Category: Asthma

Comprehensive History and Physical Examination

Identifying Data

The patient was identified as S. A. The use of initials was considered a necessity to prevent personal data disclosure.

Reasons for Seeking Health Care

Cough and wheezing; shortness of breath; chest tightness.

Chief Complaint

Difficulty breathing, especially at night.

History of Present Illness

The patient addressed the hospitals staff with complaints of having breathing issues. Particularly, S. A. reported significant troubles breathing, as well as the presence of evident wheezing sounds in their chest. The specified episodes are especially common in the night, and there are immediately followed by continuous coughing. Characteristics: nonproductive dry cough prevents S. A. from sleeping and does not contribute to any improvements only weakening her. The client explained that she experienced especially numerous problems during the night. Aggravating factors include pollen, dry weather, dust, and instances of anxiety. Relieving factors: to reduce the magnitude of the symptoms, S.A. uses a combination of herbal treatment strategies and pain relievers. Treatment: apart from using inhalers occasionally, the patient has not had any treatment so far since she is at the early stage of adult-onset asthma development.

Medication

S. A. has not been subjected to any treatment yet. Hence, no medications have been administered to her so far. The patient has been using herbs to address the coughing issue.

Allergies

The patient is allergic to pollen, dust, cold air, smoke, fumes, animals, and mold. Furthermore, the instances of allergy can be caused by strong scents, in general. For example, S. A. stated that she had a breathing problem after scenting strong perfume.

Past Medical History

S.A. had pneumonia when she was 24. As a young child, she often had a cold and a sore throat, which led to bronchitis. She also had influenza four times (at the age of 15, 18, 19, and 23). The patient claims to have never experienced any difficulties breathing before, though.

Past Surgical History

The patient had an appendectomy at the age of 17. The patient also had a partial mastectomy due to the development of breast lumps. Neither of the surgeries was followed by any complications.

Family History

The patients family history does not contain any medical issues that can be defined as possible risk factors for her health. Specifically, there has been no known history of allergies or asthma. The patients maternal grandfather developed Alzheimers disease at the age of 74, which implies that S.A. may need to consider applying preventive measures against the possible development of the disorder. Particularly, the introduction of physical exercises and a proper diet should be regarded as a necessity. It should also be borne in mind that the patients father died at 51 due to lung cancer. The patients mother is a social worker in retirement, who has been experiencing musculoskeletal issues, particularly, the effects of osteoporosis.

Social History

S. A. can be described as rather introversive, which means that it is rather difficult for her to establish social connections with the members of her community. She is a professional software developer. Her hobbies include drawing and traveling.

Sexual and Reproductive History

S. A. is heterosexual. The patient is not married and has had only two partners. She currently lives alone.

Health Care Maintenance (HCM)

S. A. rarely uses healthcare services, mostly because her work occupies a significant amount of her time. Furthermore, the patient is reluctant to use medical services because of the fear of experiencing significant pain in the process. Combined with the lack of awareness about the means of sustaining her health, the specified characteristic of the patient is likely to lead to major health concerns unless addressed.

Review of Systems

All of the patients systems except for the respiratory one function properly. According to the physical assessment results, the patients airways narrow as a result of being exposed to certain factors such as the presence of pollen in the air.

Complete Physical Examination

Vital Signs

Pulse 87, temperature 105°F, blood pressure 119/75, weight 107, height 52, respiration 23, and body mass index (BMI) 19.6.

Mental Status Exam (MSE)

S. A. is properly groomed, her clothes being neat, and her hair is arranged in a simple yet neat way. S. A. articulates her ideas well and is fully aware of her environment and condition, which can be viewed as the sign of her having no mental issues. Similarly, no behavior disorders have been spotted during the examination. Her responses to irritants are adequate and timely. Thus, it can be concluded that S. A.s state of mind is regular. It should be noted, however, that the patient had certain difficulties when communicating. The specified issue can be explained by the fact that S. A. had breathing issues and had recently experienced a fit of what was presumably asthma. As a result, of the health issue experienced by S. A., she was in distress and, thus, was rather worried (Ferro et al., 2015).

The actions of the patient, as well as her reactions to irritants and articulation of her problem and condition, can be regarded as the signs of her being in a normal state of mind and having no mental concerns. The signs of distress shown by S. A., however, may be the symptoms of developing stress and the threat of possible depression due to an increase in anxiety levels. Thus, it is essential to provide a therapy based on the enhancement of patient education and the provision of detailed instructions to S. A. to help her manage her condition.

The patients thoughts are clear and coherent. S. A. is capable of critical thinking and detailed analysis. Thus, it can be assumed that her thought process is coherent.

S. A. also displays regular cognitive functions. While anxiety has a distinct effect on her, she manages to utilize her cognitive skills. Thus, the patients mental health status can be regarded as positive.

S. A.s mental health is not impaired. She can thin coherently and properly. However, the presence of anxiety needs to be addressed (Bruzzese et al., 2016).

Skin

S. A. has a dark complexion and, therefore, is not prone to sunburns. The patients response to touch is adequate. Based on the results of the Blanch Test, S. A.s nails meet the current standards of health. S. A.s hair is dark brown and curly. S. A.s hair can be defined as relatively healthy, although it is not thick and is prone to falling out. The observed phenomenon can be attributed to the increase in the stressful experiences associated with asthma, as well as improper dieting (particularly, the lack of protein) (Grond, 2017).

Head

S. A. has a slightly elongated head, which can be described as symmetrical. The head has no signs of injuries. The lymph nodes that are located in the patients head are of a regular size.

Eyes

S. A.s eyes have white sclera, with slight shortsightedness. S. A.s eyes respond to the motion within a 1-2-second range, which can be regarded as normal. The pupils are enlarged due to shortsightedness.

Ears

The ear canals are of a regular size and color. The eardrums are not damaged. S. A. responds to sounds appropriately and is capable of hearing them at regular frequencies. The Otoscopic test carried out in the hospital setting did not reveal any deviations from the norm (Ting, Huang, & Tzeng, 2016).

Nose and Sinuses

The external portion of the patients nose is symmetrical and placed appropriately. S. A.s nostrils are currently occluded, which can be viewed as a partial reason for the observed difficulty breathing.

Mouth and Throat

The patients lips are moist and proportional. The tongue can be described as pinkish, with a geographic texture. The specified characteristic implies that the patient is experiencing inflammation (Radhika, Jeddy, & Nithya, 2016).

Neck

S. A.s neck has proportional muscle. The patient does not experience any pain when moving her neck. The size of S. A.s lymph nodes meets the standards.

Respiratory

The patient has approximately 20-23 inhalations-exhalations per minute, which can be explained by the presence of asthma. Significant respiration efforts and uneven movements were observed. The Supraclavicular lymph nodes are palpable.

Cardiovascular and Peripheral Vascular

The pulse rate is 107, which is slightly above the norm. The specified phenomenon can be explained by anxiety and the presence of asthma. There are currently no signs of varicose.

Abdomen

S. A.s abdomen is symmetrical, with no scars or evident abnormalities. Peristaltic movements are regular and within the normal range. S. A. has no bowel sounds, her stool being regular, and with no signs of either diarrhea or constipation.

Musculoskeletal

S. A. has normal muscle movement. The tissue has no abnormalities in its structure. S. A. does not have any discomfort when moving.

Neurological

Subsegmental lymph nodes are currently plugged. Furthermore, mediastinal lymphadenopathy is observed. S. A. provides adequate responses to questions and reacts to stimuli appropriately. However, there are evident signs of anxiety regarding her current health issue. The specified phenomenon must be addressed fast to prevent further development thereof. The cranial nerves of the patient are regular. CN VIII is intact (Lee et al., 2014).

References

Bruzzese, J. M., Reigada, L. C., Lamm, A., Wang, J., Li, M., Zandieh, S. O., & Klein, R. G. (2016). Association of youth and caregiver anxiety and asthma care among urban young adolescents. Academic Pediatrics, 16(8), 792-798. Web.

Ferro, M. A., Van Lieshout, R. J., Scott, J. G., Alati, R., Mamun, A. A., & Dingle, K. (2016). Condition-specific associations of symptoms of depression and anxiety in adolescents and young adults with asthma and food allergy. Journal of Asthma, 53(3), 282-288. Web.

Grond, S., Radner, F. P., Eichmann, T. O., Kolb, D., Grabner, G. F., Wolinski, H.,& Rülicke, T. (2017). Skin barrier development depends on CGI-58 protein expression during late-stage keratinocyte differentiation. Journal of Investigative Dermatology, 137(2), 403-413. Web.

Lee, Y. G., Jeong, J. J., Nyenhuis, S., Berdyshev, E., Chung, S., Ranjan, R.,& Jarjour, N. N. (2015). Recruited alveolar macrophages, in response to airway epithelialderived monocyte chemoattractant protein 1/CCl2, regulate airway inflammation and remodeling in allergic asthma. American Journal of Respiratory Cell and Molecular Biology, 52(6), 772-784. Web.

Radhika, T., Jeddy, N., & Nithya, S. (2016). Tongue prints: A novel biometric and potential forensic tool. Journal of Forensic Dental Sciences, 8(3), 117-119. Web.

Ting, C. S., Huang, K. W., & Tzeng, Y. C. (2016). Correlation between video-otoscopic images and tympanograms of patients with acute middle ear infection. Indian Journal of Otology, 22(1), 10-13. Web.

Asthma is a global non-communicable disease which has a huge public health implication for both adults and children. It is characterized by mortality and morbidity Research indicate that prevalence in asthma is higher in children compared to adults. Middle income countries are the most affected due to environmental factors (Dharmage, Perret & Custovic, 2019). It is a chronic disease that affects airways, these are the tubes which transport air in as well as out of the lungs. The interferes with the breathing process due to bronchoconstriction and inflammation of the airways. It is a condition whereby airways swell and narrow as extra mucus is produced.

The narrowing of the airways means that breathing becomes labored. This condition triggers wheezing, cough and shortness of breath. The problems and conditions related to the disease points ranges from a minor discomfort to a serious and life-threatening asthmatic attack (Dharmage, Perret & Custovic, 2019). The disease cannot be cured, but its symptoms can be managed and controlled. It is not possible to treat the disease since it changes over time and hence the need to trace and understand the inherent signs and symptoms and adjust treatment accordingly (Dharmage, Perret & Custovic, 2019). Based on these facts, it is important to analyze causes, signs and symptoms as well as treatment of asthma and this forms the basis of this research.

Currently, asthma is the most common non-communicable disease and for a long time it has had a huge impact on quality of life. Just as already indicated, the impact of asthma can range from life threatening to mild (Dharmage, Perret & Custovic, 2019). However, whether mild or life-threatening, the disease has a huge implication on the quality of life and hence the need for victims to always seek medication (Dharmage, Perret & Custovic, 2019). Worldwide, asthma is ranked 16th as the leading cause of years that people live with disability. The burden of living with asthma can be enormous. According to Dharmage, Perret & Custovic(2019) more than 300 million people have asthma worldwide. It is estimated that by 2025 100 million more will be affected. This raises concerns and calls for the need to mitigate the problem and improve quality of life for millions of people across the world (Kemp & Craig, 2009). It is on the same basis that an understanding of the disease should be enhanced, and public sensitizations improved at all levels.

