Management of Asthmatic Patient at a Community Clinic

This presentation explores the pathophysiology, aetiology and management of asthma using a case study approach of an asthmatic adult patient in the community care clinic. Learn about clinical diagnosis, diagnostic tests, management, and the nurse's role in asthma management.

Management of Asthmatic Patient
at a Community Clinic
Presented by:

Introduction
 Asthma - leading chronic respiratory illness
– 235 million people being diagnosed with the disease (WHO,
2017).
– 80% of asthma deaths in both developed and developing
countries (WHO, 2017).
 The prevention and management of asthma remain
suboptimal despite the remarkable developments in the
diagnosis and management of asthma.
 This paper uses a case study approach of an asthmatic
adult patient in the community care clinic to explore on
the pathophysiology, aetiology and management of
asthma

Definitions
 Asthma is a chronic inflammatory illness of the
respiratory system
 The chronic inflammation is linked to extreme
narrowing of the airways in response to triggers.
 Symptoms: shortness of breath, wheezing, chest
constriction and coughing (GINA, 2018).
 Comprehensive clinical assessment is critical to
ascertain the condition of a patient and the right
intervention (Potter et al., 2016).
 The complex nature of asthma requires critical
clinical diagnosis

Clinical Diagnosis of Asthma
 Patients presenting with usual symptoms of wheeze,
cough and chest constriction should be checked for
asthma (Daar et al., 2009).
 Risk of developing asthma is increased by the
presence of triggers e.g. family history, occupational
exposures, air pollution etc. (Pinnock et al., 2010).
 Esther was presented with breathlessness, wheezing
at night and her conditions are accelerated by cold
weather, dust and wood smoke
 Vital signs indicate moderate asthma

Asthma Diagnostic Tests
 The peak expiratory flow rate (PEFR) and spirometer
are commonly used
– Carried out to show reversible airflow obstruction and the assurance
functional imbalance in asthma.
– PEFR meter measures the optimal rate of flow produced during a
forceful exhalation beginning from the peak flow
– Spirometer measures FEV1 and FVC (Kirenga et al., 2015).
 The spirometer is more precise and generates reliable outcomes
than PEFR meter (Daar et al., 2009).
 Esther was diagnosed with allergic rhinitis, and PEFR and FEV1
values were less than the projected typical values and rose
beyond 12% after being administered with a bronchodilator
– Thus, evidence that she had asthma

Management of Asthma
 Reliever asthma drugs
– are bronchodilators that respond fast within few seconds after administration e.g.
Salbutamol and Levalbuterol (SABAs) (Warne et al., 2011)
– Appropriate for severe asthma symptoms due to their quick onset of
action
– In the absence of SABAs, aminophylline can be administered for the
rapid relief of asthma symptoms (WHO, 2013).
 Controller medicines
– management of asthma because they focus on the causal inflammatory
process (Barnes, 2013)
– E.g. Leukotriene modifiers and corticosteroids (GINA, 2018).
– corticosteroids (ICS) exist in all quantities as dose inhalers, classified
under low, medium or high dose depending on the amount of ICS for
each dose of the inhaler (Ramsay et al., 2011).

Management of Asthma…
 Esther was administered with ACT and low dose ICS
alongside a LABA inhaler
 Given two doses of inhaled salbutamol/LABA to take a
quarter an hour before leaving for her business
 Counselled to avoid exercise by beginning a slow walk
and increasing the speed gradually to avoid
breathlessness caused by activity
 Significant improvement observed after treatment
 Esther was released and given drug prescriptions to be
taken while at home, and required to report to the
community clinic after two days for a check-up.

Nurse’ Role in the Management of
Asthma
 Advocating for health, preventing sickness, reinstating
health and reducing or eliminating suffering (Zahedi et
al., 2013).
 Main role: promote self-management
– assisting patients to manage long-term illness, develop healthy
lifestyles (Rodriguez et al., 2013).
 Nurses in taking care of asthma patients provide them
with relevant education
 They start by obtaining relevant information regarding
their understanding of asthma
– Thus, nurses should have effective communication skills and
develop good relationships (Potter et al., 2016).

Nurse’ Role in the Management of
Asthma…
 Expert education help to avoid medication errors thus
improving their quality of life (Sleath et al., 2014).
 Self-management education is likely to cause
transformations in lifestyle behaviors and quality of life of
asthmatic patients
 The knowledge base of Esther regarding asthma was
evaluated and any shortfalls addressed (GINA, 2018).
– the specific areas that required education were
unhealthy lifestyle behaviors, how to use the inhaler
and high exposure levels to asthmatic triggers.

