Incidence Rates, Prevention, and Symptom Management of Asthma - Term Paper Example

Running head: Incidence rates, prevention and symptom management of Asthma Name Course Institution Date Asthma is a chronic disease characterized by inflammation of the airways and lungs that causes attacks of wheezing and shortness of breath (Peacock, 2000). It is characterized by: Airway inflammatory cells, including eosinophils, macrophages, mast cells, epithelial cells and activated lymphocytes that release various cytokines, adhesion molecules and other mediators (Jaggi, 2005). Inflammation resulting in an acute, subacute or chronic process that alters airway tone, modulates vascular permeability, activates neurons, increases secretion of mucus, and alters airway structure reversibly or permanently (Barnes, 2002). Airflow obstruction caused by acute bronchial constriction, edema, mucus plugs and frequently, permanent remodeling. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning (Barnes, 2002). Often identified as a disease of children, it is the most common chronic illness among children and the number one cause of school absenteeism (Kaliner, 2003). But asthma is far more than just a children’s affliction. It is on the rise among every age group all across the county. Today, asthma causes more than 5,000 deaths per year (Kaliner, 2003). Unless the rates and severity of the disease are slowed, the annual number of asthma-related deaths could double by 2020, taking a tremendous personal toll on families across our nation (Kaliner, 2003). Measured as a cost to society, the bill for asthma is staggering. If asthma prevalence rates continue to rise as they have in the past, without public health intervention efforts the number of deaths and cases is likely to continue exploding (Kaliner, 2003). The greater burden of asthma on those below the poverty level is probably attributable to risk factors that are present to a greater extent in lower income groups such as poor indoor air quality, outdoor air pollution, early and more frequent respiratory infections in children and other factors, including poorer nutrition and fewer breasts feeding (Kaliner, 2003). The prevalence of asthma in Australia is among the highest in the world: between 10% and 15% of children and between 10% and 12% of adults has asthma (Australian Bureau of Statistics, 2005). More than 2 million Australians have a current asthma diagnosis (Australian Bureau of Statistics, 2005). Its preference is relatively high by international standards, although it has decreased slightly in children and young adults in recent years (Australian Bureau of Statistics, 2005). About one in eight or nine children (11%-13%) and about one in 10 adults (10%-12%) have asthma(Australian Bureau of Statistics, 2005). In 2007, asthma killed 385 Australians, mainly older adults (Australian Bureau of Statistics, 2005). Although it is not a major cause of death, asthma is one of the most common problems managed by doctors and is a frequent reason for the hospitalization of children, especially boys (Australian Bureau of Statistics, 2005) There is good evidence for the efficacy of action plan. As part of self-management education, action plans improve health outcomes in adults with asthma (Boyer & Paharia, 2007). Outcomes examined include hospital admissions, emergency medical contacts, days missed from work, nocturnal asthma symptoms and quality of life (DIANE Publishing Company, 1996). The evidence is strongest in those with the most severe disease, following management in secondary care and in those with recent exacerbations (Peacock, 2000). A meta analysis of self management in children and adolescents (2-18 years) also showed improved lung function, reduced morbidity and utilization of healthcare resources (DIANE Publishing Company, 1996). Self-management in terms of people‘s ability to improve and maintain their health as well as to cope independently with their health problems is a central challenge in society and in health care (Dawn, Dores-Stites, Western Michigan University,2007). Patient education in addition to other psychosocial interventions and medical treatment is one method to support the self-management of patients with asthma illness (DIANE Publishing Company, 1996). Supporting self management of the patient during patient education is considered a central nursing intervention (Boyer & Paharia, 2007). Ethical codes for nurses emphasize their responsibility to promote health, to prevent illness, to restore health and to alleviate suffering (Boyer & Paharia, 2007).Regarding patient education to support self-management this means that nurses‘role is to ensure that patients receive sufficient information in a manner that respects the individual needs of the patient (Dawn, Dores-Stites, Western Michigan University,2007). Asthma self management education is a essential component of asthma management guidelines (Dawn, Stites, Western Michigan University, 2007). It should include the provision of information, self-monitoring, regular medical review and the provision of a written asthma management plan (Dawn, Dores-Stites, Western Michigan University, 2007). Asthma is predominantly managed in general practice and practice nurses are in an excellent position to complement the medical management of asthma by general public (Gulledge, Beard, Health and Administration Development Group, 1998). Practice nurses are vital members of the asthma management team, as they provide aspects of patient care including self-management education, spirometry and instructions on inhaler (Dawn, Dores-Stites, Western Michigan University, 2007). Asthma is a chronic inflammatory disorder of the airways for which the cornerstone of management is appropriate medication (Votroubek & Tabacco, 2009). Education, self-monitoring, regular medical review and a written asthma action plan have been shown to reduce morbidity and mortality (Gulledge, Beard, Health and Administration Development Group, 1998). A team approach to care for chronic diseases has been shown to improve health outcomes for patients and to reduce the disease’s economic burden (Dawn, Stites, Western Michigan University, 2007). Using the Asthma Cycle of Care and other chronic disease management initiatives (including GP Management Plan and Team Care Arrangement), practice nurses can play a key role in delivering best practice evidence-based care (Gulledge, Beard, Health and Administration Development Group, 1998). Medical management of asthma aims to achieve and maintain optimal asthma control with best possible lung function and minimal side-effects (Gulledge, Beard, Health and Administration Development Group, 1998). Asthma self-management education is essential to provide patients with the skills necessary to control asthma and improve outcomes (Votroubek & Tabacco, 2009). This management need be integrated into all aspects of asthma care, with constant repetition