On asthma prevalence, it can be argued that there is a large geographical variation with regard to severity, prevalence and mortality. Research shows that asthma is higher in the high-income nations. But mortality is higher in low income nations for reasons such as lack of resources and expertise to deal with it. Despite the advancement in technology in the treatment of asthma in the recent decades, more needs to be done to educate patients on the gains made in curbing the problem (Widegren, Andersson & Greiff, 2009).

Currently, there is evidence that asthma is a complex multifactorial disorder and is attributed to interactions between genetic susceptibility, environmental and host factors. The host factors include, weather, pollution, mold and pollen grains. Mechanism of asthma include airway inflammation, control of airway reactivity and tone. These variables define and dictate the emerging signs and symptoms, and as already indicated an understanding of these implications can help deal with the issue and problem of asthma, both locally and globally (Widegren, Andersson & Greiff, 2009). It is on this basis that it is ideal to look at causes, signs and symptoms of the disease as well as its treatment.

Causes of Asthma

The actual causes of asthma remain unknown. However, what is known is that it is a chronic inflammatory condition that affects the airwaves. What can be termed as causes are actually triggers (Alford, 2001). What happens is that as the trigger comes into contact with the airways, inflammation occurs and they get narrow, they are then filled with mucus (Alford, 2001). When a trigger occurs, an attack happens.

Asthma attack is characterized by narrowing of the airways making breathing harder and almost impossible (Widegren, Andersson & Greiff, 2009). The narrowing of the airways occurs when spasms are inflamed. It is then preceded by swelling of the mucosal membrane (Alford, 2001). The attacks are characterized by shortness of breath cough or wheezes the body fights and get rid of the mucus. Some of the most common causes of Asthma attacks comprise of allergies, food and food additives, exercise, smoking, heartburn, sinusitis, medications, weather and smoke. These triggers can lead to either a mild or severe asthma attack and forms the point of reference in the understanding of the causes and implications of the condition (Kemp & Craig, 2009). An understanding of these conditions can help manage and mitigate problems associated with asthma as a medical condition.

Allergies and asthma are a common problem. Allergies contribute to most cases of asthma (Rutkowski, 2005). Research indicate that more than 80% of individuals suffering from asthma have allergies to things like weed pollens, grass, trees, fabrics and dust. An exposure to some of these things can lead to asthma attack (Rutkowski, 2005). Food and additives as allergies can lead to a mild or severe asthma attack. The same can lead to a life-threatening reaction known as anaphylaxis (Rutkowski, 2005). Foods associated with allergic symptoms include, peanuts, eggs, tree nuts and soy. Food preservatives and especially sulfite additives which are used on food processing are likely to trigger asthma.

Symptoms of Asthma

Signs and symptoms of asthma vary from one individual to another (Dharmage, Perret & Custovic, 2019). For example, mild asthma could have symptoms only at particular times (Widegren, Andersson & Greiff, 2009). In most cases, these symptoms are sporadic and only occur at times when one is exercising or exposed to certain triggers like the pollen grains (Dharmage, Perret & Custovic, 2019). These signs and symptoms include, tightness of the chest, shortness of breath, trouble sleeping, coughing and wheezing (Widegren, Andersson & Greiff, 2009). Most common symptoms of asthma include, chest pain and tightness, shortness of breath, trouble sleeping.

Trouble sleeping is caused by shortness of breath and could lead to wheezing and coughing. Wheezing or whistling sound are other common symptoms which worsens by the respiratory virus such as flu and cold. (Lara & Esthela Hernandez, 2012) The highlighted symptoms are common to both mild and severe cases of asthma. However, signs which indicate that asthma is probably worsening include, increasing difficulty in breathing (Lara & Esthela Hernandez, 2012). This is measured by the use of a peak and flow meter, a tool used for measuring functions of the lungs. In this case, inhaler can be used, but each and every inhaler is designed to meet an individual’s needs and requirements.

It is important, however, to indicate that signs and symptoms of asthma to some people can flare up in particular circumstances (Cheung, LeMay, Saini & Smith, 2014). Exercise-induced asthma is an example of special circumstance and the same may worsen when the air is dry and cold. Occupational asthma is another case of special signs and symptoms of asthma and is induced by workplace chemical fumes, dusts and poisonous gases (Cheung, LeMay, Saini & Smith, 2014). Finally, allergy-induced asthma is another special case with unique signs and symptoms. These signs are initiated by airborne materials such as pollen, spores and cockroaches waste, dried saliva and fabric particles floating in air. In these cases, the symptoms can be severe (Coşkun, Ercan & Bostanci, 2019).

Management and Treatment of Asthma

Management and treatment of asthma requires routine tracking of symptoms as well as measuring how well the lungs are working (Warman, 2000). It involves taking an active role in the treatment and management process. These initiatives can help prevent asthma attacks and avoid long term problems. The first step is to create asthma action plan with the help of your doctor. The plan should be written and tailored to particular needs of the individual (Warman, 2000). The first action plan is to track the symptoms.

Tracking symptoms such as shortness of breath, painful chest and wheezing can help determine when medication is required. Secondly, record how the longs are working (Warman, 2000). It involves recording results of breathing test. Finally, one needs to adjust treatment according to the designed action plan. Treatment should be tailored to suit the particular signs of symptoms of the conditions (Dogru, Ozde, Aktas & Yuksel Karatoprak, 2015).

This assignment will explore in detail the chronic inflammatory lung disease known as asthma. It will identify the aetiology of the condition and explain how the causes contribute to the disease. It will present the signs and symptoms associated with asthma incorporating clinical signs whilst linking with the underlying pathophysiology. It will include the main investigations undertaken in order to aid the diagnosis of asthma and identify one common drug group used in the treatment and management of the condition. Psychological and sociological effects of the condition will also be explored.

Asthma is a common respiratory condition often chronic; it is characterized by attacks of spasm in the bronchi of the lungs, causing breathing difficulty. According to Asthma UK, currently in Northern Ireland 182,000 people (1 in 10) are currently receiving treatment for asthma. This includes 36,000 children and 146,000 adults. The National Health Service (NHS) spends around one billion pounds a year treating and caring for people with asthma attributing to 77,124 UK hospital admissions in 2016/17 (Asthma UK, 2019).

Asthma is caused when inflammation occurs in the bronchioles, these are small airways which transport air from the larger bronchial tubes to the microscopic alveoli. However, in asthma the bronchial smooth muscle wall narrows therefore making breathing extremely difficult. Plugs containing a mixture of sticky mucus form, serum proteins and cell debris production increases, which may entirely block the airway creating an airway obstruction. Certain triggers may cause hyper-responsiveness of the airways leading to bronchospasm and chronic inflammation often occurs when something that irritates the lungs enters, allergens such as animal fur, pollen, mould, cigarette smoke, air pollution, exercise and contracting an upper respiratory tract infection may also trigger asthma. (Aldington and Beasley 2007)

An exacerbation is a deterioration in the level of control experienced by a person with asthma. Recurring episodes of inflammation can lead to an obstructed airway which is a life-threatening medical emergency. It is vital a nurse takes note of the level and duration of deterioration as well as obtaining a full detailed history from the patient. Current UK guidelines advise that once an adequate history has been taken, the following parameters should be checked, respiratory rate; pulse rate; pulse oximetry; peak expiratory flow (PEF) and record and document any treatment a patient may have self-administered before presentation. After this initial assessment the patient can then be categorized as moderate, severe or life threatening based on criteria and a management plan implemented.

It can be very difficult to say for certain why some people contract asthma, although it is known that an individual is more likely to develop it if there is a family history of the condition.

Researchers in Oxford have found that the gene responsible for asthma, hay fever and other allergy-type illnesses is only active when inherited from the mother. If inherited from the father, the offspring is less likely to suffer from these illnesses. (Tanday, 2015)

Asthma may develop at any age; atopic asthma generally begins in childhood or adolescence and is associated with identifiable triggers that provoke wheezing. There are several factors can increase a person’s risk of developing asthma such as exposure to tobacco smoke as a child or a mother smoking whilst pregnant (Gilliland FD, 2001). In many cases, asthma is an allergic disorder and when an allergen is inhaled into the airway it triggers the release of the hormone histamine from the mast cells, the chemicals generate an inflammatory response leading to swelling and an increased production of viscous mucus from the epithelial lining. Histamine can also act as a bronchoconstrictor and is partly responsible for airway hyper-reactivity and increased secretions. All these effects shrink the lumen of the airway and restrict airflow entering or leaving the alveoli, fresh supplies of oxygen can no longer enter, therefore the concentration of oxygen in the alveoli will fall. As a result, blood flowing through the pulmonary circulation is no longer fully oxygenated, which can lead to hypoxaemia. Oxygen saturations will drop, and all body tissues will become hypoxic. (Cambell, 2011)

Asthma can also be drug induced, amongst the common causes are acetylsalicylic acid (ASA; aspirin) and other non-steroidal anti-inflammatory drugs (NSAIDs), which have been known to trigger asthma attacks in 4-28% of asthmatic patients. Early exposure of the drug acetaminophen (paracetamol) has also been linked to asthma. (Gonzalez-Barcala et al., 2013)

Frequency and severity of attacks varies with each person; however, the most common signs and symptoms of asthma are dyspnoea (difficulty breathing), patients may experience a tightening sensation of the chest, coughing and wheezing. A cough may be worse at night and in the early mornings. The basic underlying pathology in asthma is reversible and causes diffuse airway inflammation (Porth 2011). Asthma can also get worse for a short time – this is known as an asthma attack and can happen suddenly, or gradually over several days. It is vital for a nurse to be able to recognise the signs and symptoms of a severe asthma attack, for effective relief and treatment. This is especially important when a patient presents to an emergency department (A&E) experiencing severe symptoms as there is thought to be a link between deaths in some cases (Camargo, Rachelefsky and Schatz, 2009). Such patients have a respiratory rate of over 25 breaths per minute, a tachycardia of 110 beats per minute or more, and a peak expiratory flow rate of 33-50% of their normal volume. This happens because the lungs become hugely hyperinflated as the patient cannot breathe out effectively. Other signs may include being too breathless to eat, sleep or even speak, hypertension, cyanosis, fainting, drowsiness, dizziness, exhaustion and confusion. (Campbell, 2011).

