Asthma is a chronic disease affecting the respiratory system. The disease leads to inflammation of the airways, difficulty in breathing, and can lead to death. Asthma is a zoonotic disease but it is not transferable between individuals. This means that an affected person cannot spread the disease to others by kissing, smooching, or coughing. Inflammation of air passages constricts them and leads to tightening of the chest making the patient experience breathing difficulty, chronic coughing, and producing a wheezing sound (Young, Para 1 and 2). We can learn much about asthma.
The causes of asthma are not clearly known. However, medical experts believe that heredity, environmental factors, and allergens play a major role in determining the occurrence and susceptibility of an individual to asthma. What is clear is that individuals with inflamed airways are in danger of attack by asthma if they are exposed to certain triggers. This is because inflamed airways are hypersensitive. Triggers are things, which aggravate asthma.
When they encounter an inflamed airway, they make it swell, produce excessive mucus and tighten up causing strain in breathing. Examples of triggers include allergens, irritants, infection of the upper respiratory tract, strenuous exercise, some drugs, seasonal and weather changes, changes in temperature, and stress. Common allergens include pollen, dust, molds, insects, food additives, among others. Irritants also include smoke, strong odors, and air pollutants. Pets such as dogs and cats can be a source of asthma triggers by means of their fur.
There are two categories of asthma recognized. These are allergic (extrinsic) and idiosyncratic (intrinsic) asthma. “Allergic asthma is as a result of an antigen/antibody reaction on the mast cells in the respiratory tract”, (“Etiology of Asthma”, Para, 1). This reaction triggers the mast cells to produce inflammatory substances, which brings about a clinical reaction associated with an attack of asthma. Brain disorders cause idiosyncratic asthma. In this case, there is a lack of proper coordination of the alpha and beta-adrenergic and cholinergic sites of the autonomic nervous system.
The signs and symptoms of asthma include intermittent dyspnea, coughing especially in the morning and at night, shortness of breath, wheezing, chest pain and pressure, signs of allergy, getting tired easily during exercise, among others (“Asthma Symptoms, Para. 1). Even though these are the major symptoms of asthma, not all people will show them for a long time. Individuals can also show various signs of the disease at various times of attack.
Asthma occurs all over the world but its distribution is uneven. It is prevalent in children than in adults. The geographical area plays a major role in the distribution of the prevalence of asthma and its predisposing factors. People in areas with a high concentration of predisposing factors experience high attacks of asthma. Transmission of asthma is mainly genetic. Individuals mainly receive asthma through genetic heredity. The environment in which an individual resides also plays a major role as far as transmission of asthma is concerned. The environment harbors risk factors, which can cause an individual to be asthmatic.
Areas with a lot of dust and mold, as well as industrial areas, pose a greater danger of asthma attacks. There is scientific evidence that the presence of a history of asthma in parents is a major contribution to the occurrence of asthma in their offspring. Science also asserts that in the segregation and transfer of genes to offspring, the parents with genes causing asthma are also likely to transmit genes responsible for allergy. However, many gene models describe and determine the occurrence and expression of asthma. Therefore, the gene-gene and the gene-environment interaction determine the variation in the distribution of asthma in the world.
Diagnosis of asthma is done using the patient’s medical history and his or her family line history. The family history helps to know whether the patient is likely to have asthma because of heredity. The historical diagnosis is used in conjunction with tests of pulmonary function to give accurate results. Other tests used to diagnose asthma include chest x-ray, diffusion capacity for carbon dioxide, and allergy testing. In the diagnosis, observations should include symptoms of airflow obstruction, the patient’s hyperresponsiveness, and reversibility of airflow obstruction.
Patients receive treatment in order to minimize the effects of the disease on them and prevent chronic symptoms from developing. Treatment includes chemotherapy using orally administered drugs and inhalants, control of triggers, patient monitoring, and educating the patients. Well-administered treatment helps to reduce the devastating effects of the disease. There is no cure for asthma currently. The disease is only controlled in patients using good medication. The disease has a good prognosis.
In conclusion, asthma is a disease, which causes hypersensitivity to patients with inflamed respiratory airways. According to its severity, the disease is categorized into various levels based on the intensity of the attack. The disease is distributed worldwide, though unevenly distributed. Asthma can cause major spending of time and money in treatment. Geographical location, predisposing factors, genetic and environmental factors determine the occurrence and severity of asthma cases.
Contrary to common belief upheld by many people that health status is only determined by feeding habits, social determinants contribute largely to the same in any given place. These determinants include socio-economic, political forces, education, environmental factors, and social support networks among others. At face value, feeding habits may appear primarily to contribute to health status, but the primary factors determining health status are these social determinants aforementioned above. These factors dictate the feeding patterns hence the health status.
Ballarat Versus Melbourne
Ballarat is a town in Victoria and forms the largest inland city of the Victoria State. According to Australian Bureau of statistics (2007), this city has an urban population of 88,437 people. This is an ancient city with little development and its economic mainstay is tourism backed up with small-scale food and textile industries among others. On the other hand, Melbourne is the capital city of the State of Victoria with a population of 4 million people, making it the second most populated city in Australia (Australian Bureau of Statistics, 2007). With improved infrastructure, financial systems and good living standards, this city stands out in Australia.
Compared to Melbourne, Ballarat score below par in all sectors, that is, economically socially and politically. Consequently, living conditions and health status of Ballarat do not match those of Melbourne. The only sector Ballarat would compare to Melbourne is in tourism industry. However, according to a media release from ministry of tourism (2004), Melbourne received 1.88 million international visitors and 7.6 million domestic visitors, a number that surpasses Ballarat’s figures by a great margin.
Current Health Outcomes Experienced by Old People 65+ in Ballarat
The current health outcomes experienced by people over 65 years in Ballarat are appalling. According to Page, Ambrose, Leah and Glover (2007), in 2005 Ballarat recorded relatively high levels of asthma cases compared to Australia as whole (p 7).
This raises many questions why such a high prevalence rates exist in this particular place. According to a discussion paper for the 2009 Ballarat community summit (2009), the people above 65 years old are at risk of developing health complications. This resulted from disadvantaged economic state of inhabitants of this town. Ballarat’s salary and wage earners averaged $37,411 compared to that of the State of Victoria, which hit $42,603 in 2005. The report indicated that 37% of households in this ancient town survived on less than $650 per week while the Victorian average was only 30.6% (Discussion Paper for the 2009 Ballarat Community Summit, ¶ 15).
This clearly shows the how this town is economically disadvantaged and alienated. Consequently, the people living in this place withstand the worst of this backdrop and live with the consequences thereof. The authorities need to ask some crucial questions here, and take a firm step in scaling down these economic disparities. Has the government or the local authorities developed strategies that addresses the employment needs of the rising population effectively? From this question, the authorities will formulate and implement long-term strategies that deal with this issue perfectly.
Effects of Socio-economic Status in Accessing Health Care
Poor economic status implies that people cannot access better health facilities thus reducing lifespan drastically. This economic backdrop coupled with unemployment, which reached 8.9%, compared to 5.3% of Victoria, further presents Ballarat with recovery impasse that calls for national attention. The socio-economic factors contribute largely to the well-being and health status of the subjects. Across Australia, unlawful discrimination against aged workers continues to bite.
Perception of Society on Aged Employees
According to a report by Australian Human Rights Commission (2009), mature age workers (54-64 years) encounter massive barriers to employment due to their age. This group of people is prone to sicknesses like asthma, yet they cannot access the resources to fight off the ailments. This trend is likely to boil down to workers aged above 45 years in very recent future.
According to this human rights watchdog, this poses a great threat to economic development. By 2056, the proportion of people aged over 65 years will overtake those aged below 15 years in Australia (Australian Bureau of Statistics, 2008). This is a great challenge to the future of economic status of Australia. What is the government doing about this? Review of labor laws is inevitable if the government is to deal with these challenges effectively. The human rights watchdog has to become proactive and step up campaigns to sensitize the public on the dangers of discriminating aged workforce. With figures indicating that the proportion of people over 65 years will overtake those under 15 years, the government has to review its strategic plans.
Population Projections by 2021
In Ballarat, more than 15% of the population is over 65 years old, the projections are that by 2021; quarter of the population will be above this age (Australian Bureau of Statistics, 2008). Ageing population requires improved health services to cater for the rising needs among these people. This is a challenge to Ballarat because the available health institutions do not match the rising needs. Other determinants of health include environmental factor, education and housing.
