Category: Asthma

Introduction

Asthma is a non-Communicable Disease (NCDs) which accounts for 9 million deaths globally (WHO, 2013). Australia is among the top ranking countries of the world with a rate of 11.6% in asthma (ABS, 2009). The rate of mortality in Australia due to asthma is believed to be high by international standards (AIHW, 2012). Even though asthma is influenced genetically, there are several environmental and lifestyle factors which impact the disease. This report outlines some of the important contributing factors associated with asthma with the aim of providing appropriate interventions and strategies to reduce morbidity and mortality associated with the disease.

Biology – Pathology, Natural Progression, Genetic Influences and Effects of Age

Asthma is described as an illness of the respiratory system caused due to inflammation of the airways which causes obstruction of airflow within the lungs (AIHW, 2012). Asthma is caused due to the inflammation of the airways which in turn induces cough, wheezing, breathlessness and a feeling of tightness in the chest. However, these symptoms are reversible with appropriate treatment (AIHW, 2012). There could be extreme coughing during the night. Asthma has been conceived as a disease of gene-environment which occurs as an allergy during the early stages in life (ACAM, 2011).

Asthma is believed to be impacted by environmental factors and lifestyle and does not become severe or worse with age. It is not a progressive disease (AIHW, 2012). The impact of asthma of the lives of patients could be severe or mild depending upon the seriousness of the condition. Symptoms could be triggered by viral infections and exposure to dust, allergens or pollen, air pollution (AIHW, 2012). Asthma could prove to be life threatening in some cases.

Epidemiology

The NHS survey of 2007-2008 indicates that about six million Australians suffer from chronic respiratory conditions (ABS, 2009). Studies indicate that asthma may be caused due to environmental, genetic and lifestyle factors (ACAM, 2011). Exposure to dust, pollution, viral infections, exercise and allergens such as pollens or mites could trigger asthma attacks (ACAM, 2011).

The developed nations have been reported to have higher rates of asthma than the developing countries. Statistics indicate that the prevalence of asthma is high in Australia as compared to the United Kingdom and other English speaking countries which were found to have higher rates of asthma than the non-English speaking nations (ACAM, 2011). In Australia, asthma affects people of all ages but is more commonly found in young people (ACAM, 2011).

Statistics from the National Health Survey of 2007 and 2008 indicate that about 19% of all Australians (3,888,952) have asthma (ABS, 2009). The same survey (NHS) reports that about 9.8% of Australians are believed to be affected by asthma and the percentage of children known to be diagnosed with asthma is 10.4%. Studies indicate that asthma is a leading cause of burden of disease in newly born children to about 14 years (ACAM, 2009). This includes children between the age group 0-15 years (ABS, 2009).

The National Health Survey of 2007 and 2008 confirms that the percentage of females diagnosed with asthma is higher than males (ABS, 2009). However, among children, more boys than girls were found affected by the disease. A higher rate of asthma prevalence is found among the Aboriginal and Torres Strait Islander Australians (17%) as compared to 10% of non indigenous Australians (AIHW, 2012). The ratio of Australians in the inner regions is 12% as compared to 9% of those living in major cities (AIHW, 2012). Australia has substantially high asthma death rates by international standards with an annual mortality rate of 0.3% (AIHW, 2012).

Environmental conditions

Asthma has largely been known as a genetic disease; however, the alarming rise of asthma over the last 50 years suggests that the environment and lifestyle factors play a crucial role in the onset of the disease (Peden, 2010). Individuals living in urban areas in apartments with moulds and improper ventilation are likely to be affected by asthma. In his study, Peden (2010) confirms the link between asthma and a Western lifestyle which includes increased automobile use and exposure to tobacco smoke. Environmental air pollution is among the primary factors affecting asthma in patients and is particularly high in towns and cities. In areas of dense population, the low quality of air and high degree of pollution contributes to respiratory diseases such as asthma.

Some pollutants known for their hazardous effects on asthma include nitrogen dioxide, carbon monoxide, sulphur dioxide, ozone, lead and allergens such as pollen due to the breathing discomfort, allergic reactions, irritation of the airways and asthma triggers they are likely to cause (ACAM, 2011). Other environmental factors such as viral infections, exposure to allergens such as house dust, pollen, animal fur, and exposure to air pollutants are known to trigger symptoms of asthma (ACAM, 2011).

Environmental tobacco smoke is a significant factor in aggravating cases of asthma due to the direct effect on the airways and the development of allergies in individuals. The use of tobacco within homes also negatively affects the quality of air and is associated with increased cases of asthma Air pollution from vehicular traffic is found to be a major trigger of asthma in patients (Peden, 2010).

Data indicates that asthma is more prevalent in Indigenous Australians as compared to other Australians. There is an increase prevalence of asthma among individuals with low socioeconomic status (ACAM, 2011). Asthma is the second most common cause of hospitalization in Indigenous Australians and can be attributed to high exposure to pulmonary toxicants such as tobacco smoke, and uncertainty of diagnosis among the very young and very old resulting in long term under treatment (ACAM, 2011). Social customs and practices such as smoking habits in rural residents, less exercise and lack of nutritional diets are likely contributors of asthma.

Smoking and poor access to good quality health care are among the important causes for the high rates of asthma in Indigenous Australians as compared to other Australians (ACAM, 2011).

Societal Responses to Asthma

There is a great deal of data linking low socioeconomic status to asthma, a non-communicable disease (ACAM, 2011). It has been reported that individuals from lower status are more likely to suffer from asthma. This has been attributed to certain risk factors associated with low socioeconomic status such as reduced physical activity, smoking, inactivity and alcohol abuse (Glover et al., 2004). Studies which analyzed the impact of socioeconomic inequalities in the prevalence of disease found a large percentage of the poor population affected by the asthma which has serious implications to society and increased health care costs (Glover et al., 2004).

Societal factors which prevent self management of asthma are the lack of proper knowledge about the disease, ineffective monitoring and management of signs and symptoms of asthma, in ability to adopt a management care plan agreed and negotiated in partnership with health care professionals and inability to adopt lifestyles which promote health by addressing the risk factors associated with asthma (NHPAC, 2006).

Data also suggests a huge gap in the mortality rates between Indigenous Australians as compared to other Australians (ACAM, 2011). Death in Indigenous Australians due to asthma was 2.5 times more than other Australians indicating the strong influence of socioeconomic factors on the control of asthma and access to appropriate health care. Limited access to quality health care is a problem in economically poor communities. Some other factors which could impact the high prevalence of asthma in socioeconomically poorer Australians are lack of knowledge about the care and treatment for asthma and inaccessibility of health care services for treating it.

Health Intervention

The significant relationship between socioeconomic status and asthma points to the need for intervention for better and adequate health seeking behaviour strategies and measures for people belonging to this group.

Health promotion programs and Interventions for Asthma Self-management

The prevalence of asthma in Australia has risen in recent years necessitating the need for measures to reduce the risk of developing asthma. Community based health programs for information on asthma symptoms, prevention of asthma and communicating with asthma healthcare professionals will help individuals in effective self management of the disease (NHPAC, 2006). Written asthma management plans (AMPs) help to increase patient adherence and self management through the use of AMPs which include information about actions necessary for regular management of asthma and actions in the case of an acute attack (NHPAC, 2006).

Doctor patient relationship and clinical guidelines

Poor knowledge about asthma and poor communication about the disease have been associated with low levels of patient adherence. There should be communication between the doctor and the patient about the nature of asthma and the required daily therapy. Communication should include the necessary medications and the side effects of the therapy. The doctor’s role includes educating the patient about asthma, prescribing medication, discussing side effects, teaching and advising patients about the alleviation of burdens related to the disease (NHPAC, 2006). Doctors should adhere to clinical guidelines and include strategies such as written asthma management plans (AMPs) for patients as well as their family members. A program called the Stop Asthma Clinical System (SACS) enables doctors to get access to real time strategies about communication and teaching at their computers in their clinics (NHPAC, 2006).

