Initial Clinic Assessment And Management Of Acute Asthma Exacerbation In A 6-Year-Old With Mild Intermittent Asthma

What could be done initially in the clinic to assist Zach?

1.In response to case of Zach, a 6 year old patient with history of intermittent asthma, Anna Greene suggested providing supplemental oxygen and Albuterol/Ipratropium bromide to assist the patient. The suggestion of using combined medication is a good strategy given in the post because evidence has proved the efficacy of combined anticholinergic and a beta2-adrenergic bronchodilator on initial treatment of acute asthma in children. The study showed that anticholinergics have slower onset of action and weaker bronchodilating effect. Hence, they can enhance and prolonged bronchodilation (Griffiths  & Ducharme, 2013).. Hence, it can be said that the justification given in the post regarding the ration for using two medications is consistent with research findings. With regard to the response given by Anna Greene on specific teaching for Zach, I would say that teaching strategies has been covered in detail however one drawback is that the age of the client is not considered while planning health teaching. For instance, a 6 year old child may not engage in self-monitoring by recording peak expiratory flow. However, giving the education in front of Zach’s family member will be effective. The exacerbation plan for Zach is not properly provided and suggestions like strategies that can be taken when Zach experience severe respiratory distress would have strengthened the post. For instance, strategies like pursed lip breathing could help the client. The follow up plan is detailed enough to support the patient to report about any complications while taking medications.  

2. In contrast to Anna Greene’s response for initial intervention for Zach, the post by Macey Dodd also states the use of combivent medication. However, Macey Dodd also suggested the use of oral steroid prednisone to control asthma symptoms. This medication can be effective to control moderate or serious flare up in Zach after the first line of treatment (Abaya, Jones & Zorc, 2018). The strength of teaching plan developed for Zach is that Macey has focused a lot on common problems that patient of family members may encounter while taking medications. Hence, the teaching strategies like proper use of inhalers and situation in which taking quick relief medication is effective. Such teaching plan is likely to support patient and their family members to encounter all barriers during the management of asthma (Normansell & Welsh, 2015). The suggestion of a written asthma plan is even more useful strategy as this will family member’s with the opportunity to review the plan and then decides what actions needs to be taken for Zach. In contrast the last post, Macey also specified regarding the role of family in self-monitoring and ways to record expiratory flow in a diary. It is the most comprehensive and detailed plan that is likely to increases the confidence of family member in managing the health of Zach. Macey has also proposed a useful exacerbation plan which was lacking in the last post. Exacerbations is related to severity of symptoms and when patients are made aware regarding situations that can increase exacerbation of the disease, then many complications in patient can be prevented (Pinnock, 2015). Hence, the follow-up instruction given after taking each medication is an effective strategy proposed in the post. It clearly specified the duration and response needed by patient after use of each medication. The emphasis on timing both in exacerbation and follow-up plan is the strength of this discussion post.

Albuterol and ipratropium are nebulized medication give to patient with asthma or COPD. Albuterol is a bronchodilator given to patients with obstructive airway disease. It works to relax the smooth muscles of airways and open the airways that was affected by bronchoconstriction. It is a beta2-adrenergic agonist that activates beta 2-adregergnic recepctors present on the smooth muscle of airways. Such activation increases the concentration of cyclic AMP due to the activation of adenyl cyclase. High concentration of AMP inhibits the releases of mediators responsible for causing bronchospasm. In addition, the ionic calcium concentration is decreases resulting in relaxation of the smooth muscles (Chemm.nlm.nih.gov. 2018). In this way, Albuterol helps to reduce symptoms of wheeziness and shortness of breath in patient.

Ipratropium is also a medication given for treatment of symptoms related to shortness of breath in asthma and COPD patient. It is an anticholinergic agent that blocks the receptors of acetylcholine and the release of transmitter agent from the vagus nerve. The action of the drug results in decrease in the intracellular concentration of cyclic guanosine monophosphate (cGMP). The action of the CGMP in turn on the intracellular calcium results in decreased contractility of the smooth muscles of the airways (Bernstein & Singh, 2015).. In this way, the symptom of breathlessness is reduced in patient.

Reference:

Abaya, R., Jones, L., & Zorc, J. J. (2018). Dexamethasone Compared to Prednisone for the Treatment of Children With Acute Asthma Exacerbations. Pediatric emergency care, 34(1), 53-58.

Bernstein, J. A., & Singh, U. (2015). Neural abnormalities in nonallergic rhinitis. Current allergy and asthma reports, 15(4), 18.

Chemm.nlm.nih.gov. 2018.  Albuterol -Medical Countermeasures Database – CHEMM. Retrieved 20 February 2018, from https://chemm.nlm.nih.gov/countermeasure_albuterol.htm

Griffiths, B., & Ducharme, F. M. (2013). Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Paediatric respiratory reviews, 14(4), 234-235.

Normansell, R., & Welsh, E. (2015). “Asthma can take over your life but having the right support makes that easier to deal with.” Informing research priorities by exploring the barriers and facilitators to asthma control: a qualitative analysis of survey data. Asthma research and practice, 1(1), 11.

Pinnock, H. (2015). Supported self-management for asthma. Breathe, 11(2), 98.