Life Expectancy
Life expectancy in Ballarat for males stands at 76.9 years, which fairs poorly with that of Victoria of 84.3 (Australian Bureau of Statistics, 2007). This indicates that there is a serious problem affecting environmental factors in this region. Environment affects life expectancy largely in the long term. Polluted environment means that people fall sick often from the microbes suspended in the polluted surroundings. Even though there is a projected plan to construct 15,000 dwellings by the year 2030, the current housing patterns contribute a lot to prevalence of asthma in Ballarat. Asthma thrives well in congested environments, explaining in part the reason why this region recorded higher figures on asthma prevalence in Australia. The proposed construction of extra households by 2030 is in time and if implemented, will ease congestion in this city.
Asthma Versus Smoking
Reported asthma cases indicated that the victims were smokers. Education contributes immensely to elimination of some ailments like asthma. In Ballarat, education advancement is low in relation to Victoria. This also implies that many people did not get sufficient information on dangers of smoking. Improved education systems will alleviate illiteracy and in turn inform public on the dangers of practices like smoking.
Administration in Ballarat
Politically, Ballarat is isolated from other cities that make up the State of Victoria. This ancient town lies in the hands of municipal councils who run it. As a result, development of social amenities like hospitals and dispensaries take long before establishment. By the government stepping in and providing these crucial services, the health status will improve drastically and this will encompass reduction of asthma prevalence in this region.
Prevalent Challenges
Victorian Government Health information (2009) concur that hospitals face the challenge of increasing demands from the public especially from the aged. This prompted hosting a seminar to debate on how to improve hospital conditions and structures and still maintain consumer perspective in the process. In the seminar, reports indicated people aged above 65 years frequented hospitals and spend more time in them than young people spend. This calls for implementation of strategies, which will allow establishment of clinics for the aged. A recent policy paper from Victorian government gives an outline of a ‘person-centered’ approach will improve care for the aged.
Resilience Among Asthmatic Old People
Sources of resilience among asthmatic aged people come from family support, religious bodies, socialization and emotional control. Maintaining a strong positive attitude and meeting people of the same caliber alleviates most ailments. According to an APA taskforce set to address resilience in different age groups, emotional, social and cognitive development is important in dealing with societal problems including sickness.
The Way Forward
The current asthma situation among people aged above 65 years in Ballarat is alarming. This is because the reported cases surpassed those in Victoria and any other part in Australia. This results from several social determinants that score poor in this region. The main determinant is economic backdrop that muzzles efforts to improve the state of health among the aged. There is discrimination of aged people seeking employment thus reducing their purchasing power even for drugs. However, the Victorian government is implementing crucial reforms in housing and health sectors to improve health status of individuals.
Ballarat is far from matching with Melbourne, economically, politically, socially and all other forms of societal well-being. Nevertheless, with time, the economy will pick up with the increasing population, which presents sustained workforce. With strategic planning and resource management, Ballarat can achieve its long-term goals. This is realistic if immediate implementation of crucial process takes place now.
For more Information
To learn more about health determinants and their effect on asthmatic old people (65+) in Ballarat, visit [Insert Name of College Health Service, Campus Location, and Telephone Number and Website].
Reference List
Australian Bureau of Statistics (2008). Population Size and Growth. Web.
Victorian Government Health information. (2009). Improving Care for Older People. Web.
Australian Human Rights Commission. (2009). Experience Works Report Highlights Our Hidden Age Discrimination Problem. Web.
Science News. (2009). APA Task Force Calls For Reframing Research to Address Resilience among Black Youth. Web.
Discussion Paper for the 2009 Ballarat Community Summit. (2009). People and Communities. Web.
Page A. Ambrose L. Leah C. and Glover J. (2007). Population Health Profile of the Ballarat and District Division of General Practice: Supplement. (p 7). Web.
Ministry of Tourism. (2004). Melbourne Surpasses Tourism Expectations. Web.
Recently, asthma has become one of the common diseases. Being hard to prevent, it affects both the children and adults, mainly inhabitants of the developed countries (Yacoub, 1). The illness can have several forms, from infrequent to persistent, and is generally characterized by inflamed breathing ways and, as a consequence, hard breathing. Because of the enormous speed of the illness spread, dealing with asthma is becoming a burning issue of the modern medicine.
Even though there is a multitude of theories about the causes of the increasingly spreading disease, the scientists still have not reached any agreement (Bateman, 37). Genes and the specific features of different organisms are the main factors which are claimed to be the reasons for the disease’s development. However, there are several factors which are considered to influence the development of the disease. One of them definitely needs a precise analysis, as this factor is very spread among the developed countries’ populations. That thing is obesity.
Indeed, the fact that the overweight people are most likely to have problems with breathing is not surprising. The whole breathing apparatus is a system of muscles, which have to be in tonus so that the streams of air while inhaling and exhaling could move with no obstacles. The overweight people, especially the obese ones, have the extra level of fat, which is covering their muscles. Therefore, the lung muscles are most likely to be not fit enough to function properly.
Furthermore, the overweight children often have their breathing organs developed in a wrong way. The extra fat prevents the lungs from functioning fully; thus, they stay “half-closed” during the whole life. The obese adults also have their asthma attacks more severe because of obesity (Orriols, 252). This is due to the fact that the muscles of the broche lack the appropriate tonus.
This hypothesis, however, has been disapproved by some scientists. The numerous experiments conducted showed that the obese people are often given the misleading diagnosis of asthma. The breathing problems can be connected solely with the extra weight, and not necessarily are the symptoms of asthma. Moreover, while assuming that the obesity may not influence the development of asthma, it is worth mentioning that it does decrease the sensitivity of the organism to the medications (Beuther, 662).
Thus, following either of the given theories suggests that avoiding the obesity is better to either prevent asthma or ease its symptoms. One of the ways to keep fit is the regular exercise. The organized physical activity helps to improve the blood circulation in human organism. The bronchi, lungs, and other components of the breathing system are all covered with an intense net of arteries; therefore, the proper blood circulation can improve these organs’ functioning. As a result, the planned exercise can help to deal with asthma attacks. In addition, exercises help to avoid the obesity, which, as mentioned, can worsen the asthma’s symptoms.
Controversially to the stated idea, some scientists claim that the asthma attacks can be not prevented, but triggered by an exposure to exercise (Lazo, 14). This idea is quite logical, as asthma is often defined as the difficulties with breathing as a result of the contact of the bronchi muscular layers. During the exercises, all the muscles change the tense state to the relaxed one and back. During these movements, the muscular layers can most possibly touch, which proves an impediment for the free flow of the air stream. The predispositions for being affected or treated by exercise during asthma probably depend on the personal peculiarities of different organisms.
Besides the exercises which, as mentioned, can be ineffective, there are also many other methods to cure asthma. The most popular ones are the medications for maintenance treatment of asthma. For instance, Seretide is often prescribed to the patients who need to deal with the asthma attacks. Seretide 500/50 is one of the spread dosages of the medication. This dry powder inhaler is claimed to decrease the number of attacks and improve the patients’ breathing for 12 hours after taking (Yacoub, 2). The medication has almost no precautions and can be used by people of all ages. However, if a 14-years boy has asthma, is it necessary to treat him with such a powerful medication?
Many medics would be positive about Seretide 500/50 to be prescribed to the boy, as the medication is rather effective. However, there is also another side of the coin. For instance, the mentioned kind of Seretide contains 500 mcg of fluticasone in every dose. This element can be harmful to the young organism, especially in such great doses. 14 years is the age when the organism is not formed fully yet; the organs of breathing are also not finally developed.
The mentioned medication can affect the development of the boy’s organism and be harmful for the successful formation of his breathing ways. In addition, the cough attacks are casual phenomena at this age; this is due to the fact that the immune system is developing. That is why it may be relevant to concentrate on the physical development of the teenager and try using more natural methods of treatment. Only in case if asthma is persistent and intensive, there is a need for medications.
Thus, it can be stated that taking the Seretide 500/50 in such young age is rather insufficient. In any case, the question whether this therapy is hazardous for the boy can be answered by different medics differently, as the modern medications have a tendency to be concentrated and extremely active.