Interventions to reduce smoking

Since smoke from tobacco is believed to be an important risk factor, policy measures need to devise interventions consistent with the National Tobacco Strategy which prevents tobacco intake in non smokers, importantly children; reduces products made from tobacco; and reduces the exposure of non smokers to tobacco smoke (NHPAC, 2006).

Aboriginal and Indigenous Groups with special needs

Special interventions need to be designed keeping in mind the asthma patients from the poor socioeconomic backgrounds that have significant risks of exposure to conditions which could cause asthma. Intensive programs delivered by child health nurses have had a positive impact on reducing exposure to environmental tobacco smoke (NHPAC, 2006). Measure to educate and promote measures among the disadvantaged groups should include community based strategies and counselling programs to highlight the risks associated with the following: smoking during pregnancy, exposure to environmental tobacco smoke during pregnancy and infancy and the risk of exposure to dust, allergens and termites within homes.

Conclusion

Asthma is a NCD with a high impact in Australia. However, effective education and management of the disease can reduce the risks of morbidity and mortality associated with the disease. The report suggests that the adoption of strategies and interventions including appropriate knowledge and education about the disease could have positive outcomes. With the help of interventions, clinical guidelines and community based support programs, it is possible to reduce the impact of asthma in Australia. However, there is a need for further research for the best intervention strategies to effectively address the problem of asthma among the Indigenous and socioeconomically disadvantaged Australian populace, which seems to be at a greater risk due to asthma.

References

Australian Bureau of Statistics. (2009). 2007–08 National Health Survey: User’s Guide — Electronic Publication, Australia, Cat. No. 4363.0.55.001. Canberra: ABS

Australian Centre for Asthma Monitoring. (2009). Burden of disease due to asthma in Australia 2003, Cat. No. ACM 16. Canberra: AIHW

Australian Centre for Asthma Monitoring. (2011). Asthma in Australia 2011. AIHW Asthma Series no. 4, Cat. No. ACM 22. Canberra: AIHW.

Australian Institute of Health and Welfare. (2012). Australia’s health 2012. Australia’s health series no.13, Cat. no. AUS 156. Canberra: AIHW.

Peden, D. B. (2010). Genetic and Environmental Factors in Asthma. In: Harver A. & Kotses H. (Eds.), Asthma, Health and Society: A Public Health Perspective. (pp 43-58).

National Health Priority Action Council. (2006). National Service Improvement Framework For Asthma. Australian Government Department Of Health And Ageing, Canberra.

National Health Priority Action Council. (2006). National chronic disease strategy. Australian Government Department of Health and Ageing, Canberra.

Glover, J. D., Hetzel, D. M., et al. (2004). The socioeconomic gradient and chronic illness and associated risk factors in Australia. Aust New Zealand Health Policy 1(1): 8.

WHO (2013). Noncommunicable diseases. Web.

Objectives

Exercise-induced bronchonstriction (EIB) frequently occurs in individuals with the overtly displayed respiratory symptoms that appear as a result of strenuous exercise. It has also been found that half of the EIB diagnosed patients are athletes, among which 20 % are children (Randolph 25). The study has also reported that almost 48 % of parents recognize the fact that children suffering from asthma have higher probability of the emergence of the typical symptoms of IEB. In the paper, the scholar explores possible treatment techniques, prevention, chronic pharmacological therapy, and summary of other approaches and medications used to reduce the frequency of EIB cases.

Methods

To explore the underpinnings and precursors of IEB, the author provides an extensive review of literature to contrast and compare various treatment techniques that refer to medical and psychiatric interventions. The testing procedures have been carried out by pre- and post-bronchodilator spirometry. One research indicated that children possessing asthma have higher probability to suffer from EIB.

Additionally, there are also surrogate-testing procedures that impose a number of challenges on the participants. Prevention techniques relate to the controller therapy implying the intake of inhaled steroids. Use of inhaled-acting beta-agonists that are often preceded with tolerance, a decline in the effectiveness of preventive and protection mechanisms. Treatment procedures are associated with non-pharmacological, pharmacological for chronic asthma and for elite athletes.

Results

Individuals with normal spinometry results could relate to inhaled steroids therapy. The most effective intermittent agents refer to the use of beta-agonists. Long-term therapy of EIB is carried out by inhaled corticosteroids. Children suffering from EIB should undergo repeated testing to determine whether inhaled steroids provide efficient treatment. Additionally, physical fitness is an important condition for controlling and preventing EIB because it diminishes the occurrence of severe forms of the disorder. Nevertheless, the recent research studies have not proved that physical fitness has a positive effect on EIB severity.

Conclusion

It has been discovered that EIB occurs in patients with recognized asthma, as well as in athletes without evident symptoms of asthma. As per surrogate challenges, specific attention should be given to mannitol issue and EVH, which are more relevant for diagnosis. Treatment techniques vary from non-pharmacological interventions to dietary techniques and inhaled steroids. Finally, beta agonists could be optional drugs for protecting against asthma. Non-pharmacological intervention includes face mask and improvement of physical fitness. All these approaches are efficient for diminishing the severity of exercises-related asthma. The focus is made on children whose treatment should be considered.

Works Cited

Randolph, Christopher. Exercise-related Asthma in the 21^st Century. Clinical Perspectives. (2012): 24-28. Print.

Objective

The main objective of the given paper is to analyze the reasons of emergence of asthma among the elderly population, as well as research peculiarities of this group’s reaction to this condition as compared to other age groups with asthma. According to Vasmus, older people suffering from asthma are more sensitive to allergic reactions, impaired lung functions, and a considerably diminished quality of life (10). In the majority of cases, educating the elderly with asthma could pose challenges for all groups of patients. Inefficient treatment of asthma creates economic burdens as well and, therefore, the emergency departments and medical establishments should be more concerned with this problem.

Methods/Procedure

By investigating the environmental triggers, analyzing the current trends in medication management, and estimating people’s mental fitness and cognition, the scholar tries to define the way people react to the problem of asthma, as well as analyze their capacity to receive, process, and define the core information about health-related issues. By focusing on these three dimensions, the education specialist starts with evaluating the environmental factors, such as irritants, environmental tobacco smoke, and aeroallergens that are considered the risk factors for the emergence of asthma in all groups.

Treating the problem of asthma in the elderly population is also perceived from the viewpoint of effective medication adherence and management. The role of healthcare professionals, therefore, consists in defining possible risks factors that relate to the disease development. Finally, educator defines patients’ ability to work out coping mechanisms that can help them to diminish the severity of the asthma symptoms.

Results

75 % of the elderly with asthma are sensitive to inhaled allergens, although there is no persuasive evidence that proves the connection between asthma development and aeroallergen exposure (Vasmus 10). The report has also discovered that elderly patients with asthma often react best to the therapy that combines anticholinergic inhaled treatment and beta-2 agonist therapy. Finally, it has been found out that elderly people from 65 to 102 years old are largely influenced by cognitive impairment while treating asthma, including depression and stress disorder (Vasmus 11). The findings prove that 60 % of asthma patients follow the prescriptions of the physicians.

Conclusions

Although the report provides an extensive overview of risk factors, treatment, and medication management of asthma in the elderly population, there is still lack of research that can strengthen the quality of treatment for the group under consideration. Additionally, the research should also focus on other efficient interventions that can reduce the percentage of people with impaired lung function.

Works Cited

Vasmus, Rhonda. Educating the Elderly with Asthma. Chronic Disease Manager, (2013): 10-12. Print.

Background

This critique examines the research reported by Kaul (2011) that explored the importance of self-efficacy in the management of asthma. The purpose of this critique is to analyze the weaknesses of the study. This will offer a more informed basis of arguments when making descriptions on adoption or rejection of the procedure. Reports gathered from a single study lack the ability to affect the inherent practices put in place for a specific health practice (Eddy, 1992). Most of the published journal articles do not dwell on the weaknesses of such studies.