Asthma can be difficult to diagnose however there are several investigative tools used to assist doctors diagnose asthma, whilst also taking into consideration the patients’ symptoms and detailed past medical history. The main tests used to help diagnosis are the FeNO test, this requires the patient to breathe into a machine that measures the nitric oxide levels on the breath which can be a sign of lung inflammation. A similar test is the peak flow test, this is handheld device that will measure expiration rate and may be repeated several times over a few weeks to determine if it changes over time. Serum immunoglobulin (Ig) E levels may increase from an allergic reaction and taking a complete blood count (CBC) may reveal increased eosinophil count. Studies have shown that patients with asthma and blood eosinophil counts greater than 400 cells per μL experience more severe exacerbations and have poorer asthma control. (Price et al., 2019). Peak flow expiratory flow rate usually morning and evening measurements can be useful in long term assessment of asthma; a characteristic morning dipping pattern is seen in poorly controlled asthma. Chest x-rays can diagnose or monitor asthmas progression and may flag up hyperinflation with areas of atelectasis. It is important to consider that patients with asthma their pulse oximetry (Sao2) may be reduced and rates of There is no known cure for asthma. However, successful asthma management will achieve both control of symptoms and prevention of acute attacks. To achieve this, preventative measures including the use of medication to prevent symptoms to treat acute attacks is necessary. Avoiding triggers where possible is just as important. Drugs used in the management of asthma can be classified into two categories, preventers and relievers. The most effective forms are those delivered via inhalation directly into the lungs, this achieves high drug concentrations in the airways, the risk of adverse effects is minimal. (Douglass and Holgate, 2010)

In accordance to (Rees 2019) It is important to follow The British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Networtk (SIGN) stepwise approach to help in the diagnosis and management of asthma, it also helps guide the practitioner when prescribing treatment. For the purpose of this assignment only one drug will be focused on, due to it typically being used for acute exacerbations and exercised induced asthma.It is often the first line of treatment, the inhalation drug named Salbutomol. Salbutomol is a reliever medication (often a rescue drug) it is a short-acting bronchodilator with a rapid onset of action. β2-agonists target β2-adrenergic receptors binding to them, mimicking the effects of adrenaline, inducing relaxation of the smooth muscle in the airway, increasing airflow and reduces hypoxemia providing rapid relief of acute symptoms. Common side effects of salbutamol can include, tremors, arrythmias; dizziness; headache and hypokalameia (Excellence, 2019).

Asthma can have many psychological and sociological effects as well as physiological, as with lots of illnesses, psychological variables may influence outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma.

Asthma and major depressive disorders share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with suffer with asthma. (Van Lieshout and MacQueen, 2008). In addition, people with asthma can feel socially isolated due to having to restrict their participation in social events, limiting their working and playing and have higher tendencies to take time off work due to the illness, which may lead to financial difficulty. (NATHELL et al., 2000) Some people with asthma tend to display avoidance behaviour leading to strained relationships with friends, family and work colleagues. A study has shown asthma control is related to treatment effectiveness and patient disease behaviour, an example of which would be, avoidant or passive coping strategies (tendency to avoid, ignore, deny, or minimize the seriousness of a problem) are associated with less perceived control by patients, attendance at emergency departments, hospital admissions, symptoms and worsening pulmonary function and poor adherence. (Braido etal., 2012)

Effects during an asthma attack can be life threatening and patients can experience extreme feelings of anxiety and fear including thoughts that they may die due to the feeling of being unable to breathe. Asthma’s discomfort and stress may make a person more aggressive, lose control of their lives, leading to diminished self-care in general. According to (Asthma UK, 2017) it may also be said that a person with asthma can feel embarrassment at times whether due to coughing and spluttering during attacks or taking medication in front of others. An Australian study showed children and adolescents living with asthma suffer from lower self-esteem, behavioral problems, and poorer physical and mental health than those without asthma. (Ogundele, 2018)

As previously stated, asthma can affect persons of any age or background, but where someone lives, how much money someone has and how old they are can disproportionately affect the care an individual may receive. Asthma UK’s report On the Edge: How inequality affects people with asthma outlines the impact of health inequality on people with asthma and outlines a possible solution to help reduce this unfair burden. Some key insights noticed were asthma is more prevalent within more deprived communities, and those living in more deprived areas of England are more likely to go to hospital for their asthma. People from disadvantaged socio-economic backgrounds are more likely to be exposed to the causes and triggers of asthma, such as air pollution and cigarette smoke. There is significant variation in access to basic asthma care across geography, ethnicity and age group. Asthma requires a person to manage their own illness, self-management is difficult to embed in groups with lower health literacy. In order to reduce health inequality in asthma and enable people to better adhere to self-managed treatment, there must be preventative action on the causes of asthma and its triggers, improved access to basic care, and digital innovation to improve engagement in healthcare and health literacy (Cumella and Haque, 2018). Due to the absence of a cure and a need for asthma management, health care professionals can play a very important role in order to educate an individual around the signs and symptoms of asthma including its triggers to lessen and prevent an asthma attack occurring.

Asthma is an important chronic disease which can result in clinically significant morbidity, many missed days for people off work and school and has a substantial impact upon the NHS through rising costs, emergency care and 77,124 admissions to UK hospitals for asthma in the last year alone, 1’700 of which were Northern Ireland hospital admissions. (Asthma UK, 2019) This makes it essential for one to understand the development, causes and diagnosis of asthma, it is clear more research would be beneficial to those that suffer with asthma as health practitioners do not know what causes the disease, therefore making it difficult to treat, alongside variant symptoms from patient to patient.

Asthma is one of the most common diseases in the world especially in children it’s an obstructive pulmonary condition which affects airways such as the bronchial tubes.

Asthma can be triggered by various factors such as allergies, smoke, weather and many other factors. These triggers could result in a reaction in the airways which could damage them depending on the sensitivity, lifestyle and the genetic history of the person who is at risk of asthma. These triggers cause the muscles around the wall of the airway to become more narrower which could result in the linings of the airway to become inflamed which would lead to swelling. The narrowed airways can result in the goblet cells producing and secreting more mucus whilst damaging the cilia and airways. This build up of mucus results in persistent coughing which makes the lungs more vulnerable to infection due to the bacteria present in the mucus. These reactions caused by the triggers results in symptoms of shortness of breath, wheezing, chest tightness.

DIAGNOSIS

Before determining a treatment plan for the patient preliminary tests are conducted to find out how significant the asthma is and if there are any other possible conditions such as chronic obstructive pulmonary disease (COPD) or a respiratory infection. Some of the tests that are done are the spirometry test which involves how much air you can exhale after a deep breath and how quick the patient can breathe out using a spirometer machine. Or a peak flow test can be done to measure how hard the patient breathes out to determine their peak expiratory flow rate. if these two specific tests cannot give a clearer view on how obstructed the patient’s airways is additional tests can be done such as a nitro oxide test or allergy test. All these tests are done before or after taking bronchildators to open your airways to give clearer view on if the drug had an effect.

TREATMENT

There are various ways in which asthma can be treated and some of them are by using an inhaler or taking short term or long-term medication depending on how serious the condition is. One of the main drugs in the treatment of asthma is the use of bronchodilator medicine specifically β2-adrenergic receptor agonists and these can be used in a short term to treat acute exacerbations or can be used in the long term to treat bronchoconstriction depending on the classification of the patient’s asthma.

β2-adrenergic receptor agonists involve the activation of β adrenergic receptors this allows the airways to become more wider and reduce the stress on the smooth muscle. The mechanism on how it works involves the β2-adrenergic receptor activating the enzyme adenylyl cyclase. This activation lead to the production of cyclic adenosine monophosphate (cAMP) which also involves the activation of protein kinase A (PKA). The activation of these enzyme causes a change in calcium concentration whilst also affecting the potassium channels by increasing their levels through a different mechanism. These actions lead to inactivation of myosin light chain kinase which is a protein kinase found in the smooth muscle. This inactivation of this kinase promotes relaxation in this smooth muscle. Also from the activation of cAMP and protein kinase A. The activation of myosin light chain phosphate also occurs which causes the rapid relaxation of smooth muscle allowing inflamed areas of the airway to become alleviated. So overall from the combination of the decrease levels of calcium and increased levels of potassium as well as the activation and inactivion of certain protein kinases the smooth muscle cells in the airways become hyperpolarized allowing the airways to widen and recover from the use of the β2-adrenergic receptor agonists.

β2-adrenergic receptor agonists can come mainly in 3 different forms which are the short acting agonists the long-lasting agonists and the ultra-long acting beta agonist. The short acting agonist (SABAs) is the primary line of acute treatment of asthma Some examples of this type of drug is salbutamol albuterol and fenoterol and these drugs are mainly administered via inhalation using dry powder and the time taken for onset action can be lower than 5 minutes with the maximum effect the drug occurring within 30 minutes. These types of short β2-adrenergic can be used in conjunction with long lasting agonists and can have a therapeutic effect for a duration between 3-6 hours.

Long lasting agonists (LABAS) can also be used for patients with COPD as well as asthma they are taken when the first line of treatment (SABAs) have failed to have an effect and they are usually taken in combination with inhaled corticosteroids due to recent research suggesting a superior efficacy with dual therapy versus monotherapy as well as preventing reduced swelling in the airway. Some common examples of (LABAS) are Serevent® (salmeterol)and Foradil® (formoterol). These types of LABAS are mainly given to patients that require long term medication due to the increased severity of their classification of asthma this means the asthma sufferer would be taking these drugs every day to control their symptoms of asthma. Like the (SABAs) these drugs are also taken via inhalation and have a duration for at least 12 hours reducing the chances of symptoms occurring at night whilst sleeping.

The final type of β2-adrenergic agonists is Ultra-LABAs and this has the greatest duration of effect that lasts up to 24 hours. Some examples are Indacaterol, Olodaerol and Vilanterol and these are taken via inhalation mainly by dry powders. The administrative route of inhalation is the most recommended due to the concentrating effect on the airways and reduced chance of interference by systematic circulation.

CONCLUSION

To conclude these β2-adrenergic agonists have a great effective in the treatment of asthma specifically SABAs due to their rapid reversal of airflow obstruction and alleviation of asthmatic symptoms. However there can be adversary effects involving the cardiac and metabolic systems.

Introduction

Asthma is one of the most widely recognized heterogeneous respiratory infections and has become the fundamental explanation to visit the crisis office and admission to the medical clinic setting each year. It has been viewed as fourteenth most basic illness on the planet as far as span and degree of inability. The worldwide asthma report uncovered that 334 million individuals were influenced by the asthma all through the world, of 14% youngsters and 8.6% youthful grown-ups (matured 18-45). Moreover, around 0.25 million individuals kick the bucket every year rashly because of ill-advised administration and absence of individual asthma checking instrument. Youthful grown-ups (age 18-25) experiencing asthma ought to have an individual asthma checking gadget to survey their sickness and decline their danger of fuel and medical clinic confirmation. Consequently the early determination of asthma what’s more, accomplishing worthy asthma oversight at the ideal time stays shifty in spite of the current strategies. There are two methods to diagnose asthma; firstly, through clinical investigation carried out by the specialized physician secondly, by applying diagnostic equipment such as Spirometer and peak flow meter. However, the first method could be inaccurate sometimes due to manual and involvement of human. Whereas, the second method such as Spirometer have its own drawback like adult patients experience dizziness due to fully physical involvement, chest pain, coughing, bronchospasm and oxygen desaturation due to lack of oxygen. Indeed, it is difficult to get an accurate result if the patient is not able to understand the set of instructions, having chest pain forbidding a forceful effort, or not able to cooperate. It indicates that a successful test required full cooperation and wall chest pain-free.