Besides the traditional medications, however, there are also many other methods of treating asthma that are being developed at the time. The therapies of the new age include different immune modifiers, such as the famous anti-IgE agent. The principles of immune modifiers work are based on increasing the resistance of the organism to the external irritators. Such therapies can be really helpful, as the asthma attacks are always caused by some factors, such as fur, mound, viruses, etc.
However, just like any other medications, the immune modifiers can be disadvantageous in some respects. For instance, the anti-IgE agent is proved to cause dependency, as the human organism is not capable of keep its immune system in a good condition after such powerful stimulator. In any case, the immune modifiers are effective and their implementation should be used more widely.
All in all, asthma is a very spread disease, and the deeper investigation of its roots and development is of a vital importance. The different methods of treating asthma have their benefits and disadvantages; considering the peculiarities of one’s organism is very important while choosing an appropriate therapy. Various details which may influence the disease development, such as obesity, age, ecology, etc. should also be taken into account.
Asthma is believed to be one of the greatest threats for the health of the inhabitants of the industrialized world. The heavy molds, dusts, gases are the main irritators of the cough and wheeze, known as the basic symptoms of asthma. The dissatisfactory state of ecology and consequently weak immune systems suggest that people nowadays have a lot of predispositions to this disease. Every of us is under the threat of becoming asthmatic; that is why the question of the precautions and effective treatment are crucial.
Ironically, despite the high risks of the asthma to be developed in any organism, there is neither clear definition of the disease, nor its reasons. The difficult breathing and cough can be explained by the genes, viruses and other factors. Moreover, detecting the disease in children can be even harder. The wheeze is a common feature of all the children, and the parents do not usually worry about the possibility of a significant disease to occur. However, we all should be aware of the fact that asthma is one of the most progressing diseases.
If a person has asthma, they have to be aware of some conditions which may worsen the state of the ill person. One of the most significant features that contribute to the general state of the health and to the development of asthma in particular is obesity. Both the children and adults are proved to have their asthma progress fastened in case of being overweight (Bateman, 42). For instance, the children and teenagers all have some cough attacks, which may vary in frequency; however, the overweight children have such attacks twice more often than those with the normal weight (Wittczak, 82).
The obese children often suffer from suffocation, especially when sleeping, as the minor airways are closed in this state, and there is not enough air coming into the lungs and delivered to the whole organism. For adults, obesity is also extremely harmful. The asthma attacks are much more frequent for the obese people comparing to fit (Bateman, 36). What is more, the experiments showed that losing weight led to a significant improvement and reduction of asthma attacks.
Thus, the role of exercise in asthma management cannot be underestimated. As it was mentioned, fit people have less difficulties dealing with asthma; therefore, exercise is important as it helps to burn fats. Furthermore, the appropriately organized set of exercises helps to gradually develop the organs of breathing ways. As an example, we can compare the lungs and bronchi of an ordinary person and a person who is jogging constantly. The latter one would have these organs almost 30% bigger and their capacity greater (Yacoub, 1544). The exercise also helps to intensify the blood circulation in the whole organism, which strengthens the immune system of an individual, making them resistant to different kinds of asthma irritators. Indisputably, exercise is one of the essential and effective methods of asthma management.
However, exercises alone can be not enough to cure the disease fully. The human organism often needs the more powerful support, such as the supply of some elements which are fighting the illness. The modern world offers such conditions of life which make a person vulnerable to different viruses and other disorders. The dissatisfactory ecological state and living in non-greened cities suggest that people nowadays have the immune system becoming weaker and weaker. Thus, the help of some medications for dealing with asthma is sometimes unavoidable. The doses and sorts of the medications are usually dependent on the age of a patient and severity of illness.
However, there are cases when even the right calculation of dosage can be harmful for an organism. For example, let’s analyze the Seretide 500/50 medication. It is proved to be rather effective, as it is capable of softening the cough and guarantees the free movement of streams of air through the breathing ways. But in case of a 14 years old being prescribed this medication there can appear some doubts. First of all, it is worth mentioning that this age is known as a period when the reproductive genes are forming.
Taking the Seretide 500/50 is rather hazardous at this period, as the high concentration of the chemicals in the medication can be harmful for the process of a teenager’s development (Lazo, 14). Such intensive therapy can be rather hazardous in such young age, as it also can “program” the organism to take the concentrated medications only. As a result, taking some natural preparations in future can be less helpful because the organism will be accustomed to the great doses of chemicals. If there is a strong need in some medications to be taken, the Seretide 100/50 can be prescribed to the teenager, as it is definitely less harmful.
Among the modern methods of treating asthma, there are also different other therapies. Among them are the popular immune modifiers, which are being widely implemented for the patients with various diseases. The immune modifiers have a range of positive qualities, such as quick effect, low risk and high efficiency (Zetterstrom, 265). In case with a teenager, the immune modifiers could be recommended. Firstly, they are very helpful for managing asthma.
Secondly, many viral diseases can be avoided when a teenager is taking the immune modifiers. And finally, these preparations help to form the strong immune system at the young age, which will protect the patient during all their lives. Taking into consideration all the mentioned benefits, it can be concluded, that the immune modifiers are an efficient solution for those who suffer from asthma.
Being asthmatic does not mean being unable to lead the ordinary way of life, but it does mean a lot of work that has to be done. An asthmatic should try to maximally decrease the number of factors affecting their health. Exercises, healthy way of life, proper nutrition, and use of medications can help to successfully manage the disease. In addition, everyone should take precautions to prevent asthma from developing in their organisms. Additionally, to the mentioned points, the pregnant women should remember that smoking during pregnancy and infancy can guarantee the development of asthma in children.
To sum up, it can be said that asthma is a disease which can hardly be prevented in a modern world. Being under the constant threat of catching the disease, we should be aware of its peculiarities. Despite the unclear roots of asthma, there is a number of methods of dealing with the disease. They include exercising, taking medications and other therapies. The choice of the treating method should be made after consulting an expert, who will consider the peculiarities of a specific organism and define the needed preparation and its dosage. In addition, every individual should also try to do everything possible to avoid asthma and strengthen their organism with the help of physical training and leading a healthy way of life.
Works cited:
Bateman, E. “Can guideline-defined asthma control be achieved?” Am J Respir Crit Care Med 170 (2004): 36-44.
Beuther, D. “Overweight, Obesity, and Incident Asthma.” American Journal of Respiratory and Critical Care Medicine 175 (2007): 661-666.
Lazo, J, Gilman, A, Brunton, L, Parker K. The pharmacological basis of therapeutics.11th ed. New York: McGraw-Hill, 2005.
Orriols R, Costa R, Alberti C, Castejon J, Monso E, Panades R, Rubira N, Zock J-P “Reported occupational disease in Catalonia” Occup Environ Med 63(2006): 255-260.
Wittczak T, Dudek W, Krakowiak A, Walusiak J “Occupational asthma” Int J Occup Med Environ Health 21 (2008): 81-83.
Yacoub MR, Lemiere C, Labrecque M. “Occupational asthma” European Journal of Allergy and Clinical Imm 60 (2005) : 1544-1545.
Zetterstrom, O. “Improved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone.” Eur Respir 18 (2001): 262-268.
The leading chronic illness among children in the US under the age of 18 is asthma, coming to 5 million (Shaw, 2005). The leading cause of school absenteeism and emergency room admission is asthma. Other problems that affect children are the underdiagnosis, poor acceptance of diagnosis and poor compliance (Shaw, 2005). Adolescent asthmatics are also considered a high risk population, having a higher severity than the age group 5-12.
Asthma appears to be concentrated in the urban areas rather than the rural ones (Magzamen, 2008, p. 655). However the rural areas have more of resource deficits (Horner, 2008, p. 506). Health care interventions have been tried and studied in various locations and circumstances. Most of them had been partially successful but had met problems on the way which could be remedied and modified for future use.
Background
The prevalence of asthma is high in the Head Start population at 13.9 to 39% and the adolescent age group. The Head Start addresses emotional, social, psychological and health needs of young children being prepared for school entry. They had a program called the Early Childhood Asthma Project (Nelson, 2006). Children who had not been diagnosed yet for asthma or had uncontrolled asthma were to be identified. Care-givers were to bring their children to be checked. Children who were going to have the treatment were to be followed up. The care-givers were to be given asthma management education. The families were to be given social support. Ample communication was to be provided to the family, Head Start personnel and the Child’s physician in relation to the asthma (Nelson, 2006). A qualitative evaluation program was conducted (Nelson, 2006).