Title

The title of the report Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy adequately identified the population of interest, namely the urban African American children suffering from asthma (Kaul, 2011). Key variables to be addressed in the report were also made explicit in the report title and included the importance of self-efficacy in asthma management and how this segment of the population can be helped to apply self-efficacy in managing asthma. From the title, it was easy to identify the type of study that was conducted. The survey was carried out on a sample population.

Abstract

The main features of the report were presented clearly and concisely in the abstract. The abstract was divided into four major areas namely background, methods, results, and conclusions. This enabled the researcher to highlight all the major areas covered in the study. All the information presented in the paper is highlighted in the abstract section.

Introduction

The researcher presented the problem statement. The researcher documented evidence suggesting the availability of research conducted in this field. He went ahead and identified the gaps in the past research studies. Moreover, a lack of documented information on asthma management studies conducted on children was identified (Kaul, 2011). This statement adequately supported the need for carrying out a study of this nature. The information provided by the study will provide useful medical data. The significance of the study in nursing is that nurses will employ the method in asthma management. This will necessitate further training of the nurses to equip them with the necessary. The quantitative approach used in the study by Kaul (2011) was appropriate in the sense that it was based on a specific group of people. The sample used in carrying out the study was statistically approved to be within the required size (Eddy, 1992).

The research questions to be addressed in the study were explicitly stated as the “extent to which urban African American children managed their asthma and how the children’s self-efficacy beliefs relate to their management of chronic asthma” (Kaul, 2011, p. 29).

Literature review

In examining the literature review conducted by Kaul (2011), it was noted that the majority of the sources used in the review were primary sources. In addition, most of the references included in the report and referred to in the review of the literature were published from 1997 to 2009, indicating synthesis of current evidence on the topic of asthma management.

The information provided in the literature review offered an in-depth analysis of the existence of the problem. The literature review appreciates several initiatives conducted in that field. Most of the studies on asthma management are based on adults. Studies related to children address adult management of asthmatic children. The prevalence of asthma amongst African American children has also been reviewed. Lack of information on how self-management among children can be effective has built the foundation of the study.

Theoretical framework

The author identifies the theoretical framework of the study, namely the importance of self-efficacy in asthma management. A description of the framework has been provided as a narrative and also graphically. However, the author failed to fully implement the framework within the study. For example, the research does not consider other factors that might be aggravating the prevalence of asthma among African Americans. Factors such as logistical, cultural, and financial access to areas with no asthma triggers are of great concern in managing this infection (Waldron, 2007). Besides, the research explores the effectiveness of self-care in managing asthma. Lack of redress on health promotions that would inform the public on the importance of self-care should be addressed. These practices can be fully utilized as strategic methods of handling asthma based on the social cognitive theory (Waldron, 2007). The use of medical personnel, communities, and patients in sensitization can help in attaining the goals of this study.

Conclusions and recommendations

From the above study, the size of the sample was small while the results were overwhelmingly positive. This implies that if any other research study would have applied the same procedure, the results would still be similar. Moreover, this study provided data on self-care analysis among young children. These results meant that the training and sensitization process was greatly needed. However, the data on the outcomes of such sensitization and training exercises were not provided. This data is vital in assessing the applicability of the method (Eddy, 1992). Although minimal data was provided on the expected results, it was adequate in providing the much-needed clinical analysis on the control of asthma.

References

Eddy, D. M. (1992). A manual for assessing health practices and designing practice policies: the explicit approach. Philadelphia: American College of Physicians.

Kaul, T. (2011). Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy. Journal of School Health 81(1), 29-33.

Waldron, J. (2007). Asthma Care in the Community. New York, NY: John Wiley & Sons.

Introduction

In 2008, the World Health Organization (WHO) body estimated that more than 300 million people majority of whom were children were diagnosed with asthma while many other people continued suffering unaware of their condition (Who.com, 2010). Asthma is categorized as one of the disease conditions that are both under-treated and under-diagnosed in the larger population which was responsible for 255,000 deaths in year 2005 alone; a mortality rate that is ever increasing each year (Who.com, 2010). Worldwide asthma is the most common cause of chronic diseases among children of all ages with a prevalence rate that is in the region of 30%-60% which tends to persist even during adult life (Who.com, 2010).

The prevalence of asthmatic conditions is complicated by the nature of the disease which is incurable and therefore a major public health challenge that equally affects all countries notwithstanding their developmental status. As such, the WHO strategy on control of asthmatic incidence rate is pegged on prevention and case management; in the same way the healthcare policy on asthma in Saudi Arabia is structured along the same concept. In Saudi Arabia the prevalence rate of asthma among the general population is estimated by one study to be as high as 20% and approximately 17% among school children (Al-Frayh, 1990). The purpose of this paper is to review the current literature on asthmatic disease in Saudi Arabia to accurately determine the epidemiology nature of the condition through community assessment for purposes of compiling a health report on the disease.

Background Information on Asthma in Saudi Arabia

Bronchial asthma is one of the leading forms of chronic illnesses that significantly impacts on children health in Saudi Arabia. Among the most recent research studies conducted on the prevalence of various diseases in Saudi Arabia indicates the prevalence of asthma to be at 38.6% for bronchial asthma which was by far the leading cause of morbidity for all the cases that were reviewed (Omer, 2006). This particular research study was done retrospectively by reviewing patient’s records for 5 years from 2000 in one of the leading health facilities, King Abdulaziz University Hospital in Jeddah (Omer, 2006).

An earlier research study done by Al Frayh and Al Jawaldi that sought to quantify the change in prevalence rate for asthmatic conditions in Saudi Arabia school going children found the incidence rate for asthma to be at 15% (1992). The result of this conclusion was based on two surveys that were done 9 years apart; one in 1986 which found the prevalence to be at 8% by then and the other one completed in 1995 which determined the prevalence to be at 23% among the school going children (Al Frayh & Al Jawaldi, 1992). The results of this survey become the first reliable research findings that quantified the prevalence of asthma and its rate of increase among school going children in Saudi Arabia. In actual sense the rate of asthma in school children tends to vary across regions in Saudi Arabia with Riyadh prevalence rate being pegged at 10% while Jeddah has 12% (Al Frayh & Al Jawaldi, 1992). Nationwide the official rate according to the ministry of health is capped between 4% and 23%, with highest prevalence rates being experienced in urban areas.

The present challenges in accurate determination of asthma prevalence necessary to determine the rate at which the disease has been progressing in the population are complicated by use of various epidemiological methods that are used to measure prevalence. Most notable of which include survey techniques, changing criteria for case definitions and varying population characteristics that make it impossible to replicate the study. But despite the current challenges in determination of accurate asthma prevalence, there is no doubt that the epidemic is on the increasing in Saudi Arabia, similar to many other developed as well as developing countries worldwide. It is on this background that the Saudi National Protocol for Asthma Management was developed primarily to improve the quality of care given to asthma cases (Al-Rabegi, 2004). To understand the determinants of asthma disease in school going children in Saudi Arabia, a brief overview of the condition is necessary.

Asthma Causes, Symptoms and Management

Asthma is a chronic disease that affects the airway system through inflammation that leads to hypersensitivity. Persons suffering from asthmatic conditions have airway that is obstructed by the presence of mucus plugs, bronchoconstriction and other allergens that inflames the airway when the person is exposed (Smyth, 2002). The obstruction of this airway system is responsible for the characteristic symptoms that asthmatic cases experience which includes; wheezing, breathlessness, fatigue and lack of sleep (Smyth, 2002). In general asthma is categorized into two groups, extrinsic (atopic) and intrinsic (nonatopic); extrinsic asthma is the type that is triggered by exposure to allergic external elements that tends to vary across individuals while intrinsic is the type that does not appear to be caused by any obvious allergic factor (Smyth, 2002).

