Assignment task: How will you know if SMART therapy is working at his follow-up?
Patient Scenario
Mr. Matthews is a 46-year-old male who suffers from moderate persistent asthma, overweight due to a sedentary lifestyle and Type 2 diabetes. As a result of severe exacerbations of his asthma, he has been hospitalized once and to Urgent care twice in the past year. In the course of his work, he travels a lot, and so he spends a great deal of time outdoors. Currently, he is on a regimen consisting of a low-dose ICS, as well as LABA, but he relies heavily on SABA to relieve his symptoms.
For Mr. Matthews, transitioning from low-dose ICS to medium-dose ICS along with LABA would be beneficial to improve symptom control. To reduce exacerbations, we can replace SABA with ICS-formoterol as part of SMART Therapy as part of both maintenance and relief therapy. He should be educated that he should not be utilizing his SABA more than three to four times a day.
To detect early signs of worsening asthma in Mr. Matthews, we need to establish his peak flow monitoring so that we can gather a baseline data and track his peak flow daily to adjust his medication to match his PEF zone to detect these signs. Mr. Matthews should a log so that we can reevaluate his measurements and bring it with him to the follow-up appointment.
It is imperative that Mr. Matthews be educated on early warning signs and understands when to use rescue inhalers versus conventional inhalers. To ensure that the patient understands the disease, medications, and action plan, it is essential that NPs know their patients and how well they understand the disease, medications, and measures that are needed to ensure complaint and follow up. Teach back methods are a great way to evaluate the patient's understanding. Asthma management materials that are language-appropriate need to be provided to Matthew, as well as an understanding of what his involvement requires to control his symptoms. If communication is a barrier, we should involve his family/support system in the medication management, peak flow monitoring, triggers, and warning signs. Our aim is not only to treat our patients, but also to help them get the most out of life by offering relief and management.
It would be helpful if Mr. Mathews were given the opportunity to be educated and given information on how to improve his lifestyle by actively being proactive in improving himself by encouraging gradual weight loss to treat the symptoms of airway inflammation. As much as possible, encourage physical activity, such as walking, that will not aggravate his asthma and avoid allergen exposure by using air purifiers, limiting exposure to dust and pet dander, and wearing a mask when he is working outdoors. Referrals to dietician can be helpful to help with weight loss. Need Assignment Help?