In addition, the error rate of the spirometer may increase up to 24% of the otherwise normal subject due to the limitation of existing reference equation. Similarly, the peak flow meter is highly patient dependent and relatively insensitive which shows that unless giving a hard and fast expiratory effort, the true peak will be undervalued. However, peak flow meter is easier than Spirometer. It requires only a short blow, not continued expiration until the lungs are completely emptied. Naturally, the patient has to repeat it thrice and highest result of three attempts is the actual peak flow values. Hence both the methods required a full, deep breath in, and blast it out as hard as fast as a patient can until no more air exists in the lungs. Therefore, the aim of our research is to develop a patient-independent and home monitoring early screening asthmatic device that can be used by both asthmatic adult and children. A Recent study shows that the capnograph can be considered as a new method to monitor the asthmatic condition as it uses an infrared technology to measure the concentration of carbon dioxide during exhalation and helps to understand the respiratory status of the patients including asthma. However, most of the studies were offline. Furthermore, the existing capnograph is bulky, costly and cannot estimate components of physiological dead space as well as not able to distinguish the end of expiration from the beginning of inspiration. Thus, we have developed a light weight, effort independent and portable asthma monitoring device that can measure the expired CO2 concentrations and differentiate early stage of asthma

Literature survey: Designing a Respiratory CO2 Measurement Device for Home Monitoring of Asthma Severity. In this research, a new portable and low-cost respiratory CO2 monitoring device based on MG-811 CO2 sensor and microcontrollers was proposed. The output information of this device can be shown either in a small LCD provided or in PC through USB port. The device design will be executed, and a prototype will be developed and tested for validation. So, this new portable capnograph can be used by asthmatic patients as a homemonitoring device instead of peak flow meter without any complicated instructions

Development of an Electronic Kit for detecting asthma in Human Respiratory System. In this research a low cost and portable asthma monitoring devices is proposed. For this device, the main component is carbon dioxide sensor, TFT LCD display and also Bluetooth module. The result from the user can be displayed using TFT LCD display and also PC; meanwhile the result display in a type of graph which can categorize the user either asthmatic or normal. In this research, three asthmatic and normal users are gather to test this device and the result for each of them are gather for analysis. The pattern of the graph for asthmatic user show a significant different compared with normal user.

Problem Statement

Asthma, a constant well being condition pre-dominant in kids can be portrayed by shortness of breath, chest snugness and hacking. An asthma assault can be activated by an assortment of components including ecological conditions, serious physical movement, mugginess and dust. Because of the high commonness of asthma in youngsters and the trouble associated with diagnosing the condition it gets basic to think of mechanical answers for ceaseless consideration and the board of patients with this incessant infection.

Methodology

The MG-811 sensor must be aligned before taking any further estimations. Without the procedure, it will just give futile outcomes. Two sources at known CO2 focus levels are required to accomplish a precise alignment result. In the information sheet it is recommended to adjust the MG811 sensor for 400 ppm and 1000 ppm. Not with standing, while the outside surrounding condition can be treated as around a 400 ppm source, it is difficult for most clients to gain admittance to a solid 1000 ppm source. The sensor can even now be touchy at high fixation levels. Consequently he proposed to utilize the breathed out air as an elective source which gives a subsequent adjustment point at 40,000 ppm. The two portrayals of the alignment program and activity program. To begin the adjustment, first burden the adjustment sketch into the Arduino UNO processor through the Arduino IDE programming. The capacity of this sketch is essentially 5000mV (5V) voltmeter. It is critical to utilize this voltmeter rather that connecting an outer meter.

This is since any blunder between the Arduino esteem and the remotely estimated worth will truly disable the adjustment. The Arduino can give a conceivable however off base outcome on the off chance that it doesn’t get adequate force from the force flexibly. To check for right activity associate capacity to the Arduino and the CO2 sensor module. Likewise ensure that the showcase is fueled by means of the Arduino rationale pins. While the gadget is working under full burden, cautiously separate the yellow CO2 sensor yield wire from A0 of the Arduino and associate a hop wire from 3.3V to A0. Watch that the showcase peruses 3.3 Volts to inside 1% mistake, for example 2700-3300 mV. Any 17 deviation for the most part proposes that the force gracefully to the Arduino is deficient. This may be found if the Arduino is just force by a PC. Once the system has reached ‘steady state’ it is now time to determine the output voltage of the sensor at 400 ppm. The way by letting the device operate in a totally unoccupied and well ventilated space. Then observe the voltage without breathing on the sensor. Vacate the space for another hour and check again. If the voltage is substantially unchanged, take a note of the reading. This gives the value ‘v400ppm’ in the Arduino operational sketch. After the output voltage at 400 ppm and 40000 ppm are determined from the calibration, replace v400 and v40000 in sketch 2 with the new values, and then upload the uploaded sketch into Arduino via IDE software. The operation program allows the device to perform the following tasks:

• Monitors the CO2 concentration value every 10 seconds
• Displays the reading of CO2 concentration in ppm on the Liquid crystal Display continuously
• Write the CO2 value to the serial monitor every 10 seconds (if connected)

Once the sketch is uploaded successfully, the display will immediately give the reading of CO2 concentration levels in ppm. The equation used to convert a voltage to a CO2 concentration can be deducted from the sketch:

IMPLEMENTATION STEPS

For asthma detection using breath samples and to acquire and display the CO2 signal on display module, the library, and the local variable was included into the software (Arduino IDE). In addition, the serial communication was made by assigning the baud rate (9600), data (8-bit), stop (1-bit) with no parity. To displaying the result used Liquid Crystal Display.

Hence, whenever there was an increase in the CO2 values above to the size of the display, the output of the CO2 was printed as a zero. Next, the CO2 value was calculated by multiplying with a factor of 10 and stored in the variable named Val for further assessment.Furthermore, the thresholding and window techniques were utilized to discriminate between asthma (mild) and non asthma. For this purpose, the output of expired CO2 value was limited to 28000 (2.8 % CO2) ppm as a threshold and data were recorded for 5 seconds. Implementation setup.

RESULTS AND DISCUSSION

Asthma is exceptionally normal its difficult to state without a doubt what causes asthma yet family hereditary qualities are accepted to be a key factor. Asthma frequently runs in families. Natural components for example presentation to used smoke or air contamination assume a role. Breath sample taken from the asthma patient to MG811 Sensor. CO2 concentration in a exhaled breath will be measured with the help of formula. Result will be Displayed on LCD Screen with humidity and temperature of the air.

CONCLUSION

Observing asthma and airway obstruction by using capnography is a new approach in medical technology. How ever capnograph is too expensive and not affordable for the home monitoring applications. There fore in this research a portable and low-cost respiratory co2 observing system based on mg-811 co2 sensor and micro controllers was proposed. The output information of this device can be shown either in a small LCD provided or in PC through USB port. The information can be accessed anywhere which allows the users to know elements about risk condition for their respiratory health.

REFERENCE

1. Siti Zuleika binti Zaharudin, Mohsen Kazemi, M. B. Malarvili. 2014. Designing a Respiratory CO2 Measurement Device for Home Monitoring of Asthma Severity. IEEE Conference on Biomedical Engineering and Sciences, 8 – 10 December 2014, Miri, Sarawak, Malaysia
2. Mark Jackson, Asthma, The biography, Oxford University Press. 2009.
3. M. Cottini, and R. Asero, ‘Asthma phenotypes today,’ Eur. Ann. Allergy Clin. Immunol., vol. 45, no. 1, pp. 17–24, Feb. 2013.
4. Steven Weinberger, A. Barbara Cockrill, and Jess Mandel, Principles of pulmonary medicine, 5th ed, Elsevier Inc., 2008.
5. Melissa Langhan, ‘Continuous end-tidal carbon dioxide monitoring in pediatric intensive care units,’ J Crit Care, vol. 26, pp. 188-196, 2008.
6. M. Folke, and B. Hok, ‘A new capnograph based on an electro acoustic sensor,’ in Proc. Int Conf IEEE Eng Med Biol Soc, 2008, pp. 856-860.
7. D. Santoso, and F. D. Setiaji, ‘Design and Implementation of Capnograph for Laparoscopic Surgery,’ International Journal of Information and Electronics Engineering, vol. 3, no. 5, pp. 523–528, 2013.
8. Shyam Sivaramakrishnan, Rajesh Rajamani, and Bruce D. Johnson, ‘Dynamic Model Inversion Techniques for Breath _ by-Breath Measurement of Carbon Dioxide from Low Bandwidth Sensors,’ IEEE Sensors Journal, vol. 10, no. 10, pp. 1637-1646, 2010.
9. Tomasz Starecki, ‘Ultra-low-noise preamplifire for condenser microphones’ Review of Scientific Instruments, vol. 81, pp.124702;1-124702;4, 2010
10. Napat Triroj, Papot Jaroenapibal, Haibin shi, Joanne I. Yeh,and Roderic Beresford, ‘Microfluidic chip-based nanoelectrode array as miniaturized biochemical sensing platform for prostate-specific antigen detection’ Biosensors and Bioelectronics, vol.26, no. 6, pp. 2927-2933, 2011.
11. L. Zou, and T. Larsen, ‘Dynamic power control circuit forimplantable biomedical devices’ IET Circuits, Devices &Systems, vol. 5, no. 4, pp. 297-302, 2011.
12. http://www.mindsirobotics.com/programming-resources
13. Cheow Shek Hong, Ahmad Shahrizan Abdul Ghani, Ismail Mohd Khairuddin. 2018. IOP Conf. Series: Materials Science and Engineering 319 (2018) 012040 doi:10.1088/1757-899X/319/1/012040
14. McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (6th ed.). New York, NY: McGraw-Hill.
15. Zuleika, S., Kazemi, M., & Malarvili, M. B. (2014). Designing a Respiratory CO 2 Measurement Device for Home Monitoring of Asthma Severity, (December), 8–10

What is Asthma?

Asthma is an often chronic (i.e.-long term and persistent) medical condition, that causes difficulty in breathing. It develops as a result of inflammation and muscular contraction within the (small) air passages inside the lungs. This restriction, combined with excessive mucus production, causes the symptoms associated with asthma. Asthma can be genetically inherited or triggered by environmental factors. Trigger factors (factors that can cause asthma) include amongst other things: Infections (chest/colds), other medicines (aspirin/Ibuprofen), pollen spores, exercise, cigarette smoke, house dust mites, cold weather and also pet hair/saliva/skin. Asthma ‘attacks’ (displaying the signs of asthma) typically last for a few minutes or hours maximum when treated, but without treatment this can extend to days or even weeks.

What are the signs and symptoms of Asthma?

Asthma symptoms can occur quickly and vary in severity, depending on the individual. The most common symptoms can include a wheeze (a high-pitched sound when breathing), a persistent cough, a feeling of chest tightness or being short of breath.