Both of these forms of asthma are therefore triggered by quite different types of allergens which are used to determine the prognosis of the condition which includes pollens, tobacco smoke, specific animal fur, chemicals, dust, viral infections, drugs, emotions or even general air pollution (Smyth, 2002). The clinical process of the asthmatic condition occurs in two phases; the first stage is production of mast-cell within the lung interstitium which releases histamine caused by the lgE antibodies triggered by the allergen (Smyth, 2002). The histamine produced in lungs is transferred to the bronchi where it is responsible for the inflammation, irritation and edema in lungs that causes the bronchoconstriction which results to the typical symptoms experienced by asthmatics (Smyth, 2002).

Asthma management in cases is based on the nature and seriousness of the condition which can be categorized in any of the four clinical classifications based on diagnosis; mild intermittent asthma, mild persistent asthma, moderate persistent asthma and severe persistent asthma (Nolte, Backer, and Porsbjerg, 2001). Based on the seriousness of the condition asthma intervention is designed on five levels which include identification and elimination of trigger factors, medication, asthma attack management and clinical follow up (Al-Rabegi, 2004).

Review of Research Studies on Asthma in School Children

This section will focus on the several research studies that have sought to quantify the prevalence and incidence rate for asthma disease in school going children in Saudi Arabia. The intention is to identify common risk factors for the condition among our target groups which are school children as well as determination of the existing interventions. One of the research studies conducted in 1998 that sought to measure the disparity of prevalence rate among urban school children with school children in rural areas found a positive correlation between high prevalence rates of asthma in school children and urbanism (Hijazi, Abalkhail & Seaton).

This was one of the earliest studies that provided the first evidence that attempted to link asthma disease with high rates of air pollution that are mostly found in urban areas. The study utilized a sample size of 1444 cases pooled from two areas Jeddah and it rural environs, and thereafter analyzed the variables of interest on subjects based on their residence (Hijazi, et al, 1998). The regression analysis of the data indicated there were two major risk factors of the condition which were urban residence and lifestyle (Hijazi, et al, 1998).

The findings of the research showed high prevalence rate of asthma in urban school children to be as high as 23%; very similar to those found in developed countries (Hijazi, et al, 1998). This similarity suggests that the same culprits are responsible for the high incidence rate of asthma in Saudi Arabia cities with those found in American cities which are known to be pollutants, chemicals and lifestyles factors such as exposure to antioxidants and high fatty acids. Other lifestyle factors that were linked to the high prevalence rate of asthma in urban dwelling school children are high susceptibility of infections during early childhood and changes in diet.

The implications of these findings indicate that effective strategy for limiting new infections could be devised through modification of the major risk factors of asthma for purposes of reducing the incidence rate among children in urban areas.

Another recent research study conducted in 2005 that investigated the environmental effects on the prevalence of asthma in the general population found evidence of a strong causal relationship between high asthma incidence and low altitudes regions like the ones found in sea.

The effect of low altitude was found to be very significant in development of asthma which was at a ratio of 3:1 when compared to person living in high altitudes levels (Al-Ghamdi, Mahfouz, Abdelmoneim, Khan and Daffallah, 2008). This research study went beyond investigation of the environmental causal factors of asthma by also researching on other various known risk factors of asthma such as genetic, allergens, type of household heating method used, housing type, income level (for measuring lifestyle variable) and area of dwelling (urban or rural) (Al-Ghamdi et al, 2008).

In summary, the socio-demographic risk factors identified in the research study for asthma were use of coal and wood, low income levels, low literacy levels, mud or tent housing, use of air-conditioning, lack of electricity and presence of sheep (Al-Ghamdi et al, 2008). Some of these risk factors contrast with earlier research studies on asthma related conditions in the region but most of them conform to other studies on the subject. For instance, low income level have normally been attributed to low prevalence of asthmatic conditions but not on this study; this causal association however is explained by inability to afford clean energy and good housing which are seen to be critical factors in development of asthma.

These are not the only research studies that have been conducted to investigate the epidemiology and distribution of asthma in school children in Saudi Arabia, however they are among the most well designed that are relevant for our case analysis. Other research studies on the same subjects largely agree on the findings of these studies that we have so far summarized in previous section. Nevertheless, just to mention in brief, some of the existing research on the subject include investigation on the spectrum of skin test reactivity and it association to national prevalence of asthma in Saudi Arabia which was found to be positive. The conclusion was that “increased sensitization was associated with higher levels of asthma severity, which is compatible with present literature” (Koshak, 2006). Another research study done by Al Rawas et al found the traditional Arabian incense referred as bakhour to be a significant trigger factor for asthma but not a risk factor for the condition (Al-Rawas, Al-Maniri and Al-Riyami, 2009).

Asthma Prevention, Management and Control Challenges in Saudi Arabia

Prevention and management of asthma among cases is a public health challenge that many countries struggle with worldwide; this is largely due to the fact that the condition is incurable which leaves case management and prevention as the only viable options. The WHO strategy for prevention and management of asthma has now been integrated by many countries to complement their health policies that are designed to address the condition. It is from this framework that the Saudi National Protocol for Asthma Management (SNPAM) and the National Program on Asthma was developed to devise strategies for reduction of the incidence rate for the disease. The SNPAM attempts to address the high prevalence rate of asthma from three levels; surveillance, prevention and case management (Noha, Dashash, Saud and Mukhtar, 2003). Surveillance is intended to identify the hotspots in the region where the prevalence of asthma is at their highest to focus prevention and intervention strategies on these areas. Primary prevention is designed along the recommendation of the various research findings by limiting susceptible members of the society, such as children from the exposure to the known risk factors of the condition or by limiting the emission of these pollutants to the environment. Finally, quality medical care is essential to achieve case management that is necessary to stabilize the progression of the disease among infected persons (Noha, 2003). In this section we shall discuss the weaknesses and challenges of the Saudi healthcare system in general as pertains to management of asthma cases and more specifically the shortcoming of the SNPAM policy that is charged with the task of reducing the prevalence of asthmatic condition nationally.

A research study that investigated the quality of primary healthcare among children conducted in 2003 and published in Saudi Medical Journal by Noha et al found that prescription protocol given to “children did not conform to national guidelines for treatment of asthma” (Noha et al, 2003). The general findings of the study found that in 37% of the cases the treatment program did not document the medication given at all while preventive therapy among the most susceptible cases only occurred in 35% of the time (Noha et al, 2003). The most common type of medication prescribed to children was found to be oral salbutamol and antitussives (Noha et al, 2003). The final research findings of the study faulted the asthma management approach among children on three fronts; lack of reliable framework for case management, weak system in distribution of medication, follow up and monitoring of cases and low health education knowledge on asthma disease among caregivers and parents (Noha et al, 2003).

What is more is that asthma continues to be “underdiagnosed and undertreated” among cases despite the implementation of the SNPAM leading to sub-optimal care being given to cases (Gold, 2000). Other research studies done on the same subject in Saudi Arabia concurred with this findings as far as sub-optimal care is concerned which was attributed to limited capacity in the healthcare system in terms of lack of equipments and medications necessary to cope with the condition (Al-Shammari, Khoja, Al-Ansary, and Al-Yamani, 1996). Most government primary health care facilities (PHCC’s) suffered from shortage of the most essential asthma management equipments such as inhalers and nebulizers not to mention the medications themselves which are central to management of cases according to the SNPAM (Al-Shammani et al, 1996).

Another research study on the efficacy of the National Asthma Program in the Ministry of Health PHCCs found the quality of care to be less than optimal compared to private specialists (Khoja and al-Ansary, 1998). 11% of cases referred to PHCCs never utilized the service while 30% were referred to the private healthcare sector where quality of care was thought to be better (Berhie, 1991). The nature of the treatment itself seemed to be the root of the problem given that 46% of all treatment protocol was entirely comprised of oral salbutamol which should ideally makeup the first line of treatment for asthmatic cases (MOH.gov, 2010).