The participants were the project director, project coordinator, school liaison/field supervisor, 2 health education counselors, the data collection coordinator, and a project co-principal investigator. The evaluation included that of the project reports, staff logs, quarterly reports and taped interviews. The problems encountered were set up under 4 themes: care-giver participation, Head Start role, ECAP program factors, family beliefs and concerns (Nelson, 2006).
Awareness needed to be instilled in the care-givers and the head start staff. Misconceptions were to be removed. Families were not yet fully convinced about the role of the ECAP. The administrators were fully equipped for the program but the other staff were not really into the program though they were the ones who had direct contact with the care-givers. The capacity or number of staff was insufficient to make the program a runaway success. The skills were to be upgraded
A classroom based high school asthma education program was arranged among 10th grade students of two schools (Shaw, 2005). The objective was to improve the quality of life, self-efficacy and self-management behaviors. There was a control group with delayed intervention. The aim was to improve knowledge, improve self management techniques, self-efficacy, social support or coping skills. A program was developed and integrated into the routine curriculum in two schools.
It was known as First Aid for Asthma. Asthmatics and non asthmatics were participants. The Social Cognitive theory including “performance accomplishments, vicarious experience, verbal persuasion and emotional arousal” were added to the curriculum. A questionnaire which was self administered measured 5 variables of asthma knowledge, attitude towards asthmatics, quality of life, self-efficacy, and self-management behaviors (Shaw, 2005).
The questionnaire had asthma screening items, asthma knowledge items and asthma attitude items. Reliability was tested against Likert-type scales. Asthma knowledge scores were low for all the children. Mean attitude scores were almost similar in both schools and was favorable. Self efficacy was better in one school. Quality of life scores improved very insignificantly in both. Interventions were again followed later. Some improvement was seen.
Self management behaviors were commendable. The students happened to be health academy students hence the bias and two teachers were made to teach the curriculum which could have evoked different results. The study concluded with the understanding that classroom based asthma education is feasible and could be adopted as a strategy in all schools (Shaw, 2005).
A study was conducted to evaluate the Kickin’ asthma designed by health educators and local students which taught asthma physiology and self management techniques to middle and high school students at Oakland (Magzamen, 2008, p. 655). A nurse delivered the curriculum in four 50-minute sessions with 10-15 students in each series. A baseline and 3 month follow-up survey were done. A great reduction was seen in the asthma symptoms and emergency (Magzamen, 2008, p.664).
Unplanned health care utilization was less. School absences and activity limitations were also less. Asthma management behaviors improved and prevention was better by using medication. Getting students to register in the Kickin Asthma program and making them remain was a problem. The viability of the program would depend on whether schools want this program. However the program showed a marked improvement for symptoms, utilization of health care and reduction in asthma morbidity (Magzamen, 2008, p. 661).
Correct medicine usage and positive asthma behaviors were noted. The limitations in the days of activity and sleep disruption were less. Absenteeism showed marked reduction. The students who sought emergency care or hospitalization for asthma were diminished in number. Physician visits were less. Day time symptoms were declining and night-time symptoms were better. Asthma device use was better. The asthma symptoms were especially less after the intervention (Magzamen, 2008, p. 661).
A study which assessed the asthma education in rural schools was done. This was delivered by lay health educators (Horner, 2008, p. 78). Elementary school students were divided into two groups randomly. One group was given the asthma education and the other general health promotion education. Asthma knowledge, asthma self management, self efficacy for managing symptoms, metered dose inhaler technique and group interaction effects were measured and analyzed (Horner, 2008, p. 78). It was found that trained lay health educators were as efficient as any other person to deliver the classes. Training rural schoolchildren was possible under the circumstances to improve the knowledge and skills in self management of asthma.
Asthma education programs
These programs benefited families who attended the specialty care clinics and were admitted in hospital (Horner, 2008, p. 507). They improved the adult and children’s asthma. The success in improving outcomes was questionable. The health care based systems had limitations. Investigators developed various programs which could be instituted in public schools and community settings. Improvements were seen by these programs.
The asthma knowledge of parents and children and their perceptions improved. Combining school based programs with due referral to the asthma specialist had greater effects in health and outcomes. Most programs had been conducted in urban areas which showed a concentration of asthmatic children (Magzamen, 2008, p. 78). Only a handful of studies have been done in rural areas (Horner, 2008, p. 507). Nurse-delivered school based programs with a home visit to the family of an asthmatic child helped improve matters greatly where evaluation after one year showed improvement in self management and knowledge. Asthma self management education for parents and children in the rural area in a workshop format found improvements after one year too.
Educators and care-givers.
The educators vary from project counselors, nurses, schoolteachers and lay educators.
The education is well imparted whoever takes on the roles of delivering the class.
Those who get the training want to be able to be better equipped to handle the class delivery and face the questions directed at them (Nelson, 2006). Many care-givers are unwilling to participate for various reasons
Conclusion
Asthma is the leading chronic illness of schoolchildren, mostly of the adolescent age group, causing plenty of absenteeism, morbidity and poor quality of life. Asthma happens to be found mostly in congested urban areas (Magzamen, 2008, p.655). Programs are available in schools and the community for reducing the morbidity of asthma, improving the knowledge of the illness, improving self management techniques and thereby bettering the quality of life. The major drawback in most of the programs is that there is no uniformity of purpose, method of delivery and evaluation techniques. The Kickin asthma intervention indicated a good post intervention evaluation. However the program still had drawbacks in that the expected outcomes were much less. Selection of the educators does not seem problematic as most studies have fairly good results. These results could improve by correcting the drawbacks seen and improving the interventions to be used.
Hypothesis proposed
Educational Interventions improve the quality of life in the asthmatic adolescent urban school children.
Educational interventions do not improve the quality of life in the asthmatic urban school children
References
Horner, S.D. (2008). “Improvement of rural children’s asthma self management by lay health educators”. The Journal of School Health, Vol., Vol. 78, Issue 9, Pgs 506-513., ProQuest Educational Journals, American School Health Association.
Magzamen, S. et al. (2008). “Kickin Asthma: School based asthma education in an urban community”. Journal of School Health, Vol. 78, Issue 12, Pgs. 655-665. ProQuest Education Journals, American School Health Association.
Nelson, B.W. (2006). “Working With a Head Start Population With Asthma: Lessons Learned”. The Journal of School Health, Vol. 76, Issue 6. P. 273-275. ProQuest Education Journals, Kent.
Shaw, S.F. et al. (2005). “Effects of a Classroom-based Asthma Education Curriculum on Asthma Knowledge, Attitudes, Self-efficacy, Quality of Life, and Self-management Behaviors among Adolescents”. American Journal of Health Education, Vol. 36, Issue 3. Pgs 140-146, ProQuest Educational Journals, Reston.
In order to analyze the presented data, it is imperatively important to conceptualize and internalize the above statistical terms: Sampling is defined as the process that involves selecting units from a given population that a researcher is intending to study, while confidence interval is an interval estimate in a population to be studied and is used to show the reliability of the defined sample.
In the study which was carried out in United States in 2009 amongst the children and adults to show the prevalence of Asthma, a sample of 38,815 and confidence interval of 95% was used. Asthma is a serious common chronic respiratory disorder which affects persons of all ages. This inflammatory chronic disease whose exact cause is not known is characterized by shortness of breath, wheezing, breathlessness coughing and chest pain. With the level of danger it imposes, public health professionals must always access the kind of data on prevalence to ensure that those affected get the right medication. (Centre for Disease Control 2011)
The data presented shows the results and summary of a survey dubbed the National Health Housing Survey, (NHIS) which was conducted by phone on the prevalence of Asthma in the US between 2001- 2009. In the study a total sample of 38,815 with a 95% confidence interval was used. The above sample was used because it is not possible to interview everyone within US and also helped in getting rid of the bias. The sample was randomly picked from the entire estimated geographical coverage. The sampling error which is always provided in statistics covered for any unrepresented group within the estimated study. The confidence level used shows that the researchers are 95% confident that the parameter falls within the interval. In other words the result is having 95% probability of representing the whole value.