Conclusion
 Asthma is still ranked as a public health matter
notwithstanding the improvements in research and
management (WHO, 2017).
 The responsibility of a nurse as an educator in the self-
care for patients is important in the control and
management of asthma (Cabana et al., 2014).
 Treatment of Esther was based on the clinic’s guidelines
for mild asthma, however,
 Self-management was central in ensuring that the number
of emergency visits to the community clinic was minimal
and without which the condition would become severe.

Case Study
 Esther, a 30 years old lady presented with shortness of
breath, wheezing at night for the last one month.
 She is a hawker who sells fruits
 Allergens: cold weather, dust and smoke
 Never been diagnosed with any of the above symptoms
except for regular nasal blockage and sneezing in
childhood.
 Her mother had acute asthma throughout her lifetime
and her 12 months old baby has been diagnosed with a
constant cough
 Esther also has a history of allergic rhinitis

References
Barnes, P.J., 2013. Corticosteroid resistance in patients with asthma and chronic obstructive pulmonary disease. Journal of Allergy and Clinical
Immunology, 131(3), pp.636-645.
Cabana, M.D., Slish, K.K., Evans, D., Mellins, R.B., Brown, R.W., Lin, X., Kaciroti, N. and Clark, N.M., 2014. Impact of physician asthma care education
on patient outcomes. Health Education & Behavior, 41(5), pp.509-517
Daar, A.S., Nabel, E.G., Pramming, S.K., Anderson, W., Beaudet, A., Liu, D., Katoch, V.M., Borysiewicz, L.K., Glass, R.I. and Bell, J., 2009. The global
alliance for chronic diseases. Science, 324(5935), pp.1642-1642.
Global Initiative for Asthma (GINA), 2018. Global Initiative for Asthma Management and Control. [online]. Available from:
file:///C:/Users/Admin/Downloads/Documents/wms-GINA-2018-report-tracked_v1.3.pdf [Accessed 20 Nov. 18].
Kirenga, B.J., Schwartz, J.I., de Jong, C., van der Molen, T. and Okot-Nwang, M., 2015. Guidance on the diagnosis and management of asthma among
adults in resource limited settings. African health sciences, 15(4), pp.1189-1199.
Pinnock, H., Thomas, M., Tsiligianni, I., Lisspers, K., Ställberg, B., Yusuf, O., Ryan, D., Buffels, J., Cals, J.W., Chavannes, N.H. and Henrichsen, S.H.,
2010. The international primary care respiratory group (IPCRG) research needs statement 2010. Primary Care Respiratory Journal, 19(S1), p.S1.
Potter, P.A., Perry, A.G., Stockert, P. and Hall, A., 2016. Fundamentals of Nursing-E-Book. Elsevier Health Sciences.
Ramsay, C.F., Pearson, D., Mildenhall, S. and Wilson, A.M., 2011. Oral montelukast in acute asthma exacerbations: a randomised, double-blind,
placebo-controlled trial. Thorax, 66(1), pp.7-11.
Rodriguez, E., Rivera, D.A., Perlroth, D., Becker, E., Wang, N.E. and Landau, M., 2013. School nurses' role in asthma management, school absenteeism,
and cost savings: A demonstration project. Journal of School Health, 83(12), pp.842-850.
Sleath, B., Carpenter, D.M., Beard, A., Gillette, C., Williams, D., Tudor, G. and Ayala, G.X., 2014. Child and caregiver reported problems in using asthma
medications and question‐asking during paediatric asthma visits. International Journal of Pharmacy Practice, 22(1), pp.69-75.
Warne, T., Moukhametzianov, R., Baker, J.G., Nehmé, R., Edwards, P.C., Leslie, A.G., Schertler, G.F. and Tate, C.G., 2011. The structural basis for
agonist and partial agonist action on a β 1-adrenergic receptor. Nature, 469(7329), p.241.
World Health Organization (WHO), 2013. WHO model list of essential medicines: 18th list, April 2013. Available from:
http://apps.who.int/iris/bitstream/handle/10665/93142/?sequence=1 [Accessed 20 Nov. 18].
World Health Organization (WHO), 2017. Asthma [online]. Available from: http://www.who.int/news-room/fact-sheets/detail/asthma [Accessed 20 Nov.
18].
Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., Maddah, S.B., Cheraghi, M.A., Mirzabeigi, G.H., Larijani, B. and Dastgerdi,
M.V., 2013. The code of ethics for nurses. Iranian journal of public health, 42(Supple1), p.1.