Conclusion

Despite the numerous interventions that are available in prevention and management of asthma in cases, the condition is on the increase in most urban centers fueled by risk factors of air pollution among other factors. In school going children the rate of asthma is even on the rise complicated by the high rates of underdiagnosis and lack of awareness among the target group. Its is clear from the numerous research studies that the risk factors for asthma condition are dispersed across a variety of levels which must be adequately tackled for effective results. The National Asthma Program framework for intervention is well designed and would be most effective in reducing the high asthma prevalence among school going children if it is well implemented. Based on analysis of the literature review it is evident that the best placed actors that can significantly reduce the incidence of asthma among school going children lie with the PHCC’s which is focal point for intervention.

This health report booklet is therefore very essential in bridging the gap that is missing from lack of health education as well as acting as a framework in which review of current interventions on asthma can be assessed. More importantly it will act as a reliable tool that outlines the weaknesses of the current health intervention strategies on asthma prevention and management by identifying the areas where effective intervention strategies should be focused.

References

Al-Jahdali, H., Al-Omar, A., Al-Moamary, M., Al-Duhaim, A., Al-Hodeib, A., Hassan, I. & Al-Rabegi, M. (2004). Implementation of the National Asthma Management Guidelines in the Emergency Department. Saudi Medical Journal, 25(9):1208-1217.

Al-Frayh, R. (1990). Asthma Patterns in Saudi Children. J R Soc Health, 110(1):98-100.

Al-Rawas, O., Al-Maniri, A. & Al-Riyami, B. (2009). Home Exposure to Arabian Incense (Bakhour) and Asthma Symptoms in Children: A Community Survey in two Regions in Oman. BMC Pulmonary Medicine, 9(23): 267-178.

Al-Shammari, S., Khoja, T., Al-Ansary, L. & Al-Yamani, M. (1996). Care of Asthmatic Patients in Primary Health Care Centers. Ann Saudi Med, 16(1): 24-38.

Al-Ghamdi, B., Mahfouz, A., Abdelmoneim, I., Khan, Y. & Daffallah, A. (2008). Altitude and Bronchial Asthma in South-western Saudi Arabia. Health Journal, 14(1): 76- 83.

Al Frayh, R. & Al Jawaldi, A. (1992). Prevalence of Asthma Among Saudi School Children. Saudi medical journal, 13(2):521–534.

Berhie, G. (1991). Emerging Issues in Health Planning in Saudi Arabia: The Effects of Organization and Development on the Health Care System. Soc Sci Med, 33(7): 815-824.

Gold, D. (2000). Environmental Tobacco Smoke, Indoor Allergens, and Childhood Asthma. Environ Health Perspect, 108(4):643-51.

Hijazi, B., Abalkhail, A. & Seaton, A. (1998). Asthma and Respiratory Symptoms in Urban and Rural Saudi Arabia. Eur Respir Journal 12(1)41-44.

Koshak, E. (2006). Skin Test Reactivity to Indoor Allergens Correlates with Asthma Severity in Jeddah, Saudi Arabia. Allergy, Asthma & Clinical Immunology, 2(1):11-19.

Khoja, T. & al-Ansary, L. (1998). Asthma in Saudi Arabia: Is the System Appropriate for Optimal Primary Care? J Public Health Manag Pract, 4(3): 64-72.

MOH.gov. (2010). Ministry of Health: Kingdom of Saudi Arabia. Web.

Nolte, H., Backer, V. & Porsbjerg, C. (2001). Environmental Factors as a Cause for the Increase in Allergic Disease. Ann Allergy Asthma Immunol, 87(1):7-11

Noha, A., Dashash, I., Saud H. & Mukhtar. H. (2003). Prescribing for Asthmatic Children in Primary Care. are we Following Guidelines? Saudi Medical Journal, 24(5): 507-511.

Omer, A. (2006). Prevalence of Respiratory Diseases in Hospitalized Patients in Saudi Arabia: A 5 years Study 1996-2000. Annal Thorac Med 1(1): 76-80.

Smyth, R. (2002). Asthma: a Major Pediatric Health Issue. Respir Res, 3(1):3-17.

WHO.com. (2010). Asthma: Key Facts. Web.

Asthma is caused by several factors, which cause air pollution such as inhalable dust emissions; particulate matter. This essay provides a literature review of what has been done by scholars to relate asthma with dust emissions. It specifically deals with dust particles, which are captured remotely or through remote sensing.

Asthma and Particulate Matter

D’Amato (2011) provides that PM is a serious element of air pollution that is associated with severe respiratory problems. It contains microscopic liquid droplets and solid particles of different sizes, origin, and composition. When those fine particles are inhaled, they get deep into the lower airways, and those with 2.5µms are retained in the human lung parenchyma. Thus, they cause exacerbation of allergic asthma, and chronic bronchitis. The world health organization reported that exposure to dust emissions result in increased respiratory symptoms, aggravated asthma, and 500,000 excess deaths annually across the world.

Change of climate affects the quality of air leading to the production of aero allergens such as pollen grain and mould spores, which are linked directly with causing respiratory diseases and asthmatic exacerbations in susceptible persons. Air pollution resulting from dust emissions induce airway inflammation resulting in allergen-induced respiratory episodes (Scapellato et al, 2009). Furthermore, air pollution overcomes the mucosal layer in the lungs allowing PM_2.5 and ozone to change the allergenicity of aeroallergens. This enhances airway sensitization. Therefore, climatic factors such as meteorological events, rainfall patterns, and temperature changes trigger severe respiratory responses (NIEHS, 2010).

Strachan (2000) research found that environmental changes due to desertification or industrialization are linked with respiratory morbidity. The study concluded that experiences of adverse effects on asthma occur during summer season when inhalable dust particles are more in the air. In addition, NAS (2000) research found that individuals, who are susceptible to asthma, are likely to experience severe asthmatic exacerbations.

D’Amato (2011) research provides that increase of PM₁₀ leads to greater use of asthma medication and increased hospital admissions related to asthmatic attacks. The UAE environment is characterized with increased air pollution due to increased industrialization. Therefore, the concentration of particulate matter in the atmosphere is high, thereby leading to high cases of respiratory diseases and asthmatic exacerbation on vulnerable persons.

Sandstorms increase the concentration of particulate matter, which is highly associated with causing asthma or aggravating asthmatic effects in people with asthma. A doctor in Abu Dhabi reported that high cases of respiratory diseases and asthma hospital admissions were caused by sand storms. In Dona Ana County, dust storms increased the levels of airborne particulate matter leading to high hospital emergency admissions. In Australia, dust storms were reported to have increased emergency admissions by 39% (Barnett, Fracer, & Munck, 2012).

The table below shows the relationship between dust and asthma in semi-arid Canada. The relationship shows that middle aged people have high prevalence of asthma due to dust than children and the ageing.

Research done by WAF revealed that one in five children in the UAE are suffering from asthma while 40% of the total population is prone to allergic Rhinitis due to mould spores, and dust particles in the air. The same agency predicted that the respiratory allergies will continue increasing at the rate of 70% with sandstorms. A report released by the UAE’s national meteorology and seismology (NCMS) showed that hazy weather conditions resulted in the increased suspension of dust and sand particles. As a result, doctors reported that 25% of the hospitalized patients with respiratory problems were directly linked with increased sandstorms (Suresh, 2012).

It is approximated that 13% of the UAE population and 25% of children in the UAE are suffering from asthma and the number is expected to rise by 70% in the next 25 years. This is attributed to an increased rise of annual sandstorms and continued constructions that create a huge amount of dust in the air. This leads to high levels PM10 (Suresh, 2012).

References

Barnett, G., Fracer, J.,& Munck, L. (2012). The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia. International Journal of Biometeorol, 56(4):719-726.

D’Amato, G. (2011). Effects of climatic changes and urban air pollution on the rising trends of respiratory allergy and asthma. Multidisciplinary Respiratory Medicine, 6, 28-37.

National Academy of Sciences Institute of Medicine (NAS). (2000). Clearing the Air: Asthma and Indoor Air Exposures. Washington, DC: National Academic Press.

NIEHS. (2010). A Human Health Perspective On Climate Change: A Report Outlining the Research Needs on the Human Health Effects of Climate Change. Web.

