Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Chapter 30 Overview
▪ Asthma
▪ Pathophysiology
Asthma and Chronic Obstructive ▪
▪
Rational drug selection
Monitoring
Pulmonary Disease ▪ Patient education
▪ Chronic obstructive pulmonary disease (COPD)
▪ Pathophysiology
▪ Rational drug selection
▪ Monitoring
▪ Patient education
Copyright © 2016 F.A. Davis Company Copyright © 2016 F.A. Davis Company
Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Asthma Asthma (cont’d)
▪ Pathophysiology ▪ Classification of asthma
▪ Chronic inflammatory disorder of the airways ▪ Mild intermittent
▪ Recurrent episodes of wheezing, breathlessness, and
chest tightness
▪ Mild persistent
▪ Airflow obstruction is reversible. ▪ Moderate persistent
▪ National Asthma Education and Prevention Program Expert ▪ Severe persistent
Panel 3 Guidelines (2007) are used for management of all
types of asthma.
▪ Adult and children definitions differ slightly.
, Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Asthma (cont’d) Asthma Step Therapy
▪ Goals of therapy ▪ First determine severity of asthma symptoms.
▪ Reduce impairment
▪ Prevent chronic symptoms. ▪ Go to Step Therapy Chart and start at recommended step.
▪ Reduce use of inhaled short-acting beta agonists. ▪ The Expert Panel 3 Guidelines prefer an aggressive approach
▪ Maintain normal or near-normal pulmonary function.
▪ Maintain normal activity levels. to gaining quick control.
▪ Meet patient/family expectations of asthma care. ▪ Asthma control is “the degree to which the manifestations of
▪ Reduce risk asthma are minimized by therapeutic intervention and the
▪ Prevent recurrent exacerbations and minimize emergency department
(ED) visits and hospitalizations. goals of therapy are met” (NAEPP, 2007).
▪ Prevent loss of lung function.
▪ Provide optimal therapy with minimal adverse drug reactions (ADRs).
Copyright © 2016 F.A. Davis Company Copyright © 2016 F.A. Davis Company
Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Mild Intermittent Asthma Mild Persistent Asthma
▪ Step 1 therapy ▪ Step 2 therapy
▪ Use short-acting beta2 agonists as needed ▪ Treat with one long-term control medication daily.
for symptoms. ▪ Low-dose inhaled corticosteroids are the mainstay for all
age patients.
▪ Patients have symptoms when exposed to triggers ▪ Cromolyn or a leukotriene modifier are alternatives.
(upper respiratory infections, allergens, chemical ▪ See dosage charge for low-dose schedule of each
inhalants). inhaled corticosteroid.
▪ Exercise can be mild intermittent. ▪ Use beta agonists as needed; if using 2 days or more
per week, then step up in therapy.
▪ Need an annual flu shot.
Chapter 30 Overview
▪ Asthma
▪ Pathophysiology
Asthma and Chronic Obstructive ▪
▪
Rational drug selection
Monitoring
Pulmonary Disease ▪ Patient education
▪ Chronic obstructive pulmonary disease (COPD)
▪ Pathophysiology
▪ Rational drug selection
▪ Monitoring
▪ Patient education
Copyright © 2016 F.A. Davis Company Copyright © 2016 F.A. Davis Company
Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Asthma Asthma (cont’d)
▪ Pathophysiology ▪ Classification of asthma
▪ Chronic inflammatory disorder of the airways ▪ Mild intermittent
▪ Recurrent episodes of wheezing, breathlessness, and
chest tightness
▪ Mild persistent
▪ Airflow obstruction is reversible. ▪ Moderate persistent
▪ National Asthma Education and Prevention Program Expert ▪ Severe persistent
Panel 3 Guidelines (2007) are used for management of all
types of asthma.
▪ Adult and children definitions differ slightly.
, Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Asthma (cont’d) Asthma Step Therapy
▪ Goals of therapy ▪ First determine severity of asthma symptoms.
▪ Reduce impairment
▪ Prevent chronic symptoms. ▪ Go to Step Therapy Chart and start at recommended step.
▪ Reduce use of inhaled short-acting beta agonists. ▪ The Expert Panel 3 Guidelines prefer an aggressive approach
▪ Maintain normal or near-normal pulmonary function.
▪ Maintain normal activity levels. to gaining quick control.
▪ Meet patient/family expectations of asthma care. ▪ Asthma control is “the degree to which the manifestations of
▪ Reduce risk asthma are minimized by therapeutic intervention and the
▪ Prevent recurrent exacerbations and minimize emergency department
(ED) visits and hospitalizations. goals of therapy are met” (NAEPP, 2007).
▪ Prevent loss of lung function.
▪ Provide optimal therapy with minimal adverse drug reactions (ADRs).
Copyright © 2016 F.A. Davis Company Copyright © 2016 F.A. Davis Company
Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition Pharmacotherapeutics for Advanced Nurse Practitioner Prescribers, 4th Edition
Mild Intermittent Asthma Mild Persistent Asthma
▪ Step 1 therapy ▪ Step 2 therapy
▪ Use short-acting beta2 agonists as needed ▪ Treat with one long-term control medication daily.
for symptoms. ▪ Low-dose inhaled corticosteroids are the mainstay for all
age patients.
▪ Patients have symptoms when exposed to triggers ▪ Cromolyn or a leukotriene modifier are alternatives.
(upper respiratory infections, allergens, chemical ▪ See dosage charge for low-dose schedule of each
inhalants). inhaled corticosteroid.
▪ Exercise can be mild intermittent. ▪ Use beta agonists as needed; if using 2 days or more
per week, then step up in therapy.
▪ Need an annual flu shot.