Symptoms often appear in childhood, with 368,000 people, of whom 20% are children, receive treatment for asthma in Scotland (2018). Children can sometimes grow out of asthma but for most individuals its often a chronic(i.e.-persistent and life long) condition, that is controllable but not curable. Asthma symptoms can vary from: mild(symptoms that appear from time to time, normally caused by a trigger factor), moderate(symptoms present on most days or at certain times of the day) or severe(can occur at any time, involving a severe shortness of breath and bad wheeze).

How is the condition assessed?

Asthma assessment involves looking for the presence of typical asthmatic symptoms, as they are presented to a health care professional, such as a general practitioner (GP). Checking a patients medical and family history, as well as performing tests to confirm a diagnosis of asthma, are often carried out.

The two main asthma diagnosis tests consist of a spirometry test and a peak flow test. With spirometry, the test is carried out ideally when asthma symptoms are present, in order to provide a more accurate diagnosis.

The patient blows multiple times into a spirometer machine. This tests measures the maximum volume of air expelled in one second(called FEV1) and the maximum total volume of air expelled in one complete breath(called FVC). The ratio of FEV1 to FVC is then calculated, with a low value being typical of someone who is asthmatic. Medication to relieve asthmatic symptoms are then administered. If subsequently an increase in this ratio occurs, then a diagnosis of asthma is often given.

With peak flow, the test involves blowing as fast/hard as you can into a small device, called a peak flow meter. Your output value is then compared to the ‘normal’ value for your size, age and sex, with lower than average values indicating the possibility of having asthma. A further benefit with the peak flow is that it can be performed 24 hours a day, outside the clinical (GP surgery or hospital) environment. More rarely, a nitric oxide test (FeNO) can also be performed (often by a GP), where the greater presence of Nitric Oxide in the patients measured breath output, can indicate lung inflammation and the presence of asthma.

Asthma assessment also often involves trying to reject conditions or diseases which present with similar symptoms, for example COPD.

What treatment and care is given for asthma?

The main treatment for an asthmatic (someone with asthma), is through the use of inhalers. These are small, handheld devices that deliver a measured dose of medicine into the lungs by breathing it in (inhalation). The two main types of inhaler are: Reliever; which relax the muscles in the airways and aim to relieve asthma symptoms immediately. Preventer; which is taken daily and use steroids to prevent symptoms (inflammation) occurring. More rarely steroid tablets or liquid medication (i.e. for children) can be used. So consulting with the health care provider is essential to discuss treatment options available.

Asthma care often involves either a doctor or (asthma) nurse, providing the patient with an asthma action plan. This normally consists of the patient being prescribed reliever and/or preventer inhalers, to take in certain doses, at certain times. The patient is also given a chart to plot their breathing output, using a peak flow meter, over a period of time, so long-term breathing patterns can be monitored. Low peak flow, that varies over a time period (i.e.-a week) is typical for an unmedicated asthmatic person. Regular consultation with either a doctor or (asthma) nurse enables the medicines to be fine ‘tuned’ to suit the individual. Annual reviews are used to check for patient progress, proper inhaler usage and check that the most effective medicines are being used to prevent asthma symptoms. In all instances the main aim is to make sure the asthma is stable and well controlled.

In severe cases of asthma, more members of the multi-disciplinary team(professionals with different specialities who work together) can become involved in patients treatment and care, sometimes in a hospital environment. These include, as well as GP’s, asthma nurses and pharmacists (providing medication), also respiratory specialists, physiotherapists, dieticians and stop smoking service providers. Consideration should also be given to the fact that untreated or ‘first time’ asthma can be a life-threatening condition (1,400 dead in 2018)**. So proper treatment, by a suitable health care provider such as a GP is essential. Any severe breathlessness or not being able to breath should be treated as a medical emergency and 999 called immediately, as severe asthma can be life threatening and onsets quickly in certain cases.

Asthma is no joke, it kills, literally. People are always suffering in one way or another form asthma. But it does have to be like that for you, there are many resources, and lifestyle choices that can limit your chance of developing this life-changing disease. Asthma hits hard, take some time, read this article and protect yourself.

Jesse, a 5-year-old girl said “When I have an asthma attack, I feel like a fish with no water.”* Asthma is not just a minor breathing disorder, but serious and potentially fatal disease. Asthma is prevalent in 1 in 9 people or 11.12% of the Australian population. Unlike other lifestyle diseases, asthma has been increasing in all racial, age and gender groups. Asthma has been on the rise since the 1980s and has shown a little decline.

Asthma is a long-term disease that causes inflammation, swelling and contraction of the throat and larynx which causes difficulty breathing, Asthma is also known as Chronic Respiratory Disease (or CRD). this is a brief description a more in-depth and informative definition can be found at the national lung heart and blood foundation. (link in the bibliography)

If your family has had a history of those afflicted with asthma, you are 3 to 6 times more likely to develop asthma than someone without a family history. It has also been observed that asthma is more prevalent in obese individuals, as the fatty tissue around the lungs and throat causes stress and pressure to be put on the organs causing difficulty functioning, and leading to the development of asthma. Males are characteristically more likely to develop asthma than females. Also people who work in areas where they are constantly exposed to dust, and residue from woodworking or timber processing, are more likely to develop asthma, as the small particle can cause infections of the throat, larynx and lungs, which can lead to difficulty breathing and the development of asthma. This type of asthma occurrence can also be found in those who work with chemical fumes, in mines, around molds or harmful vapors. It can also cause scarring and damage that can lead to a vulnerability to other infections. Asthma has been steadily increasing, since its discovery

Asthma kills around 440 people a year and accounts for 0.3% of all deaths in Australia per year. People who have asthma in rural and remote areas are more likely to die of asthma due to a lack of suitable and reachable medical facilities. It has also been observed that people in rural areas are more likely to smoke, which is a lead contributor to the development of Asthma, also in places of a lower socioeconomic status. Those who are afflicted with Asthma lead very challenging lifestyles. Asthma causes inflammation of the throat and lungs, those who have asthma, especially youth, are constantly at risk when undergoing respiratory challenging activities, such as running as one would be more vulnerable to an asthma attack due to the rapid contractions of the lungs and diaphragm. If a bronchodilator is not available immediately, the person having an asthma attack is in a very dangerous situation.

Around 60% of youth with asthma limit their physical activity due to the condition, which can cause a lack of physical development. Limiting physical activity also creates less social exposure, which has been linked to depression, the development of inferiority complexes and bad mental health in general. This is because of a lack of participation and an inability to work. Asthma can cause anyone to have to take days off work or school, because of inflammation, especially in children. When the suffering individual is left out their mental health is negatively impacted, which causes depression but also insecurity, this is backed up by the fact that studies shed to light 78% of those with asthma constantly had their asthma in the back of their mind. The statistics were found in an article by the Asthma and Allergy foundation.

There are a number of effective ways to deal with asthma, one of those ways to have an asthma plan and familiarise yourself with each step, essentially memorizing it. This will allow you to inform those nearby you in the event of an asthma attack on how to help, providing a copy of your plan to your school, or work as well. This will give your co-workers and peers clear instructions on what to do.

Another way to deal with asthma is to stay away from pets, the dander of cats and dogs is a very common cause of inflammation in those who have asthma. Staying away from these animals will lower your chances of having an asthma attack. If going near cats and/or dogs it is a good idea to keep your inhaler on hand inc case of your asthma flares up.

Having a healthy diet, and maintaining a healthy weight will lower the severity and scale of an asthma attack. Having a healthy diet, with low fats and sugars, will aid your immune system and lead to less fat buildup, which would put pressure on your lungs and throat. There are a number of diets that will be beneficial to those with asthma, high fruit and veg intake is recommended, but also vitamins a, b, and d, as well as a decent amount of magnesium. The recommendation of minerals and vitamins was derived from the Mayo clinic.

Along with having a good diet, asthmatic people should also partake in regular but easy exercise to help maintain healthy body weight. Having regular exercise patterns will allow your body to become familiar with the exercise. Aqua-aerobic is a very effective way to exercise without the risk of asthma attack, as the water allows you to work your muscles efficiently, without much respiratory strain.

I also have proposed that asthmatics commit to regular exercise, but not stray away from the physical activity with others like at school but instead take 1-3 deep breaths of their puffer to calm down their throat and lower their chance of having an asthma attack. This will allow the asthmatic to maintain an active lifestyle more freely and be more social and lower the chance of developing depression, anxiety or an inferiority Complex.

There are a number of resources and facilities available to asthmatics. All hospitals have the resources to treat an asthma attack, but there is an asthma helpline 1800 ASTHMA (278462) the hotline is open 24/7 and will help you deal with/treat an asthma attack, give advice on how to reduce the risk of an asthma attack and most likely answer any queries. This service is very useful, and practical, as anyone who needs immediate help can easily access this resource. Another resource for asthmatics is the Asthma Australia website is a resource for those who seek to learn more about asthma, its risk factors, its management and also informs you on common asthma triggers and current research going towards asthma. To access the site simply search” Asthma Australia’ and access the first link. This resource if still very useful although the accessibility is considerably lower than that of the hotline, it can also offer information at higher detail, so still a very useful and effective resource. The national asthma council of Australia, provides brochures to hospitals and general practitioners, these little booklets provide ample information on asthma and risk factors, and there are also downloadable copies available on the internet, this is a very effective resource because anyone waiting for seeing a doctor will be able to read up on asthma easily, and have the knowledge of how to treat an asthma attack in the event that someone does have one, providing one to bored people is also an effective tactic as they are more likely to read it given that they have nothing else to do.

Asthma is a serious problem that affects millions of people, but when you take the right measures, precautions, and life choices, it harms can be prevented reduced, and negated, there are many resources that can help with asthma, should it come out that, but by reading this article, hopefully, you have thought of how you can take these things into account and save yourself from asthma. The inside killer.

Background:

Optimal asthma management has been found largely due to patients’ medication adherence and correct inhaler technique. This study aimed to examine drug-related factors affecting medication adherence among Egyptian asthma patients

Methods: A descriptive cross-sectional study was carried out among 110 clinically diagnosed asthma patients attending at a university hospital, in Sohag, Egypt. Inhaler criteria and adherence were evaluated by a standardized tool “Morisky Medication Adherence Scale, 2008′.

Results: Findings of the study revealed that out of 110 patients 22.9% had a medium level, 42.2% had a high level, and 34.9% had a low level of medication adherence. There was no relationship between demographic data and adherence in asthmatic patients. However, Good adherence was frequently encountered among asthmatic patients who used an inhaler twice daily, who used drugs its onset of action 5- 20 minutes, who used aerosolized and turbo haler devices and who used budesonide and budesonide/formoterol.

Conclusion: Nonadherence is high among asthma patients attending sohag university hospital in Upper Egypt. There was a strong relationship between inhaled drug criteria and the degree of adherence in asthmatic patients.

Key Words: COPD, bronchial asthma, adherence, inhaled therapy.

Introduction:

Adherence to medication is a crucial part in the long-term management of asthma. In asthmatic patients, non-adherence or inhaler mishandling increases mortality, morbidity, and hospital admission [1, 2].