Scapellato, M. L., Canova, C., De Simone, A., Carrieri, M., Maestrelli, P., Simonato, L.,& Bartolucci, G. B., (2009). Personal PM10 exposure in asthmatic adults in Padova, Italy: seasonal variability and factors affecting individual concentrations of particulate matter, International Journal of Environmental Health, 212, 626–636.

Strachan D.P. (2000). The role of environmental factors in asthma. British Medical Bulletin, 56 (4), 865–882

Suresh, R. (2012). Cases of respiratory problems up in UAE as sandstorms rage on Asthma sufferers battered by desert winds. Web.

The prevalence of asthma has been on the increase in many countries and this has led to the need for relevant studies to be done to investigate the causes of such respiratory diseases. Qasem and his colleagues (2008) did a research to investigate the relationship between the meteorological factors and the number of asthma patients in Kuwait. Their results indicated that the climatic conditions in the area favoured the current quantity of aerial fungal spores in the environment. The amount of humidity, for example, was correlated to the amount of such spores in the air. There was an indication that the temperature also favoured the abundance of the fungal spores. The patient admissions also indicated a seasonal distribution. During the winter and autumn seasons, patient admissions were highest. During spring and summer, on the other hand, the least number of such admissions were recorded (Qasem, 2008, p. 436). In this study, only asthma was studied.

Newhouse and Levetin (2003) also conducted a study to find the correlation between the airborne fungal spores, the concentration of pollen, meteorological factors and other pollutants, and the occurrence of rhinitis (hay fiver) and asthma. From the study, the authors found out that the climatic factors, the types of pollen and the ozone level were positively correlated to the occurrence of symptoms of those conditions. The spores that caused asthma and rhinitis were affected by humidity, temperature, atmospheric pressure and precipitation (Newhouse & Levetin, 2003, p. 363).

Safa and Machado (2003) explained how a respiratory disease could be contracted through the inhalation of dust. Respirable crystalline silica dust is one of the agents of pulmonary fibrosis (as explained by the authors). They interpreted a case report that involved an Afghani housewife who was complaining of having a dry cough and showed symptoms suggesting the presence of an occupational respiratory disease. These symptoms began to show when she relocated to the United Arab Emirates. They suggested that such dust (silica) could be inhaled by individuals working in mining fields, construction sites and various manufacturing industries. However, they are also abundant in domestic cleaning powder. The authors stated that silicosis is quite rare and may at times be misdiagnosed. Therefore, they advised that it is important for physicians to check the patient’s occupational history in order to properly diagnose this condition (Safa & Machado, 2003, p.103). In a similar study, Al-Neaimi, Gomes and Lloyd (2001) also studied the association between cement dust inhalation and respiratory illnesses. They concluded that such dust was associated with illnesses and conditions such as dyspnoea, sinusitis, bronchial asthma and phlegm.

In another related study, Oberg and his colleagues (2010) were seeking to understand the burden of disease due to exposure to second-hand smoke. Second-hand smoke is one of the causes of indoor pollution. Such exposures had resulted to the death of over 350,000 individuals. The causes included lower respiratory infections, asthma, among other diseases. The children were most affected by lower respiratory infections while the highest number of asthma patients comprised of adults.

Bae, Alkobaisi, Narayanappa and Lui (2003) also agreed that asthma might be caused by environmental factors. Some of the factors that they identified as responsible for developing asthma include pesticides, exhaust fumes, humidity and heat. They also agreed with Oberg and his colleagues when they suggested that asthma might be caused by smoke in the environment (Bae et al., 2003, p.3). They also mentioned that extreme heat and high humidity might increase the risks of asthma.

Table and graph obtained from Quasem et al. 2008

References

Al-Neaimi, Y., Gomes, J., & Lloyd, O. (2001). Respiratory illnesses and ventilator functions among workers at a cement factory in a rapidly developing country. Occupational Medicine, 51(6), 367-373.

Bae, W., Alkobaisi, S., Narayanappa, S., & Liu, C. (2008). A real-time health monitoring system framework: An approach for evaluating environmental exposures and health decision support. Web.

Newhouse, C., & Levetin, E. (). Correlation of environmental factors with asthma and rhinitis symptoms in Tulsa, OK. Ann Allergy Asthma Immunol, 92(1), 356-366.

Oberg, M., Jaakkola, M. Woodward, A., Peruga, A., & Pruss-Ustun, A. (2010). Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. Web.

Safa, W., & Machado, J. (2003). Silicosis in a housewife. Saudi Med J, 24(1), 101-103.

Qasem, J., Nasrallah, H., Al-Khalaf, B., Al-Sharifi, F., Al-Sherafyee, A., Almathkouri, S., & Al-Saraf, H. (). Meteorological factors, aeroallergens and asthma-related visits in Kuwait: A 12-month retrospective study. Ann Saudi Med, 28(6). 435-441.

Primary Diagnosis

The primary diagnosis is occupational asthma; the causative agents of the indicated type of the disease are located directly at the person’s workplace. Michelle notes that a worsening of the symptoms develops on weekdays, and when she gets home, they decrease. According to Vandenplas et al. (2017), occupational asthma symptoms are similar to those of non-professional bronchial asthma. It is characterized by wheezing, coughing, chest compression, and shortness of breath.

Asthma attacks appear under the influence of industrial allergens. Therefore, to make a diagnosis, it is necessary to establish the type of allergen present in the work environment at the time of the onset of an asthmatic attack (Vandenplas et al., 2017). The patient has seasonal allergies, which determines the predisposition to the development of the illness. In terms of Michelle’s case, she works in a bakery, so occupational allergens significantly increase the frequency and severity of a pre-existing disease.

Symptoms, often more serious during work and in the evening, improve on weekends, and return to work, however, they may deteriorate towards the end of the workweek. The patient may notice that particular activity or certain substances present in the work environment cause multiple symptoms.

Treatment Plan

Treatment of occupational asthma consists of medical and preventive measures in the workplace. The process begins with an accurate diagnosis and identification of the factors causing the disease. As long as occupational asthma is provoked by exposure to sensitizing substances, lowering the contact with such substances does not always lead to the complete disappearance of symptoms. Severe asthmatic attacks or progressive deterioration can be caused by vulnerability to low concentrations of the essence; therefore, it is recommended to permanently stop this exposure (Bernstein, 2016).

For a patient, a timely planned rehabilitation leave or retraining can become an integral part of treatment. Bernstein (2016) claims that if it is impossible to stop the direction entirely, it is necessary to reduce its level, accompanied by careful medical supervision and control. Medication therapy for bronchial asthma includes the basics required to continuously control the disease, including oral and inhaled glucocorticosteroids, and symptomatic, designed to attack drugs that relieve spasm of bronchial smooth muscles – β2.

Considering that asthma being a chronic disease, the duration of therapy is determined by its course, and treatment can be continued throughout life. Singulair can be used in combination therapy with other prophylactic drugs. It prevents bronchoconstriction in response to trigger effects, improves the broncho-dilating effect of salbutamol on lung function, and reduces asthma (Trivedi et al., 2017). The inhalation form is the most effective and safest as the medicine is delivered where it is needed.

The action develops quickly; the highest concentrations are created in the respiratory tract. Many medications can only be used in inhalation because, when taken orally, they are not absorbed (Trivedi et al., 2017). In the form of breath, other drugs act locally, which increases their effectiveness and safety.

Michelle’s request for an antibiotic cannot be approved. Antibiotics for asthmatics are prescribed only when the presence of an infectious process is beyond doubt. Confirmation of the assumption of infection is always done using laboratory and instrumental research methods, such as X-ray or sputum, blood, and microflora cultures in a hospital (Trivedi et al., 2017). Prescribing antibiotics for patients with bronchial asthma requires special care. Immunity weakened by an ongoing inflammatory process can react sharply to such treatment; a significant deterioration in the patient’s condition is possible.

