Pharmacological and Non-Pharmacological Management of Asthma in Zachy

Developing Integrated Care

Introduction:
Asthma is a multifaceted disease comprising of varied mechanisms like immune, allergic and
inflammatory mechanisms. Different mechanisms are involved in progression of asthma. Hence,
it is advisable to treat asthma with different drugs exhibiting effect on different targets. Non-
medication management also need to be implemented; in addition to the medication management
for the management of asthma in Zachy. In this essay, both pharmacological and non-
pharmacological treatment are discussed.
Discussion:
Pharmacological management : Ipratropium exhibit its action through exhibiting antagonistic
action on cholinergic and muscarinic receptor. Muscarinic acetylcholine receptors antagonism
lead to the degradation of cyclic guanosine monophosphate (cGMP). It led to minimum action of
cGMP on intracellular calcium which results in decreased contractibility of smooth muscle of
airways which inhibit bronchoconstriction. Hence, there would be smooth muscle relaxation and
subsequent bronchodilation. Education need to be provided to Zachy and her parents related to
ipratropium inhaler use. Nurse should encourage Zachy to apply mouthpiece rather than face
mask. Asthma symptoms should be monitored in Zachy; both before and after use of ipratropium
inhalation (Nomura et al., 2017).
Prednisolone is class of glucocorticosteroid anti-inflammatory drug. It also produces
immunosuppressant effect. It exhibits effect through immune system feedback mechanism and it
produce both anti-inflammatory and immunosuppressant effect. It produces its action through
glucocorticoid receptor binding and subsequently it led to glucocorticoid receptors activation.
Transactivation and transrepression are the subsequent mechanisms which occur after
glucocorticoid receptors activation.
Both transactivation and transrepression mechanisms are responsible for the anti-inflammatory
effect glucocorticoids. Transactivation is upregulation of the anti-inflammatory genes like
lipocortin I, p11/calpactin binding protein, secretory leukoprotease inhibitor 1 (SLPI), and
mitogen-activated protein kinase phosphatase (MAPK phosphatase). Transrepression is
suppression of expression of proinflammatory proteins in cytosol. It led to inhibition
translocation of transcription factors like NF-κB from cytosol to nucleus. It results in inhibition
of transcription of inflammatory genes like NF-κB. It is essential for nurse to monitor risk of
infection and electrolyte balance in Zazchy. Since, it has been demonstrated that prednisolone

produces disturbance in electrolyte balance and augment infection susceptibility (Zhang et al.,
2014).
Salbutamol inhaler exhibit its action in asthma patients through bronchodilator action.
Salbutamol exhibit its action as β2 adrenergic receptor agonist. Ample quality of β2 adrenergic
receptors are available in bronchial smooth muscle of lungs. Activation of β2 adrenergic
receptors lead to activation of adenyl cyclase enzymes. Adenyl cyclase enzyme play role in the
conversion of adenosine-tri-phosphate (ATP) to adenosine-mono-phosphate (cyclic AMP).
Augmented level of cyclic AMP relaxes airway smooth muscles and reduces airway airway
resistance as a result of reduced level of intracellular calcium ions. Augmented level of cyclic
AMP inhibits leukotriene and histamine release. Leukotriene and histamine release are
responsible for the bronchoconstriction (Neininger et al., 2015).
Zachy is being administered with amoxicillin through per oral route to prevent bacterial
infection. Amoxicillin is a penicillin class of antibiotic. Amoxicillin exhibit bactericidal effect
when bacteria are in active stage of multiplication. Mechanism of action of amoxicillin is
inhibition of cell wall biosynthesis which exhibit through inhibition of cross-linkage of linear
peptidoglycan polymer chains. It is essential for nurse to complete hypersensitivity test in Zachy
before amoxicillin administration. Since, amoxicillin is associated with stomach upset after
consumption on empty stomach; hence, it should be consumed along with food. Nurse should
provide education to Zachy’s parents about discontinuation of amoxicillin administration. It is
essential for Zachy to consume amoxicillin for the scheduled duration; even after disappearance
of infection (Ghoshal et al., 2012; Francis et al., 2015).
Paracetamol is being administered in Zachy for the management of pain. Exact mode of action
for paracetamol has not been founded. However, few modes of actions for paracetamol has been
proposed for the management of pain. These modes of actions include COX inhibition,
endogenous cannabinoid system inhibition in brain and transient receptor potential cation
channel subfamily V member 1 (TRPV1) activation. It is essential to monitor hypersensitivity
reaction to paracetamol for Zachy (Lourido-Cebreiro et al., 2017).
Prioritized required care : Treatment need to be initiated through salbutamol inhalation because it
provides quick relief. Initially, 2 puffs need to be administered and same repetition should be
there after four hours. However, it should not be administered prior to four hours without
doctor’s approval. Initially, education and training need to be provided to Zachy and her parents