, individualized management and medication monitoring will help to obtain better outcomes in asthma care.

References

Collins, A. (2007). Asthma: Implications and Nursing Interventions. The Kansas nurse. 82, 6-8. Web Nov 16, 2012. Retrieved from CINAHL Plus with Full Text Database: ( AN: 2009813473) http://lib1.lib.sunysuffolk.edu:2184/ehost/search/advanced?sid=4ed096734c33-4b56-9fed-b30412b35c40%40sessionmgr115&vid=2&hid=103