Patient Management Plan

The possible risk of a severe form of the disease threatens three groups of patients, including children, pregnant women, and people with chronic lung illnesses. In addition to viral pneumonia caused directly by the H1N1 virus, the course of the disease can be complicated by bacterial pneumonia, which causes a rapidly progressive deterioration in the patient’s condition (Schwarze et al., 2018).

Bacterial pneumonia is most generally affected by Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistant strains (Schwarze et al., 2018). Therefore, medicals are advised to prescribe early antibiotic therapy for the treatment of community-acquired pneumonia.

However, the condition develops on the second or third day from the onset of the disease and is characterized by evolving symptoms of acute respiratory failure. With regard to Michelle’s case, the number of respiratory rate does not exceed 30 or more per minute; oxygen saturation is slightly below 95% – 94%; cough is productive. There is no evidence that there are primary pneumonia symptoms, leading to respiratory distress syndrome and pulmonary edema development with a possibly fatal outcome.

After laboratory confirmation of the disease, the final diagnosis is possible, including a virological method of seeding nasopharyngeal mucus, sputum on certain media. Clinical signs suggesting the development of influenza complications are shortness of breath with little physical activity or at rest, difficulty breathing, cyanosis of the skin, bloody or colored sputum (Schwarze et al., 2018). Moreover, it is characterized by chest pain, high body temperature for more than three days, poorly controlled by standard doses of antipyretic drugs, painful cough, and low blood pressure(Schwarze et al., 2018).

For the entire febrile period and 5-7 days of average temperature, bed rest is prescribed to prevent complications (Schwarze et al., 2018). Antiviral drugs, for instance, oseltamivir, can be used to treat people who are at risk of severe complications from the diseases (Wang et al., 2020). The pause between taking antipyretics should be at least 4-5 hours.

It is necessary to drink plenty of water, for example, still mineral water, tea to reduce the phenomena of intoxication. Acetylsalicylic acid and metamizole sodium should not be taken for influenza (Wang et al., 2020). In case nausea and vomiting, a patient needs to drink often in several sips. Antibiotics are indicated only in case of complications, and only a doctor decides to prescribe these medications (Wang et al., 2020).

Treatment of an asthmatic with antibiotics should be provided in a hospital. It will allow the physician to avoid unforeseen effects of antibacterial drugs on the patient’s body and intervene in time if circumstances require it (Wang et al., 2020). Bed rest is required; food should contain enough vitamins, and alcohol intake is categorically contraindicated.

Home Return

Even though the illness does not seem critical, Michelle is not recommended to return home as in severe disease cases. The deterioration of the patient’s condition usually occurs 3-5 days after the onset of symptoms. The state is deteriorating rapidly – many patients develop respiratory failure within 24 hours, requiring immediate admission to intensive care (Schwarze et al., 2018).

The sick person is contagious to others not only from the moment the symptoms of influenza appear but also during the incubation period, which is usually 1-2 days, up to 7 days from the moment of the onset of the disease (Schwarze et al., 2018). Prescribed drugs provide an optimal effect when defined in the early days of illness.

Oseltamivir

This drug represses the neuraminidase action of influenza A and B viruses, ensuring the release of virions from the cell, rather than their penetration into healthy cells. It inhibits the spread of viruses in the body. Prescription: 75 mg capsule – 2 times per day for five days – no later than 48 hours after the first symptoms appear (Wang et al., 2020).

Σ-aminocaproic acid (Σ-ACA)

It is an inhibitor of fibrinolysis and has antiviral and antiallergic activity. Prescription: orally with simultaneous rinsing of the nasal passages with a 5% solution (Wang et al., 2020).

Education and Follow-Up Plan

For you, Michelle, I recommend staying at the hospital for two additional days. If the illness did not develop and cause adverse outcomes, you would come home. Nevertheless, it is necessary to inform the attending physician about all other medications used and whether side effects have occurred during the treatment.

If you do not feel well, follow the doctor’s recommendations for first aid at home. When increasing the dose of medication, monitor the maximum allowed amounts and the maximum permitted administration frequency. If you feel worse, always contact your doctor to find out tactics for further treatment. You can contact doctors’ round-the-clock information service at the short telephone number specified in the action plan. If you feel unwell or have trouble breathing, call an ambulance, or go to the hospital emergency department.

References

Bernstein, J. A. (2016). Occupational asthma. In M. Mahmoudi (Ed.), Allergy and asthma (pp. 253-270). Springer.

Rolfes, M. A., Flannery, B., Chung, J. R., O’Halloran, A., Garg, S., Belongia, E. A., & Alden, N. B. (2019). Effects of influenza vaccination in the United States during the 2017–2018 influenza season. Clinical Infectious Diseases, 69(11), 1845-1853. Web.

Schwarze, J., Openshaw, P., Jha, A., Del Giacco, S. R., Firinu, D., Tsilochristou, O., & Custovic, A. (2018). Influenza burden, prevention, and treatment in asthma‐A scoping review by the EAACI Influenza in asthma task force. Allergy, 73(6), 1151-1181. Web.

Trivedi, V., Apala, D. R., & Iyer, V. N. (2017). Occupational asthma: Diagnostic challenges and management dilemmas. Current Opinion in Pulmonary Medicine, 23(2), 177-183. Web.

Vandenplas, O., Suojalehto, H., & Cullinan, P. (2017). Diagnosing occupational asthma. Clinical & Experimental Allergy, 47(1), 6-18. Web.

Wang, Y., Fan, G., Salam, A., Horby, P., Hayden, F. G., Chen, C.,& Wang, C. (2020). Comparative effectiveness of combined favipiravir and oseltamivir therapy versus oseltamivir monotherapy in critically ill patients with influenza virus infection. The Journal of Infectious Diseases, 221(10), 1688-1698. Web.

Abstract

Asthma is a respiratory disease that causes inflammation of human lung airways. Asthma Pathophysiology is the summary of the stages that asthma undergoes. Asthma etiology is the classification of various risk factors responsible for causing asthma in children and adults. The children risk factors are called modifiable (extrinsic) factors. On the other hand, adult asthma risk factors are commonly known as non-modifiable or intrinsic factors. Asthma can be diagnosed using Hematologial asthmatic analysis, Pulmonary Function Testing, chest x-ray test, and arterial partial carbon dioxide (pCO₂) analysis. Other respiratory diseases may arise if asthma is not diagnosed and treated in its initial stages. Common disorders include airways damage, breathing difficulty, pneumonia, respiratory failure, asthamaticus, and finally death. Economic and social constraints arising from treatment failure include absenteeism and home confinement respectively. This paper analyzes the cause, development, diagnosis, and complications associated with asthma respiratory disorder.

Introduction

Asthma is a chronic respiratory disorder characterized by inflammation of the human lung airways cells. Airways cells used in asthma pathophysiology analysis include neutrophilis, lymphocytes, mast cells, and macrophages. All these cells produce different inflammatory mediators. Airways inflammations occur when two or more mediators react with each other. This inflammation causes bronchial hyperresponsiveness that leads to chest tightening, coughing, dyspnea, and wheezing. In addition, the inflammation stimulates hyperresponsiveness of the mucus glands and airways muscles (Martin & Sutherland, 2010).

Main body

Hyperresponsiveness causes peeling of the epithelial cell wall, mucus edema and hypersecretion of mucus. Pathophysiology experts assert that edema mucus triggers cell inflammation infiltration, airways venous dilation, and plasma extravasation. Increased Inflammation causes contraction, hypertrophy, and hyperplasia of the smooth muscles of the airways (Amdekar & Kabra, 2010). If the inflammation persists, a condition called acute asthma occurs. This condition is characterized by bronchoconstriction, airways inflammation, or both. Further increase in inflammation leads to increased rate of gravid ventilation resulting to high respiratory alkalinity (Harver, 2010).