In the given data the prevalence was defined using characteristics such as, adults by sex, race/ethnicity poverty and region. From the data, there was a significant increase in Asthma patients during 2009 to 2011 at 12.3%.Amongst children Asthma increased during the period from 8.7% to 9.6% while within the adults’ fraternity the proportional increase was from 6.9% to 7.7%.The above proportions marked an increase in prevalence amongst males from 6.3% to 7.1% while in females it was 8.3% to 9.2%.
The report further indicated that the prevalence was greater amongst children as compared to adults at 9.6% against 7.7% and was remarkably high in boys at 11.3% against 7.9% of the girls population. Amongst adults, the prevalence was noted to be high within women folk at 9.7% against 5.5% for men, the report further indicated that in the preceding one year there was a reported great attack amongst children than adults at 57.2% against 50.7 %.( Centre for Disease Control 2011)
Confidence interval is important in health studies because it identifies those values that will recur such that there is high probability that given figures within the population is likely to have a similar trend. The confidence interval gives a plausible range of values within a population because when we estimate different statistics in a population there will be a sampling variability making the entire samples to differ. In a nutshell, confidence intervals are recommended in these studies because they give concrete description in the range of values that should be used to ensure an exact data interpretation. With the sensitivity that health data brings with it, it is necessary that high level of accuracy is encouraged and therefore the application of confidence interval.
Reference
Centre for Disease Control. (2011) Vital signs: asthma prevalence, disease characteristics, and self-management education — United States, 2001–2009. Web.
The National Quality Measures Clearinghouse has been of great importance to the Department of Health and Human Services. A lot of useful data is available on this website. For instance, there are measures and outcomes that are extracted from the National Quality Measures Clearing House for use in the Department of Health and Human Services to tackle bronchial asthma in children. One such measure is the assessment of the percentage of members who have persistent asthma from as young as five years of age. The supporting evidence of this measure includes a guideline on clinical practice, a procedure on formal consensus involving relevant experts from clinical, public health, as well as organizational sciences, and at least one research study that has been published by the National Library of Medicine. The measure is applicable among asthma victims; those admitted in hospital, as well as outpatients. It is also used in managed care plans, emergency departments, and office-based care. Pharmacists and physicians are the professionals who have been involved in the implementation of the measure.
Another measure that has been adopted by the Department of Health and Human Services is the appropriate use of medications for people suffering from asthma, right from the age of five years. The evidence that is used to support the adoption of this measure is the guideline on clinical practice, as well as the procedure of formal consensus. The measure is applied in organizations that provide care to outpatients and inpatients too. Moreover, the measure is in use in emergency departments, as well as office-based care settings. The professionals who have been involved in the implementation of this measure include advanced practice nurses, physician assistants, physicians, and pharmacists.
One example of an outcome found in the National Quality Measures Clearinghouse that is related to bronchial asthma in children is the average number of school days that are lost due to asthma. The evidence that supports this outcome is the procedure of formal consensus that involves relevant experts in clinical, public health, and methodological sciences. The outcome is based on the available statistics that indicate there are about 4.8 million American children who have asthma. This outcome is mainly used in the community health care.
Several reasons have been widely provided in the development of clinical indicators by the Australian Council on Health Services. One of these reasons is the fact that the indicators are recognized internationally. Another reason is that health care organizations determine the selection of all clinical indicators in Australia. One of the most important conditions necessary for the development of clinical standards in Australia is that more than 40 health care colleges and organizations have to endorse the indicators being adopted for use in clinical practice. Statisticians from the University of Newcastle have to validate all the external indicators before being approved for use in the clinical departments in Australia. A detailed literature review also has to be carried out on all the new clinical indicators to ascertain their importance and applicability in the modern times. Clinicians are urged to develop clinical indicators as a way of maintaining relevant and up-to-date indicators. Appropriate coding is done in an effort to categorize different clinical indicators according to their particular groups.
Asthma is one of the immunological illnesses. Asthma and allergic disease belong to the same category of inflammatory illnesses, caused by abnormal responses of the immune system in the respiratory system. Asthma and allergic illnesses make up some of the current health issues across the world as many people are suffering from the illnesses. Scientists are yet to create a clear understanding of the chemicals responsible for triggering asthma and allergic disease (Johnson, 2013).
T-helper-2 initiates immunological responses in the respiratory system, and they lead to the development of asthma. T-helper-2 originates from the CD4+ cells, and it is responsible for stimulating the production of mucus in the respiratory system. The T-helper-2 causes excessive production of mucus in the respiratory system, and it also causes the muscles in the system to become hyperactive. This leads to the development of asthma, which involves the inability of the victim to breathe normally.
The air passages in the respiratory system fill up with mucus, and the hyperactivity of the muscles makes it difficult for the victim to control breathing. Victims have access to limited air in their lungs. Researchers have identified that immune responses caused by the T-helper-2 have a link with both asthma and allergic reactions. The production of the Th2 initiates when the victim gets in contact with allergens, contaminated air, and other infections (Umetsu & DeKruyff, 2006).
T-helper-2 and asthma
Asthma is characterized by abnormal inflammation in the respiratory cells because of the T-helper-2 response in the cells. Non-asthmatic people can inhibit TH2 response; hence, their respiratory system is not affected by allergens and other infections that may lead to asthma attacks. When asthmatic people get into contact with some particles in the air they breathe, their CD4+ cells respond by releasing Th2 cells, which cause inflammation in the cells within the respiratory system.
In the normal immunological responses, regulatory T-cells are released to counter the effects of the Th2 cells; thus, preventing inflammation. Cytokine IL-10 plays a big role in causing an anti-inflammatory effect on the cells. The immunological response in asthmatic people fails in the regulation of the production of the Th2 cells and the anti-inflammatory cells (Johnson, 2013).
The breakdown in immunological response happens every time asthmatic people come into contact with infections and allergens because their system is configured to respond without the production of the anti-inflammatory cells. Treating asthma involves administering medications that trigger the attainment of a balance between the production of the Th2 and cytokine cells (Lloyd & Hawrylowicz, 2009).
Studies
Various researchers from different institutions across Southampton undertook a joint study to identify the roles of different T- cells in the immune system. The researchers were particularly interested in finding out the role played by Th17, Th2, and Th1 among several other cells. The researchers used a sample space of 84 participants.
The participants went through various experiments aimed at detecting the release of T-cells, and the effects they had on other cells. The findings revealed that Th2 plays a big role in causing inflammatory effects in the respiratory system of asthmatic people. The researchers also found out that some of the T-cells like the Th17 have limited roles in causing asthma (Staples et al., 2013).
Researchers from various institutes developed a study to investigate the role of IL-25 in angiogenesis. IL-25 is a type 2 T-helper cell, and the scientists hypothesized that it was an integral part of the chemicals that trigger angiogenesis in the respiratory system of asthmatic people. The researchers acquired human vascular endothelial cells from tissue culture processes, which they used to conduct various experiments aimed at revealing the role of IL-25. Their findings revealed that asthmatic people have an elevated amount of IL-25, which takes part in triggering angiogenesis. The IL-25 increases the number of VEGF endothelial cells through some pathways (Corrigan et al., 2011).
Application of the studies
Asthma and allergic diseases are closely related illnesses, and the studies on Th2 cells are a recommendation made by researchers in the immunology field (Johnson, 2013). Understanding the roles played by specific T-helper-2 cells is important for experts in the field to develop the most feasible interventions to regulate immunological responses. The research work conducted by researchers from various institutions in Southampton confirmed that Th2 cells play a big role in causing inflammatory reactions in asthma patients, and this reaction is related to various allergic illnesses.
This information is important because it moves scientists a step closer to pinpointing the chemicals responsible for asthma. The study on IL-25 singled out one of the Th2 cells to reveal its role in asthmatic patients. The findings can apply in the development of drugs that inhibit the functions of the IL-25. Studies in the future should focus on developing a better understanding of the T-helper-2 cells to reveal the specific cells that cause inflammatory reactions in asthma and allergic disease (Corrigan et al., 2011).
References
Corrigan, C. J., Wang, W., Meng, Q., Fang, C., Wu, H., Reay, V., & Ying, S. (2011). T-helper cell type 2 (Th2) memory T cell-potentiating cytokine IL-25 has the potential to promote angiogenesis in asthma. Proceedings of the National Academy of Sciences, 108(4), 1579-1584.
