• Asthma is achronic airway obstructive disease (Quirt, Hildebrand, Mazza, Noya, & Kim, 2018).
• Asthma is triggered by allergens when exposed to the airway tract.
• Allergens to susceptible individuals cause inappropriate immune response
• Nurses are likely to see asthma in the emergency department and the wards.
• Asthma is an inflammatory airway diseases that is chronic in nature. The inflammatory process leads to airway hype-responsiveness, obstruction, over-secretion, and airway remodeling.
• Inhaled allergens such as dust mite, fungi, cockroaches, pollens, and animal dander create sensitization to the airway mucosa. The immune response to these allergens results in the production of cytokines that cause excessive inflammation.
• Dendritic cells within the airway are sensitized and lead to production of more inflammatory cells. T-helper cells release interleukins that increase smooth muscle contractility, over-secretion of mucus, and chronic inflammation changes (Quirt, Hildebrand, Mazza, Noya, & Kim, 2018).
• In the emergency room, nurses will see patients with acute asthma attacks following sudden exposure to allergens. The patients present with difficult in breathing and wheezing. In the wards, chronic asthmatic patients will present with obstructive airway diseases that require oxygen therapy.
• Description of Asthma and areas where nurses are likely to see it.
• Drugs used to treat asthma- actions, side effects, indications, and contraindications.
• Treatment regime
• Effects of the treatment regime
• Nursing care for asthma patients
• Controversies associated with the drugs
• Albuterol
• Albuterol is a bronchodilator used in acute asthma attacks prescribed in aerosol or nebulizer solutions
• Side Effects
• It causes tremor, insomnia, nausea, fever, bronchospasms.
• Indications
• It is indicated in actue bronchospasms, exercise-induced bronchospasms, and spinal chord injury patients.
• Contraindications
• Albuterol is contraindicated in patients with hypersensitivity to Albuterol or milk proteins
• Albuterol is a Beta-2 receptor blocker, therefore, it relaxes airway smooth muscles (Schissler& Celli, 2018). It is protein bound and metabolized in the liver. It can be administered as a nebulizer solution, aerosol spray, or oral administration. Aerosol spray is preferred in acute cases.
• Other side effects of Albuterol include dizziness, otitis media, dry mouth, cough, chills, and urinary tract infections.
• Omalizumab
• It is used in children above the age of six years and adults who present with chronic asthma attacks.
• Side effects
• Injection site reactions, viral infections, sinusitis, pharyngitis.
• Indications
• The drug is indicated for allergic asthma which is persistent and presents with frequent attacks.
• Contraindications
• It is contraindicated in patients with hypersensitivity history
• Prednisone
• It is an inhaled steroid anti-inflammatory drug used in acute asthma attacks.
• Side effects
• Prednisone causes, anaphylaxis, angioedema, cardiac arrest, acne, facial erythema, hirsutism, and hypertension.
• Indications
• It is indicated for acute asthma attacks
• Contraindications
• It is avoided in documented hypersensitive patients, untreated serious infections, and patients with varicella zoster virus.
• Prednisone
• It is an inhaled steroid anti-inflammatory drug used in acute asthma attacks.
• Side effects
• Prednisone causes, anaphylaxis, angioedema, cardiac arrest, acne, facial erythema, hirsutism, and hypertension.
• Indications
• It is indicated for acute asthma attacks
• Contraindications
• It is avoided in documented hypersensitive patients, untreated serious infections, and patients with varicella zoster virus.
• Increased expenses in the regimen.
• Poor compliance to medications.
• Avoidance of social places and exposure to potential allergens.
• Use of beta agonist may result in tachycardia and general body weakness.
• Buying of drugs and regular check up at the hospital may impact a client’s lifestyle. Some drugs such as monoclonal antibodies are expensive to buy and maintain regular doses.
• It is a tedious process to carry nasal sprays wherever a patient goes. Some may opt to avoid them. Besides, patients on monoclonal antibodies may need regular monitoring for anaphylaxis, therefore, visiting the hospital may be a challenge to some of the patients.
• Part of the regimen included environmental control. This may involve avoidance of public places or certain diets. Therefore, the patient’s lifestyle may be limited to specific places and particular foods.
• Patients on beta agonist medications have a risk of increased heart rate and this may hinder their normal work and daily activities.
• Auscultate lung sounds for patients with asthma (Scullion, 2018).
• Monitor pulse oximetry at regular intervals.
• Nurses should ensure the environment around the patient has no allergic triggers.
• Nurses should ensure the patient is in an upright position.
• Nurses will ensure that patients are following the prescribed regimen.
• Nurses should continually auscultate for breath sounds. If there are wheezes, more treatment should be instituted. Crackles should raise an alarm of pneumonia.
• If the pulse oximetry oxygen pressure is less than 90%, more oxygen should be prescribed for the patient to prevent organ damage (Scullion, 2018).
• Besides monitoring for triggers, nurses should educate patients in the right ways of avoiding the exposure to allergic triggers.
• Upright supine posture is key to. Ensuring that the lungs are patent.
• Administration of drugs should be done by nurses.
• Omalizumab has a black box warning of anaphylaxis (Szefler et al., 2017).
• There are few randomized clinical trials of omalizumab
• Use of albuterol has been controversial due to its link with increased mortality and morbidity by increasing airway narrowing (Schissler& Celli, 2018).
• The use of corticosteroids such as prednisone has been associated with exacerbation of asthma attacks (Blickstein, 2017).
• Omalizumab has had controversies since it causes significant anaphylaxis. The anaphylaxis presents as hypotension, bronchospasm, urticaria, syncope, and edema of the larynx. Therefore, patients need intensive monitoring by nurses to prevent such episodes.
• Due to the few randomized clinical trials for Omalizumab, few patients have been followed for the effectiveness of the disease for a period of more than 30 years.
• Use of albuterol without combination with other drugs has been linked to hypertension and thereby increasing the risk of death or acquiring other diseases.
• It is thought that prednisone increases inflammation of the airway tract (Blickstein, 2017)
• . However, this claim has not been proven through research. Still the controversy has made many doctors avoid prescribing the drug.
• Omalizumab has had controversies since it causes significant anaphylaxis. The anaphylaxis presents as hypotension, bronchospasm, urticaria, syncope, and edema of the larynx. Therefore, patients need intensive monitoring by nurses to prevent such episodes.
• Due to the few randomized clinical trials for Omalizumab, few patients have been followed for the effectiveness of the disease for a period of more than 30 years.
• Use of albuterol without combination with other drugs has been linked to hypertension and thereby increasing the risk of death or acquiring other diseases.
• It is thought that prednisone increases inflammation of the airway tract (Blickstein, 2017)
• . However, this claim has not been proven through research. Still the controversy has made many doctors avoid prescribing the drug.

 
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