Increased airways constriction reduces alveolus ventilation and air flow. Such situation increases carbon dioxide retention in the blood. In addition, it causes hypoxemia of the arteries that further increase respiratory alkalinity (Martin & Sutherland, 2010). Further inflammation leads to imbalanced ventilation and perfusion. This imbalance causes reduced partial arterial oxygen pressure (pO₂) in the blood. Partial arterial carbon dioxide pressure (pCO₂) may also rise if the conditions persist. Respiratory scientists argue that if asthma is not treated at this stage, the airways constriction and imbalance in partial arterial oxygen and carbon dioxide gas exchanges is fatal (Gershwin, 2011).

Asthma etiology is the scientific classification of risk factors that cause Asthma in children and adult. The risk factors are classified into modifiable (extrinsic) factors and non-modifiable (intrinsic) factors (Amdekar & Kabra, 2010). Modifiable asthmatic risk factors are associated with hypersensitivity reactions between antibodies and antigens following inhalation of certain antigens. The reaction occurs in the mast cells located in the respiratory duct. These factors are responsible for childhood asthma. Examples of extrinsic factors include genetic asthma history, obesity, tobacco smoke, illnesses, external pollutants, and male sex (Media, 2012).

Non-modifiable etiological asthma factors are the factors responsible for adulthood asthma. Intrinsic factors are caused by imbalance autonomic nervous system (ANS). The imbalance is caused by the mismatch of ANS beta and alpha adrenergic. Etiological experts argue that intrinsic factors exhibit no hypersensitivity to the external antigens. Common modifiable risk factors include airways hyper-reaction, work experiences, lifestyle behaviors, and female sex (Martin & Sutherland, 2010).

Both modifiable and non-modifiable provide clinical manifestations framework. The framework categorizes risk factors associated with childhood and adulthood asthma conditions. Research states that inhaling and smoking tobacco is the primary causes of childhood asthma. Therefore, mothers can avoid infecting their children with asthma by avoiding tobacco. On the other hand, research has proven that asthma in adolescence and adulthood is caused by risky lifestyle factors like professional exposures, smoking, and obesity. Consequently, adults can prevent asthma through eating balanced diet, avoiding smoking, and engaging in healthy occupational practices (Gershwin, 2011).

Asthma infection can easily be diagnosed in most health centers through the following methods. In Sputum analysis method, asthmatic patient’s sputum is characterized by purulent appearance, contents of Cursch-mann mucous and presence of eosiophilis debris. Hematologial asthmatic analysis may establish the presence of eosiophilis content for both modifiable and non-modifiable asthma conditions (Martin & Sutherland, 2010).

Pulmonary Function Testing analyses the status of the Forced Vital Capacity (FVC). Asthmatic patients exhibit a reduction in lung conformity, residual lung volume, and the total lung capacity. Asthma is also diagnosed using chest x-ray test analysis. Asthmatic patient exhibits inflated airways in their lungs. The final asthma test is the carbon dioxide blood test. Asthmatic victims have (pCO₂) content of more than 40 mm Hg. High content of (pCO₂) is attributed to constriction of airways due to inflammation of the epithelial walls and muscles (Gershwin, 2011).

Conclusion

Failure to diagnose and treat asthma in early stages results to adverse health complications. It is worth noting that asthma complication in children and adult are similar. The most common complications include permanent airways damage, breathing difficulties, absenteeism in schools or work and home confinement. In few cases, asthma results to advanced respiratory conditions like pneumonia, lung and respiratory failure, wheezing, asthmaticus and finally death (Harver, 2010).

References

Amdekar, Y. K., & Kabra, S. K. (2010). Allergy and asthma. New Delhi: Elsevier.

Gershwin, M. E. (2011). Bronchial asthma a guide for practical understanding and treatment (6th ed.). New York: Springer.

Harver, H. K. (2010). Asthma, Health and Society. New York: Springer US.

Martin, R. J., & Sutherland, E. R. (2010). Asthma and infections. New York: Informa Healthcare.

Media, A. (2012). Asthma a troubleshooting guide to common childhood ailments.. Cincinnati: F+W Media.

Introduction

Over the past years, the notion of asthma in the context of US healthcare has gained much recognition due to the steady increase in disease prevalence. Thus, according to the Centers for Disease Control and Prevention (2020), asthma prevalence across the state has increased by more than 2%, claiming almost 10% of the population to struggle with the health condition. Asthma, being a chronic disease, can be controlled as far as the symptoms and attacks are concerned, as the act of disease negligence will inevitably result in the overall deterioration in terms of attack severity and frequency (Centers for Disease Control and Prevention, 2019). Hence, in order to obtain a better understanding of the issue, both long-term control and quick-relief treatment options will be outlined for a chosen patient.

Patient Profile

Speaking of the patient profile, the first aspects that should be mentioned are the peculiarities of asthma disease history and other health conditions that might affect the treatment pattern. Hence, the patient is a 30-year-old female who has asthma for almost 28 years, started in early childhood. According to the general patient’s characteristics, the woman lives with obesity (with a BMI level of 31), hypertension, and type 2 diabetes. The treatment pattern of the patient includes Albuterol long-term intake, inhaling two actuations of 90mcg/ actuation, as prescribed in the recommendations for exploitation. Hence, based on the information above, both long-term and immediate relief inhalation plans will be introduced.

Stepwise Long-Term Control

According to the researchers, long-term control of asthma is primarily created for the sake of disease deterioration prevention, including wheezing, cough, breathing issues, and asthma attacks as such (Sheikh et al., 2020). Thus, such an intervention in the treatment process may be of significant benefit for the patients at risk of having severe and frequent attacks. The treatment pattern for the patient should look as follows:

• Albuterol intake, inhaling two actuations every 4-6 hours, constituting approximately 180 mcg per one procedure. The average number of intakes is not to exceed ten times per 24 hours.
• Considering the overall health condition of the patient, any physical activity may trigger the asthma attack. Thus, the Albuterol should be taken 15-30 minutes prior to the physical activity, provided the activity itself does not take more than two hours on average.

Stepwise Quick-Relief Intervention

Bearing in mind the information about the general health state of the patient, it is evident that she requires the long-term intake of Albuterol due to the various risks that trigger lack of breathing. According to the researchers, the effect of quick-relief asthma treatment Is not as visible and beneficial when compared to the one of long-term intervention (Fergeson et al., 2017). However, in some cases, i.e., during the periods of acute asthma (allergy emergence) or ordinary attacks, the long-term preventative measures are not sufficient for the patient. In the given case, such situations should be handled by immediate Albuterol intake, varying from two to four actuations depending on the attack severity level. Albuterol, as a major medication, will be used in both cases, as it is proved to be beneficial for the patient.

Treatment Complications

When speaking of asthma treatment, it should be mentioned that every pattern of medication intake obtains a variety of highly individual effects on the human body and health, depending on one’s subsequent diseases. Thus, when speaking of the adverse effects of Albuterol, the following complications may be outlined:

• The most widespread effects – tremor and nervousness, as the active substance tackles the motor nerve terminals.
• Effects occurring in one out of ten patients – insomnia and nausea
• Rare effects – fever, bronchospasm, vomiting, allergy, pain, gas, increased appetite, depression, dry mouth, increased blood pressure (Johnson et al., 2020).

Hence, as far as the aforementioned patient is concerned, it is of crucial importance for the practitioner to keep track of her general well-being due to the fact that such conditions as diabetes and hypertension may intensify the drug impact. In such cases, the average medication intake is to be modified according to the patient’s body’s condition.

Conclusion

Having taken everything into consideration, it may be concluded that asthma treatment is an extremely individual endeavor that should be customized according to the needs of each patient. In terms of the following paper, on the example of a 30-tear-old female patient, it was estimated that long-term asthma control plays a crucial role in terms of the overall disease management. Hence, both long-term control and quick relief intervention were planned regarding the use of Albuterol, as the following medication has proved to be efficient for the patient over the past years. However, in order to ensure treatment success, the patient should be constantly examined by the practitioners.

References

1. Centers for Disease Control and Prevention. (2019). Learn how to control asthma. Web.
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