Johnson, M. D. (2013). Human Biology: Concepts and Current Issues. Upper Saddle River, New Jersey: Pearson Education.
Lloyd, C. M. & Hawrylowicz, C. M. (2009). Regulatory T cells in Asthma. Journal of Immunity, 31(3), 438-449.
Staples, K. J., Mansour, S., Smith, C., Ward, J. A., Howarth, P. H., Gadola, S., & Hinks, T. S. (2013). A Comprehensive Characterisation Of Canonical T Helper Cells, Cytotoxic T Cells And Novel Invariant T Cell Phenotypes In Human Asthma. Am J Respir Crit Care Med, 187, A3770.
Umetsu, D. T. & DeKruyff, R. H. (2006). The regulation of allergy and asthma. Immunological Reviews, 21(2), 238-255.
Asthma is a widespread health problem and is a growing burden on our society in terms of morbidity, mortality, health care costs, and quality of life. The prevalence of asthma is raising both nationally and locally. Among asthma triggers, tobacco smoke is very powerful. Hence the main purpose of the study is to investigate the association of smoking and secondhand smoke with level of asthma control, severity, and quality of life among adult asthmatics.
Asthma is a chronic inflammatory disorder of the airways characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness. Clinical manifestations include wheezing, coughing, and shortness of breath (Moorman et al., 2007). Hyperresponsiveness, the exaggerated narrowing of the airways after the inhalation of various stimuli, is a key feature of asthma (Eder, Ege, & Von Mutius, 2006). Causative factors that provoke asthma include viral infections, allergy, exercise, and airborne irritants such as cigarette smoke, strong odors, dusts, and other inhaled irritants (Fireman, 2003). The exact causative mechanism of asthma is unknown, but it is believed that there is a combination of both environmental and genetic factors during the development of an individual’s immune system that leads to susceptibility of asthma. Asthma can develop during childhood, or as an adult, and the disease is believed to have strong familial ties with complex genetic derivation.
Asthma is a widespread public health problem that has increased in the past two decades in Texas and the United States (Mannino, Homa, Akinbami, Moorman, Gwynn, & Redd, 2002), and there are approximately 21 million people in the United States with the diagnosis of asthma, of which 7 million are under the age of 18 (Moorman et al., 2007). Thus, the vast majority of individuals with asthma are adults. The prevalence is higher in African-American adults, and is higher among adult women than men. Women with asthma report more symptoms and poorer quality-of-life than do men, although measures of airflow obstruction are comparable (Osborne, Vollmer, Linton, & Buist, 1998). In Texas, approximately 1,000,000 adult Texans report having asthma, and many adult Texans are not in control of their asthma symptoms. Also, health related quality of life is lower in adults with asthma compared to adults without asthma (Texas Asthma Program, 2004). In Texas, 822 people have died of asthma since 1998, and asthma is responsible for approximately 25,000 hospitalizations per year – costing Texas more than 200,000,000 dollars per year in hospital charges (Texas Asthma Program, 2004). Thus, asthma poses to be a growing burden on our society in terms of disease related morbidity, health care costs, and quality of life (Fuhlbrigge et al., 2002). Hence, disease management is in the best interest of not only asthmatics, but our society as a whole.
Asthma Control, Severity & Quality of Life among Asthmatics
Being that asthma is a disease of chronic nature, it cannot be cured; however, the clinical manifestations can be controlled. Control is the degree to which symptoms of asthma are minimized and the goals of therapy are met (Myers & Op’t Holt, 2008). Therefore, achieving respiratory symptom control is one of the main targets in the management of patients with asthma (Nieuwenhof et al., 2006). Costa, De Oliveira, Caetano, Santoro, & Fernandez (2008) suggests that “When uncontrolled, asthma can put severe limits on daily life and can even be fatal” (p. 579). By accomplishing optimal control of asthma, the risk of life-threatening symptoms of asthma can be easily controlled and reduced. According to Thorsteinsdottir, Volcheck, Madsen, Patel, Li, & Lim (2008) the attainment of asthma control correlates with improved quality of life and reduced health care use, thus the importance of obtaining asthma control. This idea is substantiated in a prior study by Vollmer et al. (1999) who found that the number of asthma control problems showed marked highly significant cross-sectional associations with self reported health care utilization relating to quality of life in patients.
To help manage the treatment of asthmatics, the National Heart, Lung, and Blood Institute (NHLBI) and the National Asthma Education and Prevention Program (NAEPP) released the Expert Panel Report 3 (EPR-3). The EPR-3 provides the most comprehensive, evidence-based guidance for the diagnosis and management of asthma to date (National Heart, Lung, and Blood Institute, 2007). Following such medical management guidelines and avoiding exposure to environmental allergens, triggers and irritants that are known to exacerbate asthma are factors that can contribute to long-term and effective management of asthma (Moorman et al., 2007).
The assessment of asthma control is a key concept in asthma management. The goal of asthma control assessment is the definition of well-controlled asthma and poorly controlled or not well-controlled asthma. Simple validated tools that measure asthma control are recommended as a means of defining asthma control (Schatz et al., 2007). Recent statistics suggest that asthma remains poorly controlled in most (53-58 %) patients (Chapman, Boulet, FitzGerald, McIvor, & Zimmerman, 2005). Despite laudable efforts to improve asthma care over the past decade, a sizeable number of patients have not benefited from advances in asthma treatment. A substantial number of adult patients with asthma are inadequately controlled despite the availability of effective asthma treatment (Nieuwenhof et al., 2006). According to Lavoie et al. (2008) achieving optimal asthma control relies upon several behavioral factors including self monitoring, and more importantly, patients’ adherence to treatment regimens including trigger and exacerbation avoidance. Backer et al., (2007) found that “Compliance with therapy is a very important component of treatment failure” (p. 379). This idea is mirrored by Rabe, Vermeire, Soriano, & Maier (2000) who continue on to suggest that patients are inadequately treated and that adherence to asthma treatment guidelines is generally poor. As a consequence of poor adherence, there is general failure to achieve the set guideline goals. In formulating the treatment of asthma, to achieve optimal control the domains of both impairment and risk need to be assessed and monitored (Busse & Lemanske Jr, 2007).
Many individual factors have been previously associated with asthma control. The main causes of uncontrolled asthma are costs of health care utilization and absence from work or school (De Vries, Van Den Bemt, Lince, Muris, Thoonen, & Van Schayck, 2005), and also exposure to asthma triggers like allergens and tobacco smoke. Previous studies (Connolly, Chan, & Prescott, 1989; Lin, Fitzgerald, Hwang, Munsie, & Stark, 1999) have shown that lower income class and lower social class were associated with poor asthma control and higher rates of hospitalization due to asthma. Also, several authors (Althius, Sexton, & Prybylski, 1999; Connolly, et al., 1989; Siroux, Pin, Oryszczyn, Moual, & Kauffmann, 2000) have shown that current smokers have a higher frequency of bothersome asthma symptoms, attacks, and higher level of asthma severity than non-smokers. According to Myers & Op’t Holt (2008), “There is no more toxic substance to the asthmatic lung than tobacco smoke” (p. 5).
Tobacco Smoke
Both environmental or secondhand smoke and active tobacco smoking are detrimental to asthmatics. Secondhand smoke contains more than 4,000 chemicals, 250 of which are proven harmful (National Toxicology, 2005). There is no safe level of exposure to secondhand smoke (U.S. Department of Health & Human Services, 2006). This is because tobacco smoke burning from the end of a lit cigarette does not pass through the filter, thus, all of the toxins are released into the air. Silverman et al. (2003) go on to find that overall, 35% of asthmatic patients between the ages of 18 and 54 years old were current smokers, 23% were former smokers, and only 42% did not have a history of smoking cigarettes or were currently smoking. In 2005, an estimated 20.9% (45.1 million) of U.S. adults were current cigarette smokers (Mariolis et al., 2006).