Factors related to adherence to inhaled therapy include the complexity of the inhalation regimen, type of inhaler device, type of inhaled agent, and a variety of patient beliefs and sociocultural and psychological factors(2). Therefore, promoting optimal medication adherence is essential to optimize the benefits of treatment. Consequently, assessment of the degree of adherence to inhaled therapy in asthmatic patients becomes increasingly important in daily practice.

By opposition, nonadherence leads to poor clinical outcomes, an increase in morbidity and mortality, and unnecessary healthcare expenditure (3). There are limited studies that have examined adherence to asthma therapy in Egypt. The aim of the study: was to assess adherence to inhaled therapy in patients with bronchial asthma and to examine drug-related factors affecting medication adherence among Egyptian asthma patients

Patients and Method:

Study subjects and design

A descriptive cross-sectional study design was used, and 110 clinically diagnosed asthma patients were selected from the inpatient department and outpatient clinic of chest diseases, at Sohag university Hospital. Before the data collection, the study was approved by the local ethical committee of Sohag university hospitals and written informed consent was taken from every patient included in the study.

After taking informed consent from the patients, the information regarding age sex, literacy, residence, occupation, smoking habits, Socioeconomic status, co-morbidities, date of diagnosis of asthma and pulmonary function tests were recorded.

Inhaler Use

Further questions related to the currently prescribed aerosol therapy for asthma-like the number of medications prescribed per day, type of device, type of drug, the onset of action of inhaler and frequency of administration of inhaler. .

The currently prescribed medications for asthma were identified for all included patients: long-acting β2-agonists (LABA), inhaled corticosteroids, combined LABA/ inhaled corticosteroids, short-acting anticholinergics, short-acting β2-agonists, long-acting anticholinergics. Most patients were on combination therapy.

Morisky medication adherence scale scores

Medication adherence was tested using the eight-item Morisky Medication Adherence Scale [4]. The MMAS-8 is an eight-item questionnaire with seven yes/no questions and the last question is a five-point scale. On the basis of the scoring system of MMAS-8, adherence was rated as follows: high adherence (score: 8), moderate adherence (score: 6 to Statistical analysis:

The data collected by using a structured questionnaire and reviewing medical record forms were entered in a separate spreadsheet using EXCEL (2010). The entered data was analyzed using Statistical package for social sciences (SPSS) software version 20. Quantitative data was represented as mean± standard deviation. Data was analyzed using ANOVA for comparison of the means of three groups. Qualitative data was presented as numbers, and percentages and compared using the Chi-square test. P-value < 0.05 was considered as statistically significant.

Results:

The demographic and medical characteristics of the studied patients are shown in Table 1.A total of 110 took part in the study at Sohag University Hospitals and Clinics, Sohag, Egypt. The patients had a mean age of 39.22±13.51 years. There were more females than males (69/ 41; 62.72%). 50% of patients are illiterate.

The most commonly used inhaled therapy in asthma patients is presented in Table (2). As regards the frequency of administration of the inhaler, it was found that asthma patients were frequently using the inhaler twice daily, also asthmatic patients used the on need more frequently. As regards the onset of action of inhalers, it was found that the inhaler that of 5 minutes of the onset of action was more frequently used by asthma patients than other types of inhalers. As regards type of device, it was found that aerosolized, MDI, turbo haler and hand haler were frequently used by asthma in order than other types of devices. As regards type of drug, it was found that budesonide, formoterol, salbutamol and budesonide/ formoterol were more frequently used by asthma in order than other types of drugs.

The proportion of patients in the different categories of adherence according to the MMAS-8 questionnaire is shown in Fig 1. Based on the MMAS-8 questionnaire, 42.2% of patients had good adherence, 22.9% intermediate adherence, and 34.9% poor adherence.

Table (3) shows the relation between demographic data and adherence in asthmatic patients already on inhaler therapy. There was no statistically significant relationship between demographic data and adherence in asthmatic patients (P>0.05).

The relation between drug characteristics and adherence patterns in asthma patients already on therapy is shown in Table (4) (Fig 2 A, B, C, D). It was found that there was a statistically significant relationship between adherence pattern and frequency of administration, onset of action, type of device, type of drug with P=(0.001, 0.002, 0.001, 0.001) respectively. It was found that good adherence was frequently encountered among patients who used an inhaler twice daily, who used drugs its onset of action

Discussion

Medication adherence is important for asthma patients for the effectiveness of the therapy. Adherence was measured using the MMAS-8 – a scale that has been used widely to investigate adherence to medication in many disease areas including asthma (5) and COPD (6), where it has been used to investigate adherence to inhaled medications.

Analysis of the demographics of the study population revealed the majority of asthma patients are female (62.72%). The study was conducted in 110 asthma patients among which 69 were female and other 41 were male. The mean age was of 39.22±13.51 years. 52.72% came from an urban area, 86.36 % had middle socioeconomic class, and .50% was illiterate. The mean duration of asthma was 11.21±8.91 years. Likewise, more than half (75.45%) of the patients had one co-morbidity.

In our study, we found that, among the studied population poor adherence was observed in 34.9%, 22.9% intermediate adherence, and 42.2% of patients had good adherence. This result matches with the results of the study of (7, 8) who found that adherence among asthmatic patients was 49%. This percentage shows that still many asthmatic patients are not adherent to their inhalational medications. Previously done research shows that adherence to inhaled therapies is worse than that seen with oral or injected therapies in patients with asthma in different age groups [9–12]. Whereas in previous studies, among asthma patients, medication adherence rates have consistently been shown to be 30–40% and may increase as high as 70% [13–17]. This discrepancy in findings may be due to the difference in knowledge regarding asthma among participants, use of different measurement tool and the inclusion of different groups of the sample population in the study.

In this study, none of the variables related to sociodemographic information (such as age, gender, place of residence, educational status, co-morbidity, the severity of symptoms and smoking habit), were associated with the patient’s level of medication adherence. Consistent to these findings, Senior et al., 2004 showed that there was no association between the level of adherence with sociodemographic and clinical variables (age, gender, marital status, and place of residence, education, type of occupation and current smoking status, and severity of asthma (18). However, these findings are contradictory to other studies (19). The difference in findings might be due to the inclusion of patients of different duration of disease, different study designs and use of different validated tools in the studies.

As regard the frequency of administration of inhaler in our study we found that 75.5% preferred twice-daily therapy, 2.7% preferred once daily and 21.8% used inhaler on need. There was a statistically significant relationship between good adherence and the use of an inhaler twice daily in asthmatic patients in comparison with the use of a need inhaler However, this result is not comparable with that of the result of (20) which showed that 61% of patients expressed a preference for once-daily treatment, 12% preferred twice-daily treatment and 27% expressed no preference. Other studies found that adherence in asthmatic patients was unrelated to the number of daily doses of inhaler therapy (21 – 23). Others observed that reliever inhalers were frequently used in asthmatic patients (24 – 25).

As regards the onset of action of an inhaler, we found in our study that the inhaler of 5- 20 minutes of the onset of action was more frequently used by patients than other types of inhalers and this was statistically significant, this result due to asthma patients almost always complaining and need rescue bronchodilators medications which rapidly acting, also it is believed that the perception of the product delivering its action rapidly may lead the patient to continue taking the therapy on a daily basis (26).

In our study, there was a statistically significant relationship between good adherence and the use of turbo haler and aerosolized in asthmatic patients in comparison with the use of MDI. Our study result agrees with a previous study of (27) which found that using dry-powder inhalers (DPIs) versus metered-dose inhalers (MDIs) was linked to adherence in this study’s results.

Moreover, we found that there was a statistically significant relationship between good adherence and the use of budesonide/ formoterol and budesonide in asthmatic patients in comparison with the use of salbutamol. This observation agrees with that of Axelsson et al. who found better adherence to ICS/LABA compared to ICS and/or LABA and/or SABA) (28) and compared with ICS in monotherapy or in combination with LABA or montelukast in the study of (29)

Conclusion: Findings of the study showed good adherence frequently encountered among asthmatic patients who used an inhaler twice daily, who used drugs its onset of action 5 – 20 minutes, who used Aerolizer and turbo haler and who used budesonide and budesonide/ formoterol and it was statistically significant. Educational programs should be included in for improving adherence to inhaled medications in asthma patients.

Conflict of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper.

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Introduction:

Research studies on occupational diseases have shown that mortality due to occupational diseases is higher than mortality due to accidents (1). Asthma is a chronic disease of the lower respiratory tract that is defined by its clinical and pathophysiological characteristics, where chronic inflammation is associated with the hyperresponsiveness of the airway, which generates episodes of cough, dyspnea, tightness in the chest and wheezing, particularly at night, early in the morning or due to the causes such as viral and bacterial infections, allergens and chemical compounds (2,3).

Developed countries has shown that occupational asthma has become the most common work-related respiratory disease. There is a proportion of 10–15% of individuals who present new cases of asthma in whose major target is related to exposure at work. Asthma has a 7% prevalence within the world population as one of the most frequent diseases. Becoming a serious public health problem (4,5). A proper diagnosis and early management are key points for the prognosis of the disease and its socio-economic consequences. The cost of asthma treatment is very high for health systems, but it is even higher when prevention is not carried out immediately and treated effectively (6).

Epidemiological studies of occupational asthma are responsible for up to 25% of cases of asthma in adults becoming the lung disease of occupational origin more common in industrialized countries and the second most common in developing countries (7,8). It contributes significantly to the mortality and disability of the economically active population. The literature defines asthma related to work as asthma that is induced or exacerbated by exposure to inhalants in the workplace. The definition of occupational asthma is referred to de novo asthma or the recurrence of quiescent asthma and asthma exacerbated by work which is defined as the pre-existing or concurrent asthma that is initiated by related factors with work (9).

Occupational asthma can be divided into two forms of work-related exposure: Irritant-Induced OA and Allergic OA. Irritant Induces OA occurs usually after a very high exposure (single) to any irritant chemical. Ammonia, acids, and smoke are the causes of direct burns which affect the airway. Symptomatic effects are presented within 24 hours of being exposed with no latent period. Symptoms might disappear over time but if symptoms persist for more than 6 months then major problems can be arising (10). Allergic OA is caused by respiratory sensitization or can be an allergic exposure to a specific chemical in the workplace. The sensitization process is a process that can only be developed over time, not after one exposure. Latency periods can vary from being a short period but as well as reaching 30 years (11).

Epidemiology

Prevalence:

During the past years, occupational respiratory has become the most frequently developed disease within most industrialized countries. As shown, pathologies such as pneumoconiosis have been decreasing periodically and on the other hand, we have occupational asthma which has been increasing rapidly (12). In different studies, it has been found that the proportion of new cases of asthma attributable to occupational exposure is high and reaches up to 10-15% in patients (7). Studies have been carried out in specific companies along with certain working groups and for the population. The estimated prevalence varies according to the definition given to OA along with the diagnostic standards. Those carried out with a questionnaire of symptoms in the general population tend to overestimate the prevalence, which is very sensitive but not very specific (13). Prevalence studies are useful for analyzing populations exposed to new agents and in countries where the OA is not well recognized, nevertheless it is necessary to unify criteria of definition and diagnostic tools that allow comparing results (14).

