NURS 6521: Advanced Pharmacology

Week 3 Assignment – Asthma Pharmacotherapy and Stepwise Management

Course and Assessment Metadata

Course code/title: NURS 6521 – Advanced Pharmacology (graduate advanced practice core)

Program level: MSN / APRN / DNP-entry (US/Canada/UK/Australia compatible pharmacotherapy case)

Assessment label: Week 3 Assignment – Asthma and Stepwise Management (Assessment 2)

Assessment type: Individual written pharmacotherapy analysis and management plan

Length requirement: 2–3 page paper (approximately 800–1,000 words), aligned with current NURS 6521 stepwise approach expectations

Weighting: 20–25% of course grade

Submission format: APA 7th edition formatted paper, LMS upload

Assignment Overview

Advanced pharmacology courses emphasize stepwise management protocols for chronic respiratory conditions such as asthma. This Week 3 assignment requires you to describe the stepwise approach to asthma treatment, apply it to an assigned patient scenario, and explain how the model supports long-term control while minimizing exacerbations. The paper should demonstrate clinical reasoning, guideline integration, and pharmacologic justification tailored to patient-specific factors.

Asthma pharmacotherapy requires structured escalation and de-escalation of treatment based on symptom frequency, lung function, and exacerbation risk. The stepwise framework promotes individualized care by aligning anti-inflammatory and bronchodilator therapies with disease severity and control. Evidence-based guidelines emphasize inhaled corticosteroids as foundational therapy because they target airway inflammation, which is central to asthma pathophysiology (Global Initiative for Asthma, 2025). Applying this framework ensures safe optimization of therapy while reducing unnecessary systemic corticosteroid exposure.

Learning Outcomes

On successful completion, you will be able to:

• Describe the six-step GINA or NAEPP stepwise approach to asthma pharmacotherapy.

• Analyze patient factors influencing asthma severity, control, and treatment response.

• Justify appropriate controller and reliever medications based on current guidelines and patient presentation.

• Explain the rationale for stepwise escalation, maintenance, or stepping down therapy.

Patient Case Assignment

Your instructor provides a specific asthma patient case via course announcements. The example below is for reference only.

Example Case

A 6-year-old boy with moderate persistent asthma presents for follow-up after two emergency visits in the past year for exacerbations triggered by exercise and pollen. Current regimen includes as-needed albuterol inhaler. Symptoms persist despite reported adherence. School absences are increasing. No recent systemic steroids. Peak flow is 70 percent of predicted.

Task Instructions

Write a focused 2–3 page paper addressing the required elements below using APA headings. Support all pharmacologic decisions with current guideline references and patient-specific rationale.

1. Describe the Stepwise Approach (Approx. 300–400 Words)

• Outline the six steps of asthma management according to current GINA (2025) or NAEPP guidelines.

• Identify preferred controller therapies such as inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and biologic agents.

• Describe reliever medication options at each step.

• Explain criteria for therapy escalation, assessment of control, and stepping down.

2. Apply to the Assigned Patient Case (Approx. 400–500 Words)

• Assess the patient’s asthma severity and current level of control.

• Identify risk factors including age, environmental triggers, adherence, inhaler technique, and comorbidities.

• Determine the appropriate step for therapy initiation or adjustment.

• Propose a detailed pharmacotherapy regimen including drug names, doses, delivery devices, and frequency.

• Address both short-term reliever and long-term controller strategies.

• Provide pharmacodynamic and pharmacokinetic rationale for medication selection.

3. Explain Stepwise Benefits (Approx. 200 Words)

• Discuss how stepwise management promotes sustained asthma control.

• Explain how the model enhances safety, reduces overtreatment, and supports individualized care.

• Describe how ongoing reassessment improves long-term outcomes.

Formatting and Academic Integrity

• Length: 2–3 pages double-spaced (800–1,000 words), excluding title and reference pages.

• Style: APA 7th edition formatting, 12-point font, 1-inch margins.

• Sources: Minimum of 3–4 current scholarly references published between 2018 and 2026.

• Originality: Provide independent analysis. Cite all guideline and pharmacologic sources accurately.

Analytic Scoring Rubric – Asthma Stepwise Assignment

Evaluation reflects guideline accuracy, case integration, pharmacologic reasoning, and scholarly writing quality.

Stepwise Approach Description (30 Points)

• Exemplary (27–30): Complete and accurate outline of all steps with preferred medications and devices; clear explanation of escalation and de-escalation criteria.

• Proficient (24–26): Minor omissions in medication details or criteria.

• Developing (21–23): Partial coverage with minor guideline inaccuracies.

• Needs Improvement (≤20): Incomplete or incorrect description.

Case Application and Regimen Justification (40 Points)

• Exemplary (36–40): Accurate severity assessment; guideline-aligned regimen; strong pharmacologic rationale tied to patient factors.

• Proficient (32–35): Appropriate regimen with minor gaps in justification.

• Developing (28–31): Partially justified regimen; overlooks important factors.

• Needs Improvement (≤27): Inappropriate therapy or weak rationale.

Explanation of Stepwise Benefits (15 Points)

• Exemplary (14–15): Insightful discussion linking safety, efficacy, and individualized care.

• Proficient (12–13): Clear explanation with examples.

• Developing (10–11): General description lacking depth.

• Needs Improvement (≤9): Minimal or inaccurate explanation.

Scholarly Writing and APA (15 Points)

• Exemplary (14–15): Clear organization; concise writing; accurate APA formatting; within required length.

• Proficient (12–13): Minor errors.

• Developing (10–11): Noticeable clarity or formatting issues.

• Needs Improvement (≤9): Frequent writing or APA errors.

 (Model Sections – Not for Submission)

The stepwise approach begins at Step 1 with as-needed low-dose ICS–formoterol as both controller and reliever therapy for mild asthma. Step 2 introduces daily low-dose inhaled corticosteroids. Step 3 adds a LABA to low-dose ICS for persistent symptoms. Step 4 escalates to medium-dose ICS–LABA combinations. Step 5 incorporates LAMA therapy or biologic agents targeting IgE or interleukins in severe asthma. Step 6 reserves oral corticosteroids for refractory cases. Escalation is recommended when symptoms occur more than twice weekly, nocturnal awakenings increase, or lung function remains below 80 percent of predicted.

For the 6-year-old patient described, findings indicate moderate persistent asthma with poor control. A Step 3 regimen is appropriate. Initiating daily low-dose fluticasone via spacer combined with a LABA such as salmeterol addresses airway inflammation and bronchoconstriction. Continued access to as-needed albuterol provides rescue therapy. Age-appropriate inhaler education and caregiver involvement are essential to optimize therapeutic response.

Stepwise management benefits patients by aligning treatment intensity with disease severity while allowing periodic reassessment. This approach prevents unnecessary high-dose corticosteroid exposure and promotes long-term control through structured follow-up.

 References

Global Initiative for Asthma, 2025. 2025 GINA report, global strategy for asthma management and prevention. Available at: https://ginasthma.org/reports/ (Accessed 19 February 2026).

Reddel, H.K., Bacharier, L.B., Bateman, E.D., Duijts, L., FitzGerald, J.M., Garcia-Garcia, M.L., Halpin, D.M.G., Holguin, F., Jackson, D.J., Papadopoulos, N.G., Pizzichini, E., Powell, H., Szefler, S.J., Yorgancıoğlu, A.O. and Boulet, L.P., 2022. Global Initiative for Asthma Strategy 2021: Executive summary and rationale for key changes. American Journal of Respiratory and Critical Care Medicine, 205(1), pp.17–35.

Cloutier, M.M., Baptist, A.P., Blake, K.V., Brooks, E.G., Bryant-McAllister, K., Dixon, A.E., Lemanske, R.F., Ouellette, D.R., Pace, W.D., Schatz, M., Skolnik, N.S., Stout, J.W., Teach, S.J., Umscheid, C.A., Walsh, C.G., Williams, P.V. and Yawn, B.P., 2020. 2020 focused updates to the asthma management guidelines. Journal of Allergy and Clinical Immunology, 146(6), pp.1217–1270.

Liu, A.H., Zeiger, R., Sorkness, C., Ostrom, E., Bloomberg, G., Fuhrmann, V., Douglas, R., Nagykalnai, T., Hoyt, A.E., Sublett, J., Peden, D., Gupta, S., Krusinska, E., Fabbri, L.M., Meltzer, E.O., Pau, A., Serota, A., Hillyer, E.V., Stoloff, S.W., Cox, L., Murphy, K.R., Schatz, M., Israel, E., Wechsler, M.E., Yawn, B.P. and Boushey, H.A., 2019. Asthma management considerations in pediatric populations. Chest, 156(6), pp.1258–1267.

Barnes, P.J., 2019. Inhaled corticosteroids in COPD and asthma: Mechanisms of action and clinical implications. European Respiratory Journal, 54(6), 1900473.