Several deleterious effects have been described in asthma because of smoking: accelerated decline in lung function, more severe symptoms, impairment in quality of life and diminished therapeutic response to steroids (Baena-Cagnani, Maximiliano-Gomez, & Canonica, 2009). Similarly, exposure to environmental tobacco smoke, as reported by parents, has been linked to diminished pulmonary function and more frequent exacerbations of asthma in children with the disease (Chilmonczyk et al., 1993). Withers, Low, Holgate, & Clough (1998) suggest that “Smoking, either active or passive, was shown to be significantly associated with current, persistant, and late-onset [asthma] symptoms” (pp. 352-357).
Several other studies (Larsson, 1995; Strachan, et al., 1996; Withers, et al., 1998) have also shown that active smoking is associated with new onset of asthma in adolescents and adults. But these studies included few adults (only up to age 33) and focused on the specificity of new onset disease. However, as with much of the previous literature found, these studies focused on children, teens, and adolescents. However, in an adult study, Niedoszytko, Gruchala-Niedoszytko, Chelminska, Sieminska, & Jassem (2008) reconfirm that “Cigarette smoking is a well-recognized factor triggering symptoms of asthma” (pp. 495-497) and that active smoking is a powerful but very avoidable asthma trigger. Despite the numerous detrimental effects tobacco smoke has on individuals that have chronic disease, adults with asthma do not appear to selectively avoid cigarette smoking (Eisner, Yelin, Trupin, & Blanc, 2001). Others have mirrored this view:
Many adults presenting to the emergency department with acute asthma are active cigarette smokers. Given the irritating effects of tobacco smoke, as well as the association of cigarette smoke with respiratory illness, patients with asthma would seem to be a group that would avoid smoking entirely (Silverman, Boudreaux, Woodruff, Clark, & Camargo, 2003, p. 1473).
A British study found that asthma incidence in individuals aged 17 to 33 had a strong association with active cigarette smoking (Strachan, Butland, & Anderson, 1996). But this study was performed on a large nationally representative sample. Another study went deeper and found that nearly 1 in 10 adults with asthma indicated current smoking, and more than half of subjects indicated past smoking, which were associated with increased asthma severity, worse asthma-specific quality of life, and worse mental health status (Eisner & Iribarren, 2007). Their data results indicate that smoking is a potentially major issue for asthmatic adults. Eisner & Iribarren (2007) further conclude that both current and past smoking had similar adverse effects on measures of disease severity and health status, whereas current smoking had a greater impact on the prospective risk of hospitalization for asthma. The previous was an excellent study and included many desired associations; however, again, it was limited to patients acutely hospitalized or presenting to the emergency department with a primary or secondary diagnosis of asthma and does not reflect populations enrolled in voluntary asthma education programs. Moreover, they made no correlation to secondhand smoke, its subsequent association with asthma severity, control, or quality of life.
Asthma Education Program
Robichaud et al. (2004) suggests that “Emergency department visits for asthma may reflect poor asthma control, often due to insufficient asthma education and medical follow-up” (p. 1495). A key component of many asthma management guidelines is the recommendation for patient education and regular medical review (Gibson et al., 2009). This notion is mirrored by Costa et al. (2008) who have also suggested that “Education is fundamental in a good clinical practice, because if patients do not understand asthma, they will not be motivated to provide the self-care necessary to achieve asthma control (p. 579). One of the many purposes of an asthma education program is to focus on trigger identification. If we can pinpoint the problematic foci, then we can remove it from the individual’s environment, thus leading to better asthma control and quality of life.
This idea is reiterated succinctly by the results of an asthma education study by Lucas et al., (2001) whom suggest that “participants’ quality of life, functional status, and appropriate use of health care resources improved and was sustained for two years after program completion” (p.329). A number of studies (De Oliveira, et al., 1997; De Oliveira, et al., 1999; Cabral, et al., 1998) have also suggested that asthma education programs can significantly improve asthma self-management skills, which has resulted in fewer patients seeking medical attention, as well as considerable improvement in quality of life. These studies have evaluated the effectiveness of asthma education programs; however they have not documented the number of adult patients presenting that actively smoke and/or are exposed to secondhand smoke. Further, none have inferred on the subsequent association between smoking and secondhand smoke with level of asthma control, severity, and quality of life.
Need for the Research Activity
Properly managing asthma is a crucial keystone in obtaining an appropriate level of asthma control. A major part of this is identifying and removing asthma triggers. Since tobacco smoke is a very avoidable trigger, theoretically, removing tobacco smoke and obtaining control should be an easily achievable goal. Despite this, the ability of individuals with asthma to avoid this potentially harmful trigger, many adult asthmatics continue to actively smoke, and subject themselves to secondhand smoke.
The subsequent associations between smoking and secondhand smoke on level of asthma control, severity, and quality of life have been extensively studied in the past. However, much of the previous published literature focuses on children, teens, and adolescents; and virtually no studies, to my knowledge, exist which focus on the association of these variables among adults enrolled in asthma education programs. Previous studies have gathered data from asthmatics that required emergency department visits, acute hospitalization, and nationally representative samples. Because asthma severity, control, and quality of life are vital concepts in the management of asthma, it is important to study it’s associations in patients presenting to asthma education programs. The subsequent benefits may not only adhere to asthmatics, but to our society as a whole.
According to a team of US scientists at the University of Wisconsin-Madison, there appears to be critical evidence relating activity in two brain areas to incidences of asthma disease. In an article whose findings appear in the BBC website (http:/news.bbc.co.uk) and based on research already published in the Proceedings of National Academy of Sciences, the US scientists led by Dr Richard Davidson have specified the role of each of these two brain regions to asthma attack. Their findings point out that one region obtains information about the asthma disease symptoms while the other region processes the patient’s emotions. These findings were obtained from experiments carried out on six volunteers with mild asthma and were designed to determine the relationship between the patient’s emotions and asthma disease.
Body
Asthma is a disease of the respiratory system which infects many people around the world (Belmont, 2009, December 9). Children are most affected as they are often much more vulnerable to this disease (Sandberg et al., 2002). Although stress and emotions are known to start in a patient’s mind, asthma in itself is a physical disease that affects the patient’s lungs, and stress can create strong physiological reactions which may lead to constriction of the airway and therefore resulting to changes in the immune system which is known to worsen asthma symptoms in patients (Rietveld et al., 2000).
Surprisingly, two brain regions, the anterior cingulated cortex and the insula have been shown to develop increased activity when the patient is subjected to stress as reported in the article which appeared in the BBC News on Health in which an experimental study involving six volunteer patients with mild asthma was carried out. The volunteers’ brain responses were closely monitored using functional magnetic resonance imaging as they were shown three different categories of words that were either related, non-related or neutral to asthma; while at the same time asthma was induced in them by some known asthma triggers such as ragweed or dust-mite extract. The results demonstrated that there was increased activity in the two brain regions when asthma related words were heard compared to other neutral word types as well as increased brain activity linked to the body reaction as a result of the inhaled asthma triggers.
However the researchers admitted that due to a small number of people who participated in the study, their findings would need to be repeated using more volunteers as it was likely that other brain parts may be involved in the relationship between emotion and asthma that have not yet been identified. The study goes on to warn that these brain regions might be hyperresponsive to disease-specific emotions and therefore contribute to other conditions that might lead to worsened asthmatic conditions such as inflammation as also previously reported by Busse (1995).
Other experts such as Dr. Mark Britton, the Chairman of the British Lung Foundation, and Dr. Lyn Smurthwaite of Asthma UK, have concurred with these findings as reported in the article under review. These findings show that there is relationship between regions of the brain that process emotion and those that deal with physiological asthma symptoms. This means that asthma and patients’ personality are closely related and therefore stresses the fact that those patients with proper knowledge of their diseases are at a much better position to deal with the disease as also pointed out by Silva (September 13, 2006). The article warns that asthma patients should not be subjected to stress as this may aggravate their condition. In addition, the article emphasizes the need to offer counseling to asthma patients to enable them cope with their condition as also advised by Innocent (2009, October 29).
Critique
This article is written for the general public as it appears in the BBC Health News website. It is largely written in simple and clear language which can easily be understood by readers who may not be familiar with technical biological or medical terms. However, the scientific inclined readers can also benefit from the article as it points out that it is based on research which appeared in the peer reviewed Proceedings of National Academy of Sciences journal which can easily be accessed in the internet or relevant libraries. It would have been better also mention the name or names of the authors of the article in the BBC News Health page, though this could depend on the policy of BBC media house or publishers.
It is commendable that a picture of the brain is also given in the article through the two specific brain regions are not discernable. To the general public, the information given in this article is therefore highly relevant as it touches on health issues that are increasingly affecting more and more people all over the world especially those who suffer from asthma.
Since asthma is a relatively common disease, the symptoms are relatively clear to majority of people, therefore not much explanation is needed as has been done in the article. However, the technique in which brain activities were monitored using magnetic resonance imaging may not be clear to the readers and hence may require further explanation in layman’s terms. The procedure used in the experiment is outlined in the simplest way possible hence they do not require any explanation as the content is self explanatory and clear to the audience. This therefore enables the readers to appreciate the results obtained from the experiment and allows them reach their informed conclusions.
The article is relatively short and the information relayed is straight to the point which can encourage those people who might not have time for long articles or finer details of the subject to quickly read the article for general knowledge. The article emphasizes the need for medics and physicians to counsel their asthma patients to enable them avoid unnecessary stress that may worsen the disease, and possibly increase dosage of their medication when under stressful situations. The article is also important to the general public as they will be enlightened on how to deal with asthmatic patients to avoid stressing them up.
Synopsis
This article meets its intended purpose as it is written in a simple and clear language that suits its target audience. The article looks at the link between parts of the brain processing emotion and physiological asthma symptoms through scientific research, and the results obtained reveal that certain emotions do cause flare ups of asthma. The article attempts to justify why asthma patients should not be subjected to stress as this may worsen their conditions since the asthmatic condition and a patients emotions are very closely related.
Rietveld S., Everaerd W., Creer T. (2000). Stress-induced asthma: a review of research and potential mechanisms. Clin Exp Allergy 2000;30:1058–1066.
Sandberg, S., McCann, D. C., S. Ahola S., Oja, H., Paton J. Y., McGuinness, D., (2002). Positive experiences and the relationship between stress and asthma in children. Acta paediatric, 91, (2), 152-158.
Respiratory diseases are some of the most prevalent and costly illnesses affecting the American population today. Asthma is one of the most common respiratory diseases and it affects an estimated 24.6 million people in America. However, the occurrence of Asthma is not uniform across the US population. Research indicates that the prevalence rate of asthma is higher among African Americans than among whites in the US (Office of Minority Health, 2012). This paper will set out to investigate asthma in the African American community with a focus on why the disease is prevalent in this population group. The paper will also highlight the effects that the treatment options used by African Americans have on the prevalence of the disease.
Description of the Disease
Asthma is a distressing and often disabling condition that can sometimes lead to death. By definition, asthma is “a chronic inflammatory disease of the airways, characterized by acute exacerbations of reversible airway obstruction” (Leach, 2010, p.193). The airway obstruction is also caused by the tightening of the muscles along the lung’s airways. Asthma is characterized by a hyperirritability of the airway to various stimuli. Individuals suffering from asthma have some degree of airway obstruction at all times. The airway obstruction becomes severe if the person is exposed to triggers, which might include smoke, pollen, air pollutants, and cold air to name but a few. Asthma is separated into several subtypes, which are; allergic, exercise-induced, nocturnal, and occupational asthma.
Asthma among African Americans
In the US, African Americans have the highest rates of asthma infections with the disease affecting 10.5% of this race while only 7.8% of the Caucasian population is affected. This represents a 35% difference in the rate of asthma prevalence between the two groups. Silvers and Lang (2012) observe that in addition to the high prevalence rates, African Americans are more likely to suffer from severe forms of asthma. This observation is corroborated by the American Lung Association (2010), which reveals that the death rate due to asthma is 3 times higher in the African American population than in the Caucasian population.
Factors that Make African Americans Vulnerable
The low socioeconomic status of many African Americans predisposes this group to asthma. A low socioeconomic status means that families will live in poor communities where living conditions exacerbate asthma. In addition to this, poverty reduces the chances of getting proper medical attention. Research indicates that African Americans are more likely to lack routine health care than Caucasians (Silvers & Lang, 2012). Even when health care is provided, there is a disparity in the quality of care among races with many African Americans receiving suboptimal care.
The genetic makeup of African American’s further predisposes them to asthma development. Genes contribute to the susceptibility to asthma development among individuals. Silvers and Lang (2012) document that genes make the African American community prone to some subtypes of asthma. For example, this community is more likely to be sensitive to allergens that trigger asthma attacks.
Exposure to tobacco smoke as a child increases the risk of developing asthma. African American children are more likely to be exposed to secondhand smoke at home. The very high prevalence of tobacco smoking among low-income African American households means that more children from this community are exposed to smoke in their homes. The Office of Minority Health (2012) reports that this exposure contributes to the high prevalence of asthma among African American children compared to Caucasian children.
Disease Transmission Modes
Genes play a significant role in asthma transmission. Genetic and familial factors play a major role in the development of Asthma with research estimating that the heritability of asthma is at 70% (Silvers & Lang, 2012). A person suffering from asthma cannot spread it to others since it is an inherited condition. As such, there are no methods to control the spread of the disease. However, since environmental factors trigger the symptoms of the disease, measures can be taken to control the environment.
Alternative Treatment
There is no cure for asthma, but there are ways to manage the condition and ensure that the patient lives a normal and productive life. Conventional treatment often entails the use of prescribed inhaled corticosteroids. This medication remains the most effective means of treating asthmatic patients. However, many African Americans demonstrate a marked resistance to this treatment option. Instead, they make use of alternative treatment options. These alternatives are used due to financial considerations and a deep suspicion of the conventional treatment options offered by the health care industry. Research by Birck (2006) revealed that African Americans use herbs and rubs to manage asthma. Treatments such as herbal tea and vitamin supplements are used to increase the body’s natural immunity, therefore, mitigating asthmatic attacks. In addition to this, some African Americans make use of prayer due to their deep religious beliefs.
Social and/or Cultural Influences
Some social and cultural influences promote the use of alternative medicine among African Americans. Birck (2006) documents that the preference for alternative medication also stems from the experiences with institutionalized racism by the African American community. The experience led to a great mistrust of the government and corporations in the US. In addition to this, the community has limited expendable income, making a cheaper medical alternative preferable. Most African Americans suffer from a lack of social support to deal with asthma. This lack of social support is mostly attributed to the low-income status of many African Americans. Without adequate support, the patient is at a higher risk of suffering from the severe outcomes of asthma. Silvers and Lang (2012) document that poor support is associated with high asthma morbidity among the African American community.
Effects of alternative treatments
Birck (2006) attributes the gap in asthma prevalence between African Americans and Caucasians to the use of alternative medicine by African Americans suffering from mild or severe asthma. To begin with, the efficacy of alternative medicine is not assured. Using this form of treatment increases the risk of the patient developing severe asthma or even dying. Some researchers attribute alternative treatment use by African Americans to the significantly higher death rate from asthma among this population. The use of the alternative treatment also leads to a decrease in the dosage of prescription medicine used by African Americans. Birck (2006) explains that for some African Americans, alternative drugs are considered part of conventional medicine. As such, a person using alternative medicine will engage in less intensive treatment even if he/she is suffering from severe asthma.
Promoting Health
The African American community recognizes that knowledge limitation has contributed to asthma prevalence and severity in this segment of the population. Efforts have therefore been made to increase people’s knowledge on asthma development and management strategies. Initiatives have been implemented to provide more knowledge to help control asthma among African Americans. In addition to this, steps are being taken to reduce the disparities in asthma care outcomes between Caucasians and African Americans. Awareness campaigns promote the use of conventional medication such as prescribed inhaled corticosteroids to manage asthma. With good management strategies, asthma-related morbidity and death among African Americans will be decreased.
References
American Lung Association (2010). State of Lung Disease in Diverse Communities. Web.
Birck, K. (2006). Beliefs About Asthma and Complementary and Alternative Medicine in Low-Income Inner-City African-American Adults. J Gen Intern Med, 21(12), 1317–1324.
Leach, M. (2010). Clinical Decision Making in Complementary and Alternative Medicine. Sydney: Elsevier.
Office of Minority Health (2012). Asthma and African Americans. Web.
Silvers, S.K., & Lang, D.M. (2012). Asthma in African Americans: What can we do about the higher rates of disease? Cleveland Clinic Journal of Medicine, 79(3), 193-201.