and reinforcement (Gulledge, Beard, Health and Administration Development Group, 1998). . It begins at the time of diagnosis and continues through follow-up care and involves all members of the health care team (Gulledge, Beard, Health and Administration Development Group, 1998). The principal clinician introduces the key educational messages and negotiates agreements about the goals of treatment, specific medications and the actions patients will take to reach the agreed upon goals to control asthma (Gulledge, Beard, Health and Administration Development Group, 1998. Nurses can take a leading role in the development of inter professional learner-centered self-management programs for adults with asthma that address both the physical and psychological aspects of this chronic disease (Gershwin & Eugene, 2001). Effective patient education calls for a partnership between the patient and healthcare provider (Gulledge, Beard, Health and Administration Development Group, 1998). Recent studies showed that patients taught by nurses had significantly lower symptom scores and fewer physician visits and urgent care visits for asthma after 6 months (Votroubek & Tabacco, 2009). To manage asthma successfully, nurses need to help patients identify and reduce exposure to known allergens and irritants and to control comorbid conditions and other factors that worsens symptoms or trigger exacerbations (Gulledge, Beard, Health and Administration Development Group, 1998). Nurses ought to teach and reinforce the basic facts about asthma, role of medications and patient skills with asthma patients at every opportunity (Votroubek & Tabacco, 2009). Evidence is at present plentiful that asthma self-management education is effective in improving outcomes of chronic asthma (Kaliner & Barnes, 1991). Specific training in self-management skills is necessary to produce behavior that modifies the outcomes of chronic illnesses such as asthma (Gershwin & Albertson, 2001). Patients must actively participate in their own care, which means consciously using strategies and taking actions to minimize exposure to factors that make asthma harder to control and adjusting treatments to improve disease control (Votroubek & Tabacco, 2009). The benefits of educating people who have asthma include; reduction in urgent care visits and hospitalizations, reduction of asthma-related health care costs and improvement in health status (Kaliner & Barnes, 1991). Other benefits of value from self-management education are; reduction in symptoms, less limitation of activity, improvement in quality of life and perceived control of asthma and improved medication adherence (Gershwin & Albertson, 2001). Once asthma is developed, it is important to manage the disease and prevent asthma attacks (Votroubek & Tabacco, 2009). For most people, asthma can be controlled with; regular preventative healthcare, a clear asthma action plan, medication and by avoiding known asthma triggers such as colds, smoke, allergies, or exercise (Votroubek & Tabacco, 2009). Daily self- management plan need to be developed to keep the patient from getting the symptoms (Gershwin & Albertson, 2001). It is important to reduce the swelling of the airways and control the build up of mucus; it is achieved by taking anti-inflammatory medicine (Kaliner & Barnes, 1991). In other instances we can treat asthma attacks by use of bronchodilators medicines that help muscles in the airway relax (Jones, 2004). Proper medicines work by either opening the narrow airways or preventing them from narrowing in the first place (Gershwin & Albertson, 2001). The common types are; relievers and preventers (Gershwin & Eugene, 2001). The population should be informed about what constitutes a healthy lifestyle such as healthy nutritional habits, regular exercise and avoidance of tobacco, airway irritants and allergens. Early detection of occupational asthma is vital to prevent further progression and to ensure cost-effective management (Kaliner & Barnes, 1991). Secondary prevention includes; treating atopic eczema/atopic dermatitis topically and possibly with systemic pharmacotherapy to prevent respiratory allergy, treating upper airways disease to reduce the risk of development of asthma, in young children already sensitized to house dust mites, pets or cockroaches (Barnes, 2002). Specific exposure should be reduced or abolished to prevent onset of allergic disease and removing of employees from occupational exposure if they have developed symptoms caused by occupational allergic sensitization (Barnes, 2002). Moreover infants with cow's milk allergy should avoid cow's milk proteins if a supplement is needed, use hypoallergenic formula to improve symptom control (Barnes, 2002). The aim of asthma management is to achieve and maintain control of symptoms (Jones, 2004). Its efficacy has been established for many decades and it remains the foundation of both chronic and acute asthma management (Jones, 2004). Asthma care and patients self management has show to decrease asthma morbidity and asthma’s effects on activities on daily living and the overall quality of life (Gershwin & Eugene, 2001). Behavioural modification through specific training in various self-management skills is essential to produce positive outcomes in chronic conditions (Jones, 2004). In other words it strives to achieve a symptom-free normal life for the person with asthma and prevent the development of permanent lung damage and abnormal lung function (Jones, 2004). Hence people with asthma understand their condition and treatment and can successfully manage it themselves between doctor visits (Jones, 2004). The usual follow-up to asthma diagnosis is a symptom-suppressing medication followed with a set of general guidelines. Health conditions, environmental factors and nutritional deficiencies are major factors of asthma (Jones, 2004). Food allergies and low gastric acid are main conditions that predispose people to asthma by causing immediate responses (Gershwin & Eugene, 2001). Low level of anti-oxidants exposes lungs to damage by oxidation which directly leads to asthma vulnerability. Vitamin B12 has shown preventative capability especially for sulfite-induced asthma symptoms (Gershwin & Eugene, 2001). Therefore proper identification and avoidance of asthma triggers, with combined correction of health conditions, environmental intolerances and nutritional deficiencies should be in the forefront for asthma treatment (Jones, 2004). However medications should be used only for temporary or infrequent assistance. Asthma can be monitored by use of peak flow meter which measures the maximum rate at which air can be forced out of ones lungs in one blow or by use of symptoms diary (Gershwin & Eugene, 2001). In summary, effective management of asthma can be effected by; recognition of symptoms, altering the environment to improve health by eliminating or decreasing factors that lead to increased airