Category: Asthma

Summary

Bronchial asthma, being one of the significant health problems due to the high prevalence of the disease worldwide, has not received an adequate assessment concerning coronavirus disease, the most relevant today. The article focuses on research on this problem because respiratory allergy is associated with a significant decrease in the expression of ACE2 receptors, which are the entry receptor for COVID-19. The research reflected in the article aims to trace the susceptibility of patients with bronchial asthma to coronavirus disease. The observed results served as the basis for recommendations for the treatment of bronchial asthma.

Significance

The article “COVID-19 susceptibility in bronchial asthma” can be assessed as significant for society, and that is why it was selected as the object for review. Bronchial asthma itself is a significant threat to human death; constant monitoring is necessary to prevent the onset of asthma attacks. The acute problem with coronavirus today still requires attention and further research. The importance and relevance of the article are that it explores this relationship and can offer some statistics and figures “indicating low susceptibility to COVID-19” in patients with pre-existing asthma. (Green et al., 2021, 688) Thus, research makes it possible to comfort these patients and shield them from the greater fear that they suffer in such a situation. Bronchial asthma is a chronic disease, and most often, genetic causes are the main ones for the onset of the disease. However, asthma can develop under the influence of unfavorable working environment factors, and in this case, more people are at risk.

Personal Response

The article reviewed is of particular interest, as it explores the relationship between diseases and hence susceptibility, which are the most relevant at the moment. The new coronavirus infection continues to spread worldwide, and research related to it is also relevant and necessary to the current state of affairs. In addition, the situation in the world with bronchial asthma has been aggravated in recent decades. Despite the fact that the second has been studied much more than the first, asthma is a severe disease that cannot be cured entirely; coronavirus disease overlaps with asthma and can be an additional trigger for asthma patients.

It is noted that the receptors that respond to those occurring in the environment are the same, and the susceptibility of patients with bronchial asthma to COVID-19 remains a crucial topic for study. However, the study cited in the article suggests low susceptibility, which is to some extent consolation and good news for patients with asthma. Cases of coronavirus infection are more common in people who smoke, so they are more at risk compared to asthmatics. The article is not difficult to read; the information provided and the evidence base on statistics, tables, figures, and relevance are traceable and do not require any changes.

Describing the Bronchial Asthma

Etiology and Mechanism the Bronchial Asthma

Bronchial asthma is a chronic inflammation of the airways; respiratory symptoms can vary in time and intensity and appear with airway obstruction. The following internal and external etiological factors can influence the development of BA:

• genetic, hereditary, allergic, and/or dysmetabolic predisposition;
• allergens and / or non-specific agents – pollutants;
• auxiliary adverse environmental factors (Hall & Agrawal, 2017).

BA symptoms develop after contact with allergens, which are non-infectious and infectious. Pollen, household, food, epidermal, chemical, insect, medicinal, professional allergens are considered non-infectious, and fungal, bacterial, parasitic, viral ones are infectious. In addition, chemical substances, tobacco smoke, biological inducers, and neuropsychic effects can serve as allergens; this group is non-specific inducers of pollutants. Allergens are responsible for 60-85% of asthma in adults and 64-90% of asthma in children. The central mechanism of the pathogenesis of bronchial obstruction in any clinical and pathogenetic variant of asthma is congenital or acquired hyperreactivity and hypersensitivity of the bronchi. Hypersensitivity is the condition of bronchial receptors to low doses of allergens and pollutants (Semernik et al., 2017). Hyperreactivity of the bronchi is an increased, in contrast to the norm, response to allergens or non-specific agents, characterized by a decrease in the threshold of sensitivity to them.

Signs and symptoms

The following signs of bronchial asthma are noted:

• Asphyxiation can arise both during physical exertion and in complete rest and when inhaling the allergenic particles in the air.
• Shortness of breath co-occurs with cough and has a harsh character.
• An asthma attack involves an inability to breathe deeply and frequent shallow breathing.
• Wheezing accompanies the breathing of a person during an attack and is sometimes listened to even remotely.
• Orthopnea is a posture that a person reflexively assumes during an attack; this pose promotes deeper exhalation (Hou et al., 2018).

Without treatment, symptoms can progress over time; as the disease develops in the body, such disorders arise as:

• General weakness
• Cyanosis of the skin
• Difficulty breathing
• Shortness of breath
• Dry cough
• Dizziness and headache
• Susceptibility to various diseases.

Diagnostic methods

A clinical diagnosis of bronchial asthma should be established by a doctor based on patient complaints, medical history, and diagnostic methods. A specific examination for allergic pathology is carried out, while it is necessary to consider the bronchial obstruction and the degree of its reversibility. The following methods are used to assess lung function and the degree of reversibility of bronchoconstriction:

• Spirometry is an essential method of investigating the reversibility and severity of bronchial obstruction.
• Peakflowmetry is performed with a peak flow meter and is used to measure the maximum expiratory flow rate.
• Bronchoconstrictor test is currently the most common method for studying bronchial hypersensitivity at present.
• The allergological examination includes provocative tests on the skin, laboratory tests for the detection of specific IgE antibodies are also relevant.

Pathology, pathophysiology, systems affected

Bronchial asthma affects the respiratory system; it is provoked by bronchial hyperactivity, leading to shortness of breath, repeated attacks of suffocation, chest congestion, and wheezing. It manifests in the form of shortness of breath that occurs in the area of the bronchi. At the later stages of asthma, structural changes occur in the airways: fibrosis, vascular proliferation—an increase in the number of mucous glands in the submucous layer. The progression of these processes leads to an aggravation of asthma, a deterioration in lung function, and a decrease in the effectiveness of therapy.

Prognosis, treatments, might we expect a chronic phase?

Predominantly, the disease occurs in the chronic phase, and modern medicine cannot cure bronchial asthma. However, all efforts are aimed at creating a therapy that preserves the patient’s quality of life. Pharmacotherapy of the disease is divided into two groups:

• Preparations for situational use
• Preparations of constant use (Khaitov et al., 2018).

Medicines aimed at relieving seizures include anticholinergic drugs, combination drugs, theophylline. Medications for the supportive therapy of bronchial asthma include inhalation and systemic glucocorticosteroids, long-acting theophylline, anti leukotriene drugs, antibodies to immunoglobulin E. Treatment of bronchial asthma involves complexity; drugs and methods of using these substances are equally important. The drugs are administered by inhalation, parenterally, or orally. To deliver medicines through the respiratory tract, the following groups of drugs are possible:

• aerosol inhalers;
• powder inhalers;
• nebulizers.

Public health impact: who does this affect, how, why, where?

Bronchial asthma is a severe medical, social and economic problem. On average, 4-18% of the world’s population suffers from asthma of varying degrees. In childhood, the disease is diagnosed to a greater extent, predominantly in boys. The ratio of cases to boys and girls is usually equated to adolescence; in adults, women are at risk and, for the most part, suffer from bronchial asthma. According to statistics, cleanliness increases the incidence of allergies and its clinical climax – asthma (Uwaezuoke, 2018). It is noted that townspeople suffer from asthma more often than rural residents. This is since the human body cannot adequately respond to natural allergens in too clean conditions of civilization and urbanization polluted with exhaust gases.

Technological and research advancements on the horizon

Research in this area is underway, and the article cited confirms this. Many sources also note the need for further research on this problem associated with bronchial asthma. Technological and research advancements are especially relevant in evidence-based medicine, treatment, diagnosis of asthma, etiology of the disease. Fundamental questions of modern directions devoted to bronchial asthma are designed to optimize the treatment and focus on controlled clinical trials in the field.

References

Green, I., Merzon, E., Vinker, S., Golan-Cohen, A., & Magen, E. (2021). COVID-19 susceptibility in bronchial asthma. The Journal of Allergy and Clinical Immunology: In Practice, 9(2), 684-692.

Hall, S. C., & Agrawal, D. K. (2017). Vitamin D and bronchial asthma: an overview of data from the past 5 years. Clinical therapeutics, 39(5), 917-929.

Hou, C., Zhu, X., & Chang, X. (2018). Correlation of vitamin D receptor with bronchial asthma in children. Experimental and therapeutic medicine, 15(3), 2773-2776.

Khaitov, M. R., Gaisina, A. R., Shilovskiy, I. P., Smirnov, V. V., Ramenskaia, G. V., Nikonova, A. A., & Khaitov, R. M. (2018). The role of interleukin-33 in pathogenesis of bronchial asthma. New experimental data. Biochemistry, 83(1), 13-25.

Semernik, I. V., Semernik, O. E., Dem’yanenko, A. V., & Lebedenko, A. A. (2017). A method for noninvasive diagnosis of bronchial asthma based on microwave technology. Biomedical Engineering, 51(2), 124-127.

Uwaezuoke, S. N., Ayuk, A. C., & Eze, J. N. (2018). Severe bronchial asthma in children: a review of novel biomarkers used as predictors of the disease. Journal of asthma and allergy, 11, 11.

As recorded in her medical history, the patient in discussion has experienced asthma. This is important as it enables a practitioner to identify one of the potential causes of her symptoms. She claims that she has been coughing and wheezing since three weeks ago. These are indicators of various illnesses, including pneumonia and influenza. This paper aims to diagnose the patient’s condition and offer treatment options.

Diagnosis

My diagnosis is that she is experiencing asthmatic symptoms, which might have been triggered by hormonal changes or stress as she is pregnant. According to Nadolpho (2012), there is proof that some hormones can trigger asthma, for example, progesterone and estrogen. Nadolpho (2012) further claims that this is due to their ability to increase inflammation in the body, which affects the air paths. Additionally, it is recorded that she has not had a flu shot yet. Even though this could have led to issues such as influenza and pneumonia, the evidence is insufficient (Nadolpho, 2012). Using the symptoms only, one can argue that wheezing is mostly seen more in individuals with asthma than in influenza and pneumonia.

Pharmacological Intervention

For pharmacologics, I am prescribing medications use of inhalers and oral drugs safe for pregnant women, for example, glucocorticoids. Therefore, prescribing medications and methods that are safe for her condition should be a priority (Ahmed & Turner, 2019). Glucocorticoids can be utilized in this situation to treat asthmatic symptoms. Experience from the use by pregnant women shows that they are safe for not only the mother but for the child as well (Akar-Ghibril et al., 2020). They consist of pills such as inhaled drugs, for example, budesonide, fluticasone, beclomethasone, and prednisone. Many inhalers combine a glucocorticoid with a long-acting bronchodilator (Akar-Ghibril et al., 2020). It may be essential to modify the type and dose of medication to compensate for the alterations in the female’s metabolism and the severity of her health condition.

Pharmacodynamics and Pharmacokinetics of Glucocorticoids

The impact of glucocorticoids is mediated by genomic as well as nongenomic mechanisms. According to Akar-Ghibril et al. (2020), the former consists of activation of the cytosolic glucocorticoid receptor that causes suppression of manufacture of inflammatory enzymes and chemokines. The pharmacokinetics consisting of distribution, absorption, and elimination, are key determinants of the duration or magnitude of action. According to Akar-Ghibril et al. (2020), the above-mentioned factors control dosage. Similar to other steroid hormones, glucocorticoids access the cognate intracellular receptors by passive diffusion via the plasma membrane (Akar-Ghibril et al., 2020). From there, they are bound to a particular plasma transport called transcortin. It is important to note that the majority of it is eventually excreted in urine (Akar-Ghibril et al., 2020). Glucocorticoids should be consumed with care as excessive dosage can result in abnormalities of placental and fetal growth in pregnant women.

Non-pharmacological Intervention

For non-pharmacological intervention, I am recommending massage, which has several benefits; including helping alleviate the risk of developing severe asthma. When the respiratory system is affected, the rib cage’s tightness increases, the lung capacity becomes shallow, and the nervous and muscular systems have difficulty relaxing. According to Asthma for Health Professionals (2022), massage allows the muscles to be stretched and release tension, which decreases lung congestion. In addition, it generates heat to increase body temperature and rate of respiration.

Exercise

Apart from massage, I am recommending exercise but with caution. Despite regular physical activity being identified as one of the methods to reduce the effect of asthmatic symptoms, some exercises can lead to a worse asthma condition. According to National Heart, Lung, and Blood Institute, National Institutes of Health (2017), the key will be to perform jogging exercise once daily for twenty minutes. They can work by making the lungs stronger without the risk of inflammation. The more someone engages in physical activities, the more their lungs become used to consuming oxygen.

As a nurse practitioner, experience in the field suggests that the exercises reduce symptoms as they increase endurance. According to National Heart, Lung, and Blood Institute, National Institutes of Health (2017), over a period, exercising helps the air paths to establish tolerance to physical activities. This allows someone to be less tired than before when engaging in normal activities such as using the stairs or running. Exercise will improve cardiovascular fitness, which is the overall conditioning of the heart, and better the blood and oxygen flow.

Meditation

I am recommending that the patient embraces meditation and chiropractic adjustments. On the one hand, results from personal trials show that meditation may be useful in minimizing stress. Among asthma patients, it can improve life quality (Ahmed & Turner, 2019). On the other hand, the condition in discussion results in airway constriction and inflammation, leading to breathing difficulty. Gentle adjustments will allow appropriate nerve communication that will guarantee the entire body is working at optimal health levels. This will provide as well better immune responses in her to help combat the symptoms any time they arise.

Communication Plan

Communication is an important tool that guarantees the patient understands the instructions given by nurse practitioner. It is essential to ascertain verbal as well as nonverbal information concerning the condition and approach them. An NP can determine the emotional state through eye tracking (Ahmed & Turner, 2019). It helps to develop a communication culture and engage the individual during recovery. For instance, for the patient in discussion, to ensure that she takes her medication seriously, it would be essential to consider developing a channel through which she will feel comfortable speaking about any emerging issues as she continues with the prescription.

During this process, it will be important to ask her whether or not she understands the instructions I give and allow her to demonstrate one of the suggested or recommended actions. For example, in case the goal is performing a breathing exercise, she could illustrate that to enable the practitioner to identify if she needs more education on that or not (Ahmed & Turner, 2019). Apart from that, there is the issue of medication, whereby it would be beneficial if she could show that she comprehends how much she needs to consume daily. A simple questionnaire can help the nurse practitioner to determine the length of her understanding.

Local Resources to Address

In addition to interventions, there are issues that one must address, including housing, medical insurance, and counseling. In the city of Chicago, there is an establishment named Home for New Moms. It offers parenting, child development initiatives, and career readiness for young mothers. Additionally, the patient can access instant and temporary coverage from Medicaid Presumptive Eligibility program in Illinois, if she meets certain income requirements. Lastly, for counseling, she can get support from Caris Pregnancy Counseling and Resources in Chicago. All these facilities are found within the state of Illinois which makes it easier for her to access.

Conclusion

The paper includes a diagnosis of the patient’s asthmatic condition and treatment using glucocorticoids and non-pharmacological ways such as massage and meditation. From the symptoms, it is obvious that she is experiencing asthma which might have been triggered by hormonal changes as she is pregnant. The interventions suggested have considered her state and thus, recommend methods that are safe for her and the baby. It is important for a pregnant female to constantly seek medical attention to ensure her safety and that of the unborn child.

References

Ahmed, H., & Turner, S. (2019). Severe asthma in children—a review of definitions, epidemiology, and treatment options in 2019.Pediatric Pulmonology, 54(6), 778–787. Web.

Akar-Ghibril, N., Casale, T., Custovic, A., & Phipatanakul, W. (2020). Allergic endotypes and phenotypes of asthma.The Journal of Allergy and Clinical Immunology: In Practice, 8(2), 429-440. Web.

Asthma for health professionals. (2022). Asthma for Health Professionals | NHLBI, NIH. www.nhlbi.nih.gov. Web.

Nadolpho. (2012). Pregnancy and Asthma. ACAAI Public Website. Web.

National heart, lung, and blood institute, national institutes of health. (2017). Guidelines from the National Asthma Education and Prevention Program. Web.

Introduction

Asthma is an illness that disproportionately affects many adults and children globally. In 2019, 262 million people had asthma, causing 461 000 deaths (WHO, 2020). Scholars have done asthma-related research to provide information on causes, symptoms, therapies, and asthma mitigation. This study will describe asthma as a chronic condition, including its symptoms and signs, incidences, surveillance, reporting, epidemiological analysis, screening, prevention, and prevalence by state and national statistics.

Background and Significance

Asthma is a lung disorder that makes it hard to breathe occasionally. Many people experience symptoms during childhood, though they can occur at any age. Asthma is caused by inflammation and subsequent muscular tightening around the narrow airways in the lungs, causing further narrowing of these passageways, leading to symptoms such as wheezing, coughing, chest tightness, and difficulty breathing (He et al., 2020). These symptoms and signs come and go and tend to be more intense at night or when exercising. Symptoms might be worsened by a variety of other typical triggers, including virus infections, weather fluctuations, fumes, smoke, dust, animal feathers and fur, tree and grass pollen, perfumes, and harsh soaps. Asthma has a variety of symptoms and pathogenesis, including acute, subacute, or chronic inflammation of the airways, intermittent blockage of airflow, and hyperresponsiveness of the bronchi (Sullivan et al., 2016). Mucus secretion and airway edema can lead to airflow restriction and bronchial reactivity (Sullivan et al., 2016). Mucus hypersecretion, epithelial desquamation, smooth muscle hyperplasia, airway remodeling, and mononuclear cells and eosinophils are all varying degrees.

Asthma prevalence has been shown to vary under various factors. It is higher in girls at 6.0% than in boys at 5.7% in the U.S., where it impacts more than 25 million people, including 8.4% of adults and 5.8% of children (CDC, 2020). There are 10.4% of women and 6.2% of males with asthma (CDC, 2020). Prevalence is higher among African Americans at 11.6% than Whites at 9.3% and lowest among Hispanics at 6.7% (CDC, 2017). In 2020, the CDC found that 7.4% of Texan adults and 7% of youngsters were currently dealing with asthma. Approximately ten individuals in the United States die every day from the illness (CDC, 2020). There were 232 fatalities in Texas in 2018, representing an annual mortality rate of 8.3 per 1,000,000 residents (CDC, 2019). The table below describes the CDC’s data about asthma prevalence in Texas and the United States.

Table 1: Prevalence Of Asthma In the U.S. & Texas

Surveillance and Reporting

Information gathered through public health monitoring is used to inform and improve programs and policies to reduce disease incidence and mortality rates. Surveillance information on the prevalence of asthma in the United States is compiled from various sources, including the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (Pickens et al., 2018). The local burden of asthma has been estimated in several states and towns using surveys or administrative data, including Medicaid claims data and hospitalization (Benka-Coker, 2018). All these are accurate and credible sources of surveillance data and reports.

Cases of asthma have been identified using administrative data such as outpatient, pharmaceutical, or hospital billing data. Prevalence monitoring in schools has shown to be a fruitful exercise as most children are evaluated by school-based surveillance systems because they are present at school (Benka-Coker, 2018). In the U.S., laboratories and healthcare professionals report cases of communicable disease to state or local health centers as part of the country’s primary public health surveillance system, which relies on a passive, notifiable disease monitoring system (Haghiri et al., 2019). Compared to systems that rely on administrative data, this method often provides a timelier response and can facilitate the reporting of instances or clusters of cases.

Occupational asthma has prompted the creation of the Sentinel Event Notification System for Occupational Risks (SENSOR), which functions similarly to a system for reporting communicable diseases. It is currently conducted in ten states and includes a team of sentinel healthcare practitioners who are likely to meet an instance of occupational asthma reporting specified health events (Moloney, 2022). The results of SENSOR have led to the discovery of additional triggers for asthma in the workplace, but it does not collect data on the incidences of asthma in children or adult-onset asthma unrelated to work (Moloney, 2022). The SENSOR system offers helpful data on the prevalence of asthma in the workplace.

Epidemiological Analysis

This section focuses on asthma – a chronic disease (What) that seriously affects children and adults (Who). Some of the most extensive asthma statistics come from high-income countries (Where) like the UK, Canada, Germany, New Zealand, and Australia, with severe asthma having a prevalence of 2-10% for the years 2017-2020 (When) (Stern et al., 2020). An estimated 23.4 million people have asthma, including 7 million children (Batra, 2022). If those without asthma are not counted, the prevalence of exercise-induced bronchial asthma is between 3 and 10%; if individuals with chronic asthma are included, it rises to 15% (Dharmage et al., 2019). Asthma morbidity and its prevalence appear to be on the rise, especially among children younger than six (Stothers, 2022). Interestingly, about two-thirds of those with asthma have their condition identified before they turn 18 (Stern et al., 2020). Therefore, prevalence changes with the country, sex, and even age.

Various factors contribute to developing asthmatic symptoms at any age (Why). While heredity plays a significant part in predicting susceptibility to developing asthma, environmental factors, rather than race, contribute more significantly to the disease (Dharmage et al., 2019). Air pollution, urbanization, passive smoking, and shifts in exposure to environmental allergens are among the factors that have been suggested as causes (Stothers, 2022). Most children with asthma see improvement or complete resolution of their condition by the time they are young adults because airway reactivity and poorer pulmonary function levels contribute to higher asthma rates in young patients (Stern et al., 2020). Hence, prevalence is higher among children than adults because most of the young ones will recover.

Asthma costs can be broken down into two categories: direct costs and indirect costs. Expenses considered “direct” are associated with hospital stays, doctor visits, nurses, ambulance rides, prescriptions, lab work, diagnostics, and preventative measures (Nunes et al., 2017). The costs associated with morbidity cannot be directly measured, such as the time and energy a parent or caregiver invests in caring for an asthmatic kid. Expenditures on prescription drugs and hospital stay accounted for the bulk of direct medical costs, significantly higher than indirect costs (Nunes et al., 2017). Direct medical expenditures may rise, but the total cost of treatment may go down if indirect costs fall by an even more significant amount due to better clinical outcomes.

Screening and Guidelines

Diagnosis begins with a discussion between the patient and the doctor regarding symptoms and general health. The doctor asks about existing symptoms and any possible triggers. The doctor carries out different types of screening, including spirometry, challenge tests, lung tests in children, and exhaled nitric oxide tests (Saglani & Menzie, 2019). For patients aged five years and above, spirometry is the standard diagnostic procedure that evaluates the inhaling and exhalation volumes and air rates (Louis et al., 2022). Asthma causes airway narrowing, so if the patient’s vital signs are below average for someone of the patient’s age, it may indicate that the patient needs medical attention. If the patient has asthma, the doctor may request that the patient inhale a medication to relax the patient’s airways before repeating a lung function test (Louis et al., 2022). Signs of marked improvement after this treatment suggest the possibility of asthma.

Since spirometry is a rather effective diagnostic tool, it is essential to analyze some of its characteristics. Thus, the research by Meneghini et al. (2017) showed that “the specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%” (p. 428). These findings show that this test can be used only in specific cases like screening workers exposed to pollutants, but for most patients, this test is not enough because of its low sensitivity. However, since spirometry has a high NPV, it is likely that when the test is negative, a patient does not have asthma. Noticeably, spirometry shows higher levels of specificity than some other tools. Overall, spirometry is relatively cheap and rather common (Aaron et al., 2018). Patients not diagnosed using spirometry have higher overall costs than those who use this method.

The American Thoracic Society (ATS) and the European Respiratory Society (ERS) have published a standardized spirometry protocol. One indicator of airway obstruction is the fraction of one second’s forced expiratory volume divided by one’s forced vital capacity (FEV1/FVC) (Graham et al., 2019). Asthma is characterized by reversible physiological airflow restriction and airway diameter changes; spirometry should be the first step in the diagnostic process.

Plan: Integrating Evidence

To control asthma, it is important to uncover and discuss its primary, secondary, and tertiary interventions that can be used by a nurse practitioner after graduation. The primary intervention is to position the patient properly, check the vital signs, and administer bronchodilators and oxygen if needed (Issel et al., 2021). These methods will help the nurse mitigate the asthma attack. Then, for the secondary intervention, the medical worker should use long-term control drugs like inhaled corticosteroids, prednisone, and budesonide (Sobieraj et al., 2018). These preventative asthma drugs target the inflammation of the airways, which is the root cause of asthma symptoms.

Finally, the education of patients is the tertiary method a nurse has to implement. Asthma interventions targeting teenagers and children must be customized to their specific conditions. Teens and kids in rural areas are more likely to benefit from interventions that include school-based health education programs and nurse services for asthma treatment (Horner et al., 2016). Rural children’s asthma outcomes are most likely to improve from interventions that go beyond encouraging strict adherence to prescribed medications. Positive results have been seen from interventions that boost healthcare providers’ understanding of asthma and its treatment (Estrada & Ownby, 2017). Programs with the most effects have trained primary care physicians and school nurses to better educate their patients about asthma and its management.

In order to ensure that the interventions have utility and that they are useful, I will incorporate their key aspects and components when treating the patients (Issel et al., 2021). I will also identify the patients that benefit from each type of intervention. I will also record and analyze specific conditions under which each intervention achieves maximum results (Issel et al., 2021). It will be possible to integrate health policy advocacy efforts, namely, the creation of school-based preventive programs to reduce the number of accidents among children.

Conclusion

In conclusion, the paper has discussed vital issues relating to asthma by collecting and interpreting data from previous research sources. The report has described and defined critical terms related to asthma, provided a background review, and discussed its signs and symptoms. The symptoms and signs identified are breathing difficulty, coughing, chest tightness, and wheezing (He et al., 2020). The paper has also discussed numerous approaches to monitor and survey disease prevalence, such as primary public health and sentinel surveillance system (Moloney, 2022). Epidemiological analysis, screening, and guidelines associated with asthma have also been discussed. Since statistics show that over 20 million people have asthma in America, this is a rather serious public health issue (Batra, 2022). Finally, the paper has provided a plan discussing the key interventions that can be incorporated to mitigate asthma. The interventions discussed are providing health care education, quick-relief efforts, and long-term asthma medications (Sobieraj et al., 2018). Healthcare education provided in schools also ensure that children and teenage cases are properly managed.

References

Aaron, S. D., Boulet, L. P., Reddel, H. K., & Gershon, A. S. (2018). Underdiagnosis and overdiagnosis of asthma.American Journal of Respiratory and Critical Care Medicine, 198(8), 1012-1020. Web.

Batra, M., Vicendese, D., Newbigin, E., Lambert, K. A., Tang, M., Abramson, M. J., & Erbas, B. (2022). The association between outdoor allergens–pollen, fungal spore season, and high asthma admission days in children and adolescents.International Journal of Environmental Health Research, 32(6), 1393-1402. Web.

Benka-Coker, W. O., Gale, S. L., Brandt, S. J., Balmes, J. R., & Magzamen, S. (2018). Optimizing community-level surveillance data for pediatric asthma management. Preventive Medicine Reports, 10, 55-61. Web.

Centers for Disease Control and Prevention (CDC). (2020). Most recent national asthma data. Web.

Centers for Disease Control and Prevention (CDC). (2019). Most recent national asthma data. Web.

Centers for Disease Control and Prevention (CDC). (2017). Adult asthma data: BRFSS prevalence tables and maps. Web.

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults.Frontiers in Pediatrics, 7, 246. Web.

Estrada, R. D., & Ownby, D. R. (2017). Rural asthma: Current understanding of the prevalence, patterns, and interventions for children and adolescents.Current Allergy and Asthma Reports, 17(6), 1-8. Web.

Graham, B. L., Steenbruggen, I., Miller, M. R., Barjaktarevic, I. Z., Cooper, B. G., Hall, G. L., & Thompson, B. R. (2019). Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement.American Journal of Respiratory and Critical Care Medicine, 200(8), e70-e88. Web.

Haghiri, H., Rabiei, R., Hosseini, A., Moghaddasi, H., & Asadi, F. (2019). Notifiable diseases surveillance system with a data architecture approach: A systematic review.Acta Informatica Medica, 27(4), 268. Web.

He, Z., Feng, J., Xia, J., Wu, Q., Yang, H., & Ma, Q. (2020). Frequency of signs and symptoms in persons with asthma.Respiratory Care, 65(2), 252-264. Web.

Horner, S. D., Brown, A., Brown, S. A., & Rew, D. L. (2016). Enhancing asthma self‐management in rural school‐aged children: A randomized controlled trial.The Journal of Rural Health, 32(3), 260-268. Web.

Issel, L. M., Wells, R., & Williams, M. (2021). Health Program Planning and Evaluation: A Practical Systematic Approach to Community Health. Jones & Bartlett Learning.

Louis, R., Satia, I., Ojanguren, I., Schleich, F., Bonini, M., Tonia, T., & Usmani, O. S. (2022). European Respiratory Society guidelines for the diagnosis of asthma in adults.European Respiratory Journal. Web.

Meneghini, A. C., Paulino, A. C. B., Pereira, L. P., & Vianna, E. O. (2017). Accuracy of spirometry for detection of asthma: A cross-sectional study.Sao Paulo Medical Journal, 135, 428-433. Web.

Moloney, M. (2022). Promoting evidence-based asthma diagnosis and surveillance using electronic tools.

Nunes, C., Pereira, A. M., & Morais-Almeida, M. (2017). Asthma costs and social impact.Asthma Research and Practice, 3(1), 1-11. Web.

Pickens, C. M., Pierannunzi, C., Garvin, W., & Town, M. (2018). Surveillance for certain health behaviors and conditions among states and selected local areas—behavioral risk factor surveillance system, United States, 2015. MMWR Surveillance Summaries, 67(9), 1. Web.

Saglani, S., & Menzie-Gow, A. N. (2019). Approaches to asthma diagnosis in children and adults.Frontiers in pediatrics, 7, 148. Web.

Sobieraj, D. M., Weeda, E. R., Nguyen, E., Coleman, C. I., White, C. M., Lazarus, S. C., & Baker, W. L. (2018). Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. Jama, 319(14), 1485-1496.

Stern, J., Pier, J., & Litonjua, A. A. (2020). Asthma epidemiology and risk factors. In Seminars in immunopathology (Vol. 42, No. 1, pp. 5-15). Springer Berlin Heidelberg.

Stothers, B. (2022). Examining the effect of salbutamol use in ozone air pollution by people with asthma and/or exercise-induced bronchoconstriction. The University of British Columbia.

Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma.Respiratory Research, 17(1), 1-11. Web.

World Health Organization (WHO). (2020). Chronic respiratory diseases: Asthma. Web.

Case Summary

A 23-year-old female patient presents with coughing and wheezing, which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her respiratory symptoms brought her to your office today.

History

She had chickenpox as a child. She had asthma as a child, diagnosed at age 8, for which she used an SABA when needed. She has not needed to use an inhaler since she was 19. She takes only her prenatal vitamins. No other acute or chronic problems. She advises you that she is up to date on all immunizations, except she has not had a flu shot (it is October).

Social

Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.

HPA

Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.

PE/ROS

The patient appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.

02 98% and FEV 70%

Diagnosis

The most likely diagnosis is asthma exacerbation based on the patient’s symptoms, medical history, and physical examination results. The patient has had asthma and has been experiencing typical signs for the past three weeks, including wheezing and an ineffective cough. She claims to be exhausted even in the morning due to the constant wheezing that can be heard from across the room. The diagnosis of asthma exacerbation is also supported by the physical examination findings of wheezing in all lung fields and decreased lung function, as demonstrated by an FEV1 of 70%. The lack of a support system and the patient’s recent move to a new area could have contributed to her asthma symptoms (Namazy & Schatz, 2021). The prenatal care provider should confirm this diagnosis at the visit the following week. Given that maternal hypoxia and fetal distress should be avoided when a patient has a history of asthma and is 25 weeks pregnant, doctors may decide to confirm this diagnosis using lung function tests. For instance, peak air flow or spirometry tests are done before and after using a bronchodilator. However, these tests are not currently recommended due to the patient’s history of asthma.

Treatment Plan

The diagnosis of asthma exacerbation is made after examining the 23-year-old female patient who has been coughing and wheezing for three weeks. The patient has a history of childhood asthma diagnosis, and she is presently exhibiting typical asthma symptoms like wheezing and a nonproductive cough. Her physical examination reveals she has reduced lung function, as indicated by an FEV1 of 70%, and wheezing in all lung fields. The patient’s recent move to a new area and lack of a support system might have exacerbated her asthma symptoms.

The doctor will suggest combining pharmaceutical and non-pharmacological interventions to treat this patient (Schatz & Namazy, 2018). On the pharmaceutical front, a short-acting beta-agonist (SABA) inhaler, like albuterol, will be recommended for use as required for symptom relief. Hence, a low-dose inhaled corticosteroid (ICS) like fluticasone will also be prescribed to reduce airway inflammation and stop further exacerbations. Therefore, a Leukotriene modifier such as montelukast will also be specified to reduce airway inflammation and eliminate further exacerbations.

In addition to pharmacological therapy, patients will receive instruction on keeping track of their symptoms and abiding by their doctor’s prescription. The doctor will also instruct the patient on avoiding or managing triggers for asthma flare-ups, like cold air, allergens, and stress. The clinician will suggest a social worker or counselor help the patient with her recent experiences of domestic abuse and lack of a support system (Namazy & Schatz, 2021). The doctor will direct the patient to a patient assistance program so she can access her medications. Last but not least, the doctor will direct the patient to a prenatal care specialist for follow-up treatment, monitoring her pregnancy and asthma, and, if possible, an influenza shot (Wu et al., 2019). The patient’s asthma must also be closely monitored throughout her pregnancy, and her care plan must be adjusted as necessary in consultation with her prenatal caregiver.

Community Resources

Several local resources could be helpful for the pregnant 23-year-old who recently moved to the area, is suffering from an asthma exacerbation, is dealing with an abusive partner, and does not have access to a support system or health insurance. Social service organizations can help with housing, food, and financial support. They might also offer assistance through case management and counseling. Community health clinics offer low-cost or free medical care to people who lack or have inadequate insurance. Additionally, they might assist with case management and health education. Community-based organizations can offer various services, including education, recreation, and employment programs. They might also help in case management and counseling.

A referral to nearby services to help this patient should also be considered. For instance, giving her information on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which offers formula and other foods after the baby is born. Some pharmaceutical companies offer patient assistance programs that offer free or inexpensive medications to people who lack insurance or have inadequate insurance. Hence, if this young woman meets the requirements, the Employment Security Commission can help her apply for unemployment benefits by providing open position listings. The public health department provides various services, such as health screenings, immunization programs, and information and resources on health-related topics. Additionally, they might offer assistance with case management and health education (Schatz & Namazy, 2018). Prenatal care providers provide prenatal checkups, prenatal testing, and childbirth education. Additionally, they might offer assistance with case management and health education.

Moreover, domestic violence shelters can offer safe housing, counseling, and support services for victims of domestic abuse in addition to these resources. For example, the Lighthouse Shelter and Heart2Heart Place offer housing and counseling to victims of domestic violence (Ventura County Rescue Mission, 2021). Women fleeing abuse can find great support in these groups, which also gives them a chance to connect with others in the neighborhood who have gone through similar things.

Communication Plan

Several clinical communication constructs would be used in an efficient communication plan to guarantee that the patient is actively participating in their treatment regimen. Tailoring teaching initiatives, tackling obstacles and worries, ensuring the patient has enough support systems, and promoting her health literacy are all tactics for an efficient communication plan (Cvietusa et al., 2019). A patient is more inclined to succeed in understanding the illness process and take an active role in their care plan if they are open-minded, participate in the learning process, are interested in managing their health care, and are willing to make necessary adjustments to enhance their overall result.

As a result, the doctor should start by expressing concern and empathy for the patient’s current situation and circumstances. It is critical to developing a positive and respectful relationship with the patient to communicate with them and engage them in their care effectively (Cvietusa et al., 2019). The doctor would encourage active listening by allowing patients to express their concerns, emotions, and expectations openly. To show that the clinician understands and values the patient’s point of view, they would listen carefully and repeat what the patient said. The doctor would also use a patient-centered approach, adapting the treatment regimen to the patient’s specific needs, preferences, and principles and involving the patient in decision-making.

The doctor would simply and concisely explain their diagnosis, available treatments, and any potential risks or side effects of the treatment. Furthermore, the patient is encouraged to ask questions and is provided with written materials or other resources to consult (Cvietusa et al., 2019). The doctor would schedule regular follow-up visits to assess the patient’s progress, address any issues or complications, and make necessary changes to the treatment regimen. The patient is also encouraged to keep in touch if they have concerns between consultations.

Furthermore, the doctor would respect the patient’s autonomy by allowing them to make decisions about their care, even if they choose not to follow the recommended course of action. The doctor would always respect and support their choices and guide them through any concerns they may have (Cvietusa et al., 2019). Hence, by employing these therapeutic communication constructs, the doctor can establish a strong rapport with the patient, encourage participation in their treatment plan, and ensure they are always informed, engaged, and respected.

References

Cvietusa, P. J., Goodrich, G. K., Shoup, J. A., Steffen, D. A., Tacinas, C., Wagner, N. M., Anderson, C. B., Ritzwoller, D. P., & Bender, B. G. (2019). Implementing Health Care Technology research into practice to improve adult asthma management. The Journal of Allergy and Clinical Immunology: In Practice, 7(3), 908–914. Web.

Namazy, J. A., & Schatz, M. (2021). Contemporary Management and treatment strategies for asthma during pregnancy. Expert Review of Respiratory Medicine, 15(9), 1149–1157. Web.

Schatz, M., & Namazy, J. (2018). Management of asthma during pregnancy: Optimizing outcomes and minimizing risk. Seminars in Respiratory and Critical Care Medicine, 39(01), 029–035. Web.

Ventura County Rescue Mission. (2021). Lighthouse Recovery Program for Women & Children. Ventura County Rescue Mission. Web.

Wu, T. D., Brigham, E. P., & McCormack, M. C. (2019). Asthma in the Primary Care Setting. Medical Clinics of North America, 103(3), 435–452. Web.

Introduction

Asthma is a disorder that affects the airways. As a result, asthma patients experience cough, short breath, and chest pain. Asthma could be diagnosed using specific test examination. The features of the air passage include the bronchi, alveoli and the bronchioles. As a result, clinical manifestations of asthma include wheezing, short breath, cough, and chest blockade.

The pathophysiological mechanisms of chronic and acute asthma exacerbation

The feature of asthma obstruction includes inflammation, mucus, hypersecretion, and angiogenesis (Huether & McCance, 2012). However, inflammation is influenced by cell interaction with various mediators. The pathophysiological feature of chronic asthma includes bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling. The pathophysiology of chronic and acute asthma exacerbation describes the process and stages that lead to airway obstruction (Barnes, 2013).

Bronchoconstriction

The major physiological event that causes clinical symptoms is airways obstruction and interference. However, in acute asthma exacerbation the physiological even includes muscle contraction and airway obstruction. Various irritants cause the bronchial contraction. As a result, the irritants catalyzed immunoglobulin to release dependent mediators. Mediators such as tryptase and prostaglandins cause airway obstruction. However, aspirin, cold air, and allergen trigger the hyperresponsiveness of dependent mediators. In acute asthma exacerbation, stress may influence the severity of clinical symptoms.

Airway Edema

At this stage, clinical symptoms become persistent and progressive. As a result, inflammation and other features of chronic and acute asthma exacerbations are activated. The patient may experience persistent inflammation, mucus secretion, and changes in airway muscle.

Airway hyperresponsiveness

The severity of airway obstruction causes hyperresponsiveness. Thus, the degree of responsiveness is assigned to the stimuli. However, contractile responses determine the severity of acute asthma exacerbation. The change mechanism is influenced by inflammation, neuroregulation, and morphological changes.

Airway remodeling

It is a feature of asthma and acute asthma exacerbation. Airway remodeling can be reversible. Thus, changes in airway obstruction include membrane thickness, hypertrophy, and blood muscle dilation. We will discuss the process and stages of airway inflammation.

Inflammatory cells

Lymphocyte subpopulation describes the mechanism of airway inflammation in chronic and acute asthma. Thus, the displacement in helper 2 cells causes eosinophilic inflammation. However, the production of Th2 helper cells explained the development of airway obstructions. The interaction of lymphocytes and other T helper cells describes the severity of airway modeling. Another feature of airway remodeling is the mast cell. The generation of mast cell secretes bronchial mediators.

The changes in the arterial blood gas pattern

Arterial blood gas patterns influence the response to chronic and acute asthma exacerbation. As a result, the arterial blood pattern indicates the severity of the disorder. At the time of the attack, the arterial blood gas fall below 60mmHg, while the PaCO2 drops below 40mm Hg. As the attack progresses, the PaO2 and PaCO2 will drop below optimum levels. In severe cases, the PaO2 and PaCO2 would rise above optimum levels. As a result, the pH will drop below 7.40. Thus, PaO2 level will determine whether the attack is chronic or acute asthma exacerbation.

The impact of gender on the pathophysiological mechanism of chronic and acute asthma exacerbation

Hyperresponsiveness occur when airway muscles contract and narrows due to stimulus (Iannuzzi, Rybicki & Teirstein, 2009). However, the inflammatory response is the progressive stage of hyperreactive response. Risk factors contribute to the amplification of severe response.

Numerous risk factors predisposed an individual to chronic and acute asthma. However, the prevalence of the disorder has not been attributed to the risk factors that predispose an individual to asthma. The risk factors include gender, age, obesity, behavior, and ethnicity. We will discuss the impact of gender on the pathophysiology of chronic and acute asthma. The cause of asthma has not been established, however documented reports revealed that it is prevalent in adolescent male than female. The case is different in adults as women are prone to asthma attack than men.

Diagnosis and treatment of chronic and acute asthma

It is easier to diagnose adults than children. However, the patient’s family history is an important factor to consider. As a result, a doctor will conduct a physical and diagnostic test. Physical exam includes nasal condition, skin infections, nasal obstruction, and skin conditions. However, diagnostic test includes lung function tests, chest x-rays, vocal cord dysfunction test, and bronchoprovocation. As a result, gender does not affect the treatment and diagnosis of asthma. Asthma treatments are prescribed based on the severity of the attack. However, treatment procedures follow a specific procedure. The aim of treatment will either slow the inflammatory process or eliminate the risk factors that trigger the attack. Treatment interventions include quick relief, inhaled steroids, short acting beta agonist, long acting beta agonist, oral steroids, leukotriene modifiers, anticholinergic, Cromolyn sodium, immunomodulators, and methyl xanthine.

Conclusion

The major changes during an asthma attack include airway hyperresponsiveness and inflammatory response. Quick relief medication can be used to control chronic and acute asthma exacerbation (McPhee & Hammer, 2012). Thus, clinical symptoms such as wheezing, chest tightness, shortness breath, and cough can be treated with quick relief medications.

Mind map of acute asthma exacerbation

Mind map of chronic asthma

References

Barnes, C. (2013). Evidence for common genetic elements in allergic disease. J Allergy Clin Immunol. 106(3), 192–200.

Huether, E & McCance, L. (2012). Understanding pathophysiology. Mosby, USA: St.Louis Press.

Iannuzzi, C., Rybicki, A., & Teirstein, S. (2009). Sarcoidosis. The New England Journal of Medicine. 357(21), 2153-2165.

McPhee, J & Hammer, D. (2012). Pathophysiology of disease: An introduction to clinical medicine. New York, USA: McGraw-Hill Medical.

Introduction

• Asthma is one of the most common chronic respiratory diseases.
• More than 6 million American children are currently diagnosed with asthma.
• About 20 million adult patients treat asthma annually (Centers for Disease Control and Prevention, 2018).
• $100 is an approximate annual medical cost of asthma per child in the US.

Today, asthma is known as one of the most common respiratory diseases in the United States, as well as in the whole world. It affects both, children and adults, and includes a variety of symptoms from a regular cough to insomnia because of shortness of breath. The Centers for Disease Control and Prevention (2018) reports that about 6 million children and 20 million adults are currently diagnosed with asthma. It is a burning problem for the US government because it is stated that about $100 should be spent on one child’s treatment plan (Zahran, Bailey, Damon, Garbe, & Breysse, 2018). Regarding such facts and urgency of asthma issues in the American society, one should know how to develop SOAP notes and underline the most important information.

Case Presentation

Patient: Kelly, a 10-year-old white girl.

CC: “I feel it is difficult for me to breathe in deeply when I play with my friends.”

HPI: The girl’s mother started worrying about her breathing complaints three days ago. Kelly feels pain from time to time and cannot play with her friends all the time she wants. No medications are taken.

PMH: No surgeries, no allergies. Pneumonia at the age of 4.

Social history: She lives with her parents. The father is a smoker.

The patient is delivered to the hospital by her mother. Kelly is a 10-year-old white girl who admits that she cannot easily breathe when she plays with her friends and run outside. Her mother observed these health changes three days ago but did not decide to take some medications. The girl was treated for pneumonia six years ago. No surgeries neither allergies are reported by the mother. In their family, the father is a regular smoker. Smoking is one of the risk factors of asthma for patients (Ierodiakonou et al., 2016). Therefore, the girl could be exposed to indirect smoking even unintentionally.

Review of Systems (ROS)

• General: No chills, night sweats, or migraines. Fatigue and fear.
• HEENT: No complaints.
• Gastrointestinal: Abdominal pain once at night.
• Genitourinary: No complaints.
• Respiratory: Chest pain and a dry cough after extensive running.
• Neurological: No complaints.

The review of systems helps to recognize the main health problems and changes. The patient has a good general look. She denies chills, night sweats, and migraines. Still, she, as well as her mother, says that fatigue starts bothering you from time to time. At the same time, it is evident that the girl experiences fear because of the inability to understand what happens. No complaints are reported on HEENT, the genitourinary system, and the neurological field. Abdominal pain bothered her once at night before this visit. Chest pain and a dry cough were observed several times during the last week after long runs with her friends.

Physical Examination

Vital Signs: BP: 110/70, P: 90, RR: 30, T: 97.5, height: 55”, weight: 70 lbs.

General: The patient looks calm but constrained. She is eager to talk but feels that something wrong.

HEENT: Normal, without deviations.

Gastrointestinal: Symmetrical abdomen without distention, normal bowel sounds.

Respiratory: Wheezing (not frequent).

A physical examination of a patient is developed in a good manner. The child sits still and makes the physical examination possible from different perspectives. All vital signs, including blood pressure, pulse, respiratory rate, temperature, meet the norm. In general the patient looks calm, but a portion of fear cannot be ignored because of the girl’s fear that her health is not ok. She like talking and shares her thoughts about her condition openly. NEENT findings are normal, but respiratory findings prove wheezing and chest pain that turn out to be the main early signs of asthma in children (Zahran et al., 2018). Gastrointestinal examination does not define any changes or complications in the patient.

Differential Diagnoses

• Congestive heart failure, unspecified (ICD-10: I50.9).
• Chronic obstructive pulmonary disease, unspecified (ICD-10: J44.9).
• Gastroesophageal reflux without esophagitis (ICD-10: K21.9).

Regarding the signs and symptoms, as well as the age of the patients and the fact of her exposure to passive smoking, the following differential diagnoses can be given:

1. Congestive heart failure (CHF) (the reduction of lung compliance may lead to dyspnea and wheezing in a child);
2. Chronic obstructive pulmonary disease (COPD) (cough and wheezing because of passive smoking may be the dangerous signs for the patient even at her young age);
3. Gastroesophageal reflux (GER) (a cough and wheezing along with the patient’s history of pneumonia at the age of 4 may be associated with GER).

All these diagnoses may be excluded after several laboratory tests and examinations are developed:

• GER (exclude gastric juice);
• CHF (exclude blood pressure changes);
• COPD(exclude emphysema).

Labs and Tests

• Peak flow;
• Spirometry;
• Chest X-ray;
• Challenge tests:

• • methacholine challenge;
  • nitric oxide test;
  • allergy test.

The main goal of any laboratory tests is to check the condition of the patient’s lungs. A peak flow meter can be used to check how hard a child may breathe. Low flows prove that some problems in the lungs occur. Spirometry is another important tool to check the condition of bronchial tubes and the volumes of air that could be breathed in (Ierodiakonou et al., 2016). Chest X-rays aim at detecting lung abnormalities that lead to breathing problems. There are also several challenge tests that may be additionally assigned to the patient:

• Methacholine challenge (when methacholine is breathed in, it causes numerous constrictions which prove the patient has asthma);
• Nitric oxide test (this gas determines the level of inflammation that may occur in the airways);
• Allergy test (blood tests can be used to identify if the patient has specific reactions to irritants that may cause a cough or wheezing).

Medications

• Inhaled corticosteroids: (Fluticasone or Budesonide);
• Combination inhalers: (Advair or Symbicort);
• Leukotriene modifiers: (Montelukast or Zileuton);
• Theophylline: (Elixophyllin).

Treatment that can be offered to asthmatic patients, including children, is based on the necessity to prevent and control attacks before they start. It is necessary to remember that asthma can hardly be cured, and the task of medications is to reduce associated symptoms. Some medications may be taken seasonally to reduce the risks of allergy, and some drugs should be used on a long-term basis in order to control asthmatic attacks.

1. Inhaled corticosteroids (to reduce oxidative stress and improve airway functions) (Ierodiakonou et al., 2016).
2. Combination inhalers (to reduce and control the number of severe asthma attacks) (Buelo et al., 2018).
3. Leukotriene modifiers (to control asthma symptoms in a short period of time and reduce the risks of unpredictable attacks).
4. Theophylline (to open airways).

Outcomes for Asthmatic Patients

• Reduced exposure to a harmful environment;
• Decreased number of unplanned visits to the ED;
• No missed days at school because of asthma;
• Control of severe asthma attacks.

In case of appropriate treatment, certain expected and unexpected outcomes for asthma may be observed:

1. The reduction of exposure to a harmful environment;
2. The decrease in unplanned visits to the ED;
3. Zero missed classes because of unpredictable asthma attacks;
4. The possibility to control or avoid severe asthma attacks.

Patient Education

• Understand the diagnosis;
• Impact on everyday activities;
• Importance of inhalers;
• Control of attacks;
• Ask for emergent help.

Patient education plays an important role in asthma treatment. Children, as well as their parents, should know how to behave during asthma attacks and how to avoid the situations that can worsen this condition. As a part of educations, it is recommended for patients and their families to:

• Gain a better understanding of the diagnosis and take tests regularly;
• Realize that asthma determine certain human activities;
• Comprehend the worth of inhalers and always have at least one nearby (Ehteshami-Afshar & FitzGerald, 2017);
• Recognize the possibilities to control asthma attacks and avoid unsafe environments;
• Never be afraid to ask for help.

Conclusion

• Asthma cannot be cured but can be controlled;
• Children should ask their parents for help;
• Inhalers must be at hand;
• Medical control is important.

In general, the analysis of this SOAP note on asthma shows that this condition may be dangerous for unprepared patients. It is important to understand that this disease cannot be cured, and people should learn how to live with it and control attacks. Children are in need of additional help and support from their parents. The main rule is to never forget about inhalers and ask for medical assistance anytime. Nurses and therapists are eager to educate children and help their parents or caregivers understand the basics of the life with asthma.

References

Buelo, A., McLean, S., Julious, S., Flores-Kim, J., Bush, A., Henderson, J., … Pinnock, H. (2018). At-risk children with asthma (ARC): A systematic review. Thorax, 73(9), 813–824.

Centers for Disease Control and Prevention. (2018). Most recent asthma data. Web.

Ehteshami-Afshar, S., & FitzGerald, J. M. (2017). Asthma patient education, the overlooked aspect of disease management. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 1(1), 43–45.

Ierodiakonou, D., Zanobetti, A., Coull, B. A., Melly, S., Postma, D. S., Boezen, H. M., … Gold, D. R. (2016). Ambient air pollution, lung function, and airway responsiveness in asthmatic children. Journal of Allergy and Clinical Immunology, 137(2), 390–399.

Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., & Breysse, P. N. (2018). Vital signs: Asthma in children – United States, 2001–2016. MMWR Morbidity and Mortality Weekly Report, 67(5), 149–155.