Incidence:

Clear clinical diagnostic criteria have not been yet developed for this disease, there are no complete records that determine if the incidence and the actual frequency of the disease are unknown. However, it is believed that the proportion of asthma in adults due to occupational causes can be as high as 25%, making it a search on how adults are presenting airway obstruction due to occupational asthma (15,16).

Even though the respiratory symptoms appeared about the third year for those workers exposed to any kind of chemical, enzyme, and laboratory workers the incidence of probably obtaining OA was of 2.7% (17). In this case, medical records are not a reliable source therefore many of the patients do not declare the illness because of the bad compensatory system and fear of dismissal from their workplace (17,18).

Interventions have allowed the modification of the incidence in various workplaces, an example made was the detergent industry that demonstrated the drastic reduction of new cases and how excluding atopic workers performed a better control of the environment. The two most significant sentinels’ registries that initiated standard measures for voluntary purposes were (Surveillance of Work-Related and Occupational Respiratory Disease) SWORD made in the United Kingdom and in the United States (17,19,20).

Symptoms:

The symptoms of occupational asthma vary depending on the type of asthma a worker presents. Whether it is occupational asthma with exacerbated previous asthma which may present severe symptoms compared to real occupational asthma. Patients are known to have (work-related) OA because they are patients who present or report symptoms during work hours and/or exacerbation which symptoms improve during weekends or vacation periods (21).

Occupational asthma naturally deals with the classic symptoms of asthma in general. The classic indicators are cough, wheezing, and dyspnea (2). The cough is usually not unique but followed by several accesses which makes it a dry cough can evolve to a more humid aspect with sputum production. The wheezing is noticeable among patients even without using a stethoscope if noticed on an early stage it will do no harm. The dyspnea described is dyspnea of small exertions exacerbated by the need for air that causes anxiety and high-intensity movements in the patient. The asthmatic patient may present mild to severe dyspnea with associated respiratory failure. Sometimes the indications become chest pain commonly described as oppression (22,23).

Among other symptoms and less common signs are vomiting, syncope, fatigue, abdominal pain, myalgia, headache, loss of visual acuity and others (24).

Diagnose:

Patients diagnosed with OA should be revised periodically even though they have changed their previous jobs. Approximately 25% of them have a complete recovery of lung function but there are still chances of developing bronchial hyperactivity within diagnosed patients (25). Occupational asthma can lead to serious health consequences, loss of employment and financial losses for employers. Early diagnosis is important for the removal of the precipitating agent during the first year of the onset of symptoms and can lead to a better prognosis (26).

A well-performed diagnosis and a complete medical history should be performed as mentioned in the guidelines of the American chest association, which suggests that a well-structured questionnaire should be asked to all patients to identify a proper diagnostic of their OA history (9). Nevertheless, a patient’s occupational asthma clinical history should include the following type of questions: previous work-related jobs, exposure to chemical compounds, the use of specific equipment and any medical respiratory diseases among colleagues. The patient’s work history should also be investigated to determine if there was prior exposure and if there are other factors affecting those still at the workplace (27).

Whenever you think about the diagnosis of occupational asthma you should first analyze the affected chemical products with which the patient has worked with (28). There are many biochemical reagent cases of patients who work with high molecular weight compounds whose symptoms improve over days as well as long periods of time, which in cases like this would be enough to determine the diagnosis of the patient (29). Within these risk factors nasal symptoms, wheezing and cough in the workplace should be investigated and verified to perform the exact diagnosis.

When medical professionals have the correct diagnosis of an OA patient the Peak Expiratory Flow (PEF) measurements should be taken during work days and the following days (30, 31). This method should be the first line for the diagnosis of occupational asthma because it is cheap, non-invasive and can be implemented in low-complexity medical services (30).

Through the analysis of spirometry tests, there are three different patterns can be recognized (32). The first pattern is the daytime worsening of the PEF, this pattern is observed during the workday which it does not progressively get worse during the week but improves within the days off. The second pattern is the worsening of progressive PEF during the work week. Intermittent falls in the PEF during workdays will mark improvement in the holidays (32).

The methacholine challenge test (MCT) is another diagnostic aid if a negative response is detected the MCT should not be even considered for a patient with OA (33). However, in other situations the response might be positive and if so other conditions such as a recent respiratory infection, heavy smoking, and chronic bronchitis are detected. Inclusions have even been reported of negative responses to MCT in occupational asthma due to isocyanates (9). It is suggested to perform the airway responsiveness test with methacholine or histamine at the end of a week of work with a repeated test after ten to fourteen days of absence of exposure to the agent. Performing MCT on patients after work has shown a decrease of about 20% during work (8,30).

Among other less common tests we can find the increase of eosinophils in the induced sputum, this test is associated with the measurement of exhaled nitric oxide but there is still limited evidence of its usefulness (34). However, there are differential diagnoses that can imitate occupational asthma among them: Dysfunction of the vocal cords, irritation of the upper respiratory tract, pneumonitis, rhinosinusitis, psychogenic factors, byssinosis, bronchiolitis obliterans and eosinophilic bronchitis (9).

Treatment:

Patients who present a diagnosis of occupational asthma should be considered for observation following any related work-related asthma, de novo asthma and/or worsening asthmatic symptoms (35). Following this, the diagnosis of asthma and its onset must be confirmed, as well as: medical history probably asthma in childhood or any kind of allergies, symptoms, spirometry, and medications which depends on the result of the diagnosis on previous asthmatic patient or patient without a history of the asthmatic disease (9,36).

In some cases, the non-asthmatic patient is presented leading to other clinical pictures like asthma are evaluated such as vocal cord dysfunction, irritation of the upper respiratory tract, hypersensitive pneumonitis, eosinophilic bronchitis, other occupational lung diseases (byssinosis, bronchiolitis obliterans), rhinosinusitis and psychogenic factors (9).

It must be considered that all these conditions can coexist with asthma. When diagnosing asthma, exposures will be sought by factors that cause or exacerbate asthma-like: occupational history, allergens, irritants at work, exercise, cold, infections, type of work process, ventilation, use of respiratory protection, symptoms of co-workers, magnitude and exposure time, environmental history, atopy, allergies, rhinitis, gastroesophageal reflux and smoking (37).

After considering everything previously mentioned, a relationship between asthma and work must be verified: the onset of symptoms and their severity during work hours, spirometry and airway hypersensitivity tests must be performed as well as immunological tests if available (9,15). The greater the number of positive results, the greater the relationship between symptoms and work-related issues which in this case occupational asthma or asthma exacerbated can be diagnosed effectively (15).

If work-related asthma is diagnosed, it should be classified as primary occupational asthma (sensitizer or irritant) or asthma exacerbated by work (9,15,38). When asthma is intensified by work-related medical issues it should be optimized, the triggers should be reduced at work and at home. If a diagnosis of occupational asthma is obtained, the management in OA should be divided by irritants, sensitizers or both (37,38).

The best way to treat occupational asthma is to avoid the trigger or allergen because the prognosis is better in those patients who leave the job than those who continue in it. Optimizing medical management, and implementing employment with compensation are to be considered for preventing measures for exposing workers (39).

In patients who do not want or cannot give up their work, the implementation of high hygiene in the work area or the use of protective respiratory measures should be mandatory as an alternative. These actions have only shown good results in some types of occupations, in the case of asthma triggered by Toluene Diisocyanate TDI-asthma and some sensitizers of low molecular weight but unfortunately, no promising results have been found (40,41). Patients who continue to be in contact with their sensitizer in the workplace should be kept under medical supervision.

Treatment measures for the patient can have a negative impact on their economy because they must leave their place of work and have lower-paying jobs or become unemployed. The pharmacological treatment is essentially the same as for non-occupational asthma patients. One of the first steps for the management of occupational asthma is to determine the severity of the disease to select the medications necessary to intervene immediately for a patient.

Prevention:

The prevention of occupational asthma can be divided into primary, secondary and tertiary phases. The first phase involves environmental control measurements and industrial hygiene to help reduce any exposure. The second phase essentially focuses on the early detection of asthma, this, however, is obtained by information needed through questionnaires and clinical records among workers. The third phase involves therapeutic measures and environmental resources on how to control the evolution of a diagnosed patient (43,47).

A most important fact for the prevention of occupational asthma is to eliminate any type of sensitized agent at the workplace (42). The use of protective respiratory equipment lowers the incidence and lowers the intensity of exposure but does not completely prevent the development of occupational asthma. Continuous monitoring and surveillance by medical and well-trained personnel could identify which agent is harming the patient’s health and thus come up with a plan to remove or avoid the exposure (42,43).

There is a low predictive level between atopy and the development of occupational asthma. It is estimated that about 50% of young adults are atopic and these should not be excluded from high-risk workplaces (44). However atopic individuals who work in a high-risk place and are exposed to agents that can provoke occupational asthma should be followed for early detection of respiratory sensitizers and bronchial hyperresponsiveness (45).

Advises To quit completely the consumption of cigarettes is a useful tip for health in general, especially in patients presenting OA. It has shown that the decrease of nicotine can lower the levels of the aerial routes of the antigens because it diminishes the chronic inflammation that causes the toxic agents of tobacco (46).

Conclusion:

In conclusion, occupational asthma is a quite common disease in developing countries, despite this, it is underdiagnosed, therapeutically poorly managed and compensated. A greater number of surveillance systems and the application of international definitions are required for an accurate medical diagnosis and proper management of the disease. The use of internationally validated questionnaires, immunological tests, and serial PEF measurements used uniformly and standardized, will increase the detection of the disease in developing countries.

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Asthma

Non-Communicable Diseases (NCDs) are long-term chronic illnesses that often develop as a result of genetic, physiological, behavioral or environmental factors (World Health Organisation 2019). Asthma—a Chronic Respiratory Disease—is one such NCD that affects the Respiratory System. Asthma can be defined as a chronic disease wherein resistant flow in the airways incites breathlessness and chest tightening as a result of narrowed and inflamed airways (Australian Institute of Health and Wellness 2019; Godfrey 1985). In 2018, 339 million people globally suffered from asthma-related health conditions with lower and middle-income countries having the highest mortality rates for asthma-related deaths (The Global Asthma Report 2018). Recent reports indicated that 2.7 million Australians, and 112,000 Indigenous Australians, suffered from asthma in 2018; with Indigenous Australians being 1.9 times as likely to develop asthma compared to non-Indigenous Australians (The Australian Bureau of Statistics 2018; The Australian Bureau of Statistics 2013). Further analysis of Australian asthma patients revealed, females (12.3%) were more at risk of developing asthma-related health conditions as opposed to men (10.2%); and male children under the age of fourteen (12.1%) and women between the ages of sixty-five and seventy-five (>15%) were the most at risk of developing asthma-related illnesses according to age (The Australian Bureau of Statistics 2018). Thus, this paper proposes that asthma is a serious long-term condition whereby educational awareness of asthma-related conditions can be utilized to ascertain to what extent asthma impacts health and society. Through a health science framework, this essay will discuss the function, anatomy and physiology of the Respiratory System; analyze the pathophysiology of the Respiratory System post-asthma diagnosis; discuss current and new trends in asthma-related treatments; explore the social impact asthma has on sufferers’ quality of life; examine the impact asthma has on society, and consider public health initiatives to determine in what ways society can facilitate the empowerment of individuals living with asthma-related health conditions.

Anatomy and Physiology:

Oxygen plays a vital role in the function and continued maintenance of the body. The Respiratory System is the system of organs that are responsible for gas exchange: providing oxygen to the body’s cells, ensuring air quality and removing carbon dioxide (Barclay 2018). The Respiratory System contains six major structures: the pleura, the lungs, the trachea, the bronchi, the bronchioles and the alveoli. Additionally, the Respiratory System has comprised of two zones: the conducting zone and the respiratory zone. The conducting zone includes all structures in the Respiratory System that forms a continuous passageway allowing air to travel throughout the system; whereas the respiratory zone is found deep within the lungs and includes the structures responsible for oxygenating blood and exchanging oxygen for carbon dioxide (Get Body Smart 2019). The Respiratory System can be further categorized as the upper respiratory tract and the lower respiratory tract.

Image 1: The Upper Respiratory Tract (Barclay 2018)

Image 2: The Lower Respiratory Tract (Barclay 2018)

The upper respiratory tract is where oxygen first enters the body. There are four main structures within the upper respiratory tract: the nose and nasal cavity, the oral cavity, the larynx and the pharynx. The upper respiratory tracts’ main function is to enable smell and speech and ensure air quality via air filtration processes. Hair fibers lining the nose act as protective agents preventing large dust particles from entering the system; whilst mucus and blood-warming capillary cells in the nasal cavity trap finer dust particles whereby passing cilia cells transport these dust particles to the pharynx where they can be expectorated (Peate 2018). The pharynx and the larynx act as passages for food and air, with the larynx being located between the pharynx and trachea, protected by the epiglottis. The epiglottis prevents food from entering the airways.

Diagram 1: Structures of The Upper Respiratory Tract (Peate 2018).

The lower respiratory tract is primarily responsible for gas exchange: oxygenating blood, removing carbon dioxide and carrying oxygenated blood around the body. There are six main structures in the lower respiratory tract: the trachea, bronchi, lungs, bronchioles, alveoli and diaphragm. The trachea transports oxygen from the larynx to the lungs where it diverges into two separate bronchioles and delivers oxygen to their respective lungs (Get Body Smart 2019). The bronchioles have cartilage embedded into the walls to keep airway passages in the bronchi open. The lungs are divided into lobes: two on the left and three on the right, which are protected by the ribs, sternum and vertebrae. The bronchioles, the alveoli and the diaphragm assist the lung muscles by contracting and dispersing oxygen throughout the alveolar ducts (Peate 2018). In pre-asthma-diagnosed individuals, this process allows the human body to breathe without difficulty.

Diagram 2: Structures of The Lower Respiratory Tract (Peate 2018).

Pathophysiology:

Three major pathophysiological changes occur within the Respiratory System of asthma-diagnosed individuals: firstly, the lining of the bronchial tubes are exposed to abnormal swelling; secondly, the formation of excess mucus obstructs air passages resulting in the buildup of excess fluid in the system (mucus hypersecretion); and lastly, the smooth muscles lining the airways narrows (bronchoconstriction), restricting oxygen travel throughout the body (Ellis 2018; Kaufman 2011). These pathophysiological changes can lead to symptoms of breathlessness, sporadic wheezing, tightening of the chest, excess coughing that intensifies over an extended period of time and limited airflow; and may be triggered by environmental exposure to allergens and pollutants, exercise, stress, allergies, food preservatives and smoke (Global Asthma Network 2018; Kaufman 2011).

O’Byrne et al (2013) argue that despite access to medication and interventions to control the effects of asthma, a high percentage of asthma-related diseases remain uncontrolled due to fear of the possible side effects that may develop as a result of prolonged exposure to inhaled corticosteroids medications, which help to alleviate the swelling of the bronchial tubes. Additionally, empirical research suggests that prolonged exposure to inhaled corticosteroids medications escalated hospital admissions, and increased the risks of fractures and the contraction of cataracts in elder patients (Jick, Vasilakis-Scaramozza & Maier 2001; Kaufman 2011; Lee & Weiss 2004). In children, uncontrolled asthma can lead to learning disabilities and impaired cardiovascular fitness; whereas, in adults, uncontrolled asthma can negatively affect concentration, and increase the risk of depression and contraction of respiratory infections (O’Byrne et al 2013). Thus, Kaufman (2011) stresses the importance of maintaining control of asthma as a preventative measure against the contraction of preventable diseases.

Current and New Treatments:

Current treatments for asthma can be categorized in two ways: “pharmacological treatments” and “preventative measures”. Both, pharmacological treatments and preventative measures, rely heavily on self-management strategies and interventions whereby patients administer treatment based on personal monitoring of symptoms and seek guidance from healthcare professionals when symptoms progress or regress to ensure adequate needs are addressed. Pharmacological treatments involve the use of prescription medication and can be further defined as “relievers” (medications that relieve symptoms) or “preventers” (medications that prevent symptoms). These medications include short-acting beta2-agonists (medications that provide short-acting pain relief); inhaled corticosteroids medications (medications that prevent the cell production of asthma-related symptoms); long-acting beta2-agonists (medications that encourage mucociliary clearance, relax the airways and decreases vascular permeability); Leukotriene receptor antagonists (medications that reduce hyper-responsiveness and inflammation of the airways, bronchoconstriction and mucus production); Methylxanthines (high-risk medications that can help trigger breathing responses in the brain); and oral corticosteroids (a medication comprised of synthetic hormones that can reduce inflammation in the Respiratory System and the Immune System) (Kaufman 2011). Preventative treatments implement control measures to minimize exposure to asthma-induced triggers. The Asthma and Allergy Foundation of America (2019) recommends the use of Asthma Action Plans as a “preventative measure” regarding self-management and relief of symptoms. A well-executed action plan should reduce hospital admissions and the side effects of pharmacological treatments whilst allowing patients to maintain and facilitate quality of life (Asthma and Allergy Foundation of America 2019). That is to say, physical activity, sleep and regular attendance of school and work should not be impeded upon as a result of asthma-related symptoms.

Impact of Asthma on Individuals:

Quality of life is the measure by which individuals who suffer from chronic illnesses rate their own personal satisfaction utilizing five primary domains: physical, social, psychological, spiritual and economic well-being (Australian Centre for Asthma Monitoring 2004). The Australian Centre for Asthma Monitoring (2004) proposed that individuals who suffer from asthma self-reported a lower quality of life in areas of physical, psychological and social well-being, compared to those who did not suffer from asthma-related conditions. Individuals who suffered asthma-related illnesses reported impairment of physical functioning (limitations of activities of daily living, restricted physical movement, exhaustion and chest pain); negative effects on psychological well-being (symptoms of distress, anxiety and depression, feeling embarrassed, inadequate or burden); and impairment of social relationships (prolonged absences from work or school, inability to partake in social events and loss of contact with family and friends) (Australian Centre for Asthma Monitoring 2004). Furthermore, The Australian Centre for Asthma Monitoring (2004) indicated that familial and personal relations were also impacted: family members undertook carer responsibilities. That is to say, family members and spouses were often relied upon for assistance; suffered sleep deprivation upon subjection to physical symptoms; impaired mental well-being due to stress and worry, and were often subjected to family life disruptions that involved rescheduling of social activities.

Impact of Asthma on Society:

The burden of Asthma on society is one that carries both resource and monetary significance. Over the years, an increasing trend of the hospital, emergency room and physician visits has meant a burden of the healthcare system leaving healthcare professionals unable to offer adequate support (Ford & Mannino 2010). The Hidden Cost of Asthma Report (2015) revealed that $27.9 billion was spent on asthma-related treatments in 2015. From these figures, the cost on the Australian economy neared $3.3 billion which included annual health system figures, productivity losses, government programs and formal care, whereas, individual patients spent $24.7 billion in the burden of disease costs, where predominant spending included medications and treatments; additionally, carers of individuals who suffered from asthma lost $72.9 million in wages with the average patient spending $11,740 a year on asthma-related treatment costs (Hidden Cost of Asthma Report 2015). This figure seemed high given that the median gross average for personal income in Australia was $65,572 (Australian Bureau of Statistics 2017). However, Nunes, Pereira and Morais-Almeida (2017) offer one reason as to why this may be the case: non-communicable diseases are non-priority diseases with little access to government subsidies for those who suffer from them. Thus, the burden that asthma plays on society is one that has many economic implications, resulting in a lack of resources and the potential to accumulate unpayable debt.

Public Health Initiatives:

The National Asthma Council Australia (2019) highlights several Public Health Initiatives aimed at improving the quality of life for individuals who suffer from asthma-related conditions: The Asthma Handbook (a free flagship publication that compiles resources and educational material to empower asthma management); Asthma and Respiratory Education Programs (a free, community-based workshop approach to training healthcare professionals in the latest intervention methods to respiratory management in asthma sufferers); The National Asthma Strategy (an initiative that aims to develop a national strategy and action plan to deal with asthma-related illnesses); and The Sensitive Choice Community Program (an initiative that seeks to enable and empower asthma sufferers to make healthier lifestyle choices by connecting companies with educational resources in order to produce asthma-suitable products). Public Health Initiatives are beneficial to the greater public and those who suffer from asthma-related conditions. In other words, Public Health Initiatives have the ability to empower the quality of life in asthma sufferers through social, educational and practical intervention methods, utilizing socializing agents, validation therapy and community orientation to negate the psychological and physical limitations of asthma symptoms.

Asthma is a serious long-term chronic illness that affects the Respiratory System whereby resistant flow in the airways incites breathlessness and chest tightening as a result of narrowed and inflamed airways. Educational awareness of asthma-related conditions can be utilized to understand the extent asthma impacts health and society. In asthma sufferers, normal respiratory functions are impaired. As a result, major pathophysiological changes occur within the Respiratory System: firstly, the lining of the bronchial tubes are exposed to abnormal swelling; secondly, the formation of excess mucus obstructs air passages resulting in the buildup of excess fluid in the system; and lastly, the smooth muscles lining the airways narrows. To treat these symptoms two self-management interventions exist: “pharmacological treatments” and “preventative measures” to reduce the impact these symptoms have on the physical, social, psychological, spiritual, and economic well-being of asthma sufferers. Although symptoms have a significant impact on individuals, who report a lower quality of life, family members and significant others of sufferers also reported similar physical, social, psychological, spiritual and economic impairments on well-being. Therefore, Public Health Initiatives should be utilized and implemented to negate the negative effects of asthma-related symptoms and empower the quality of life in asthma sufferers through social, educational and practical intervention methods, utilizing socializing agents, validation therapy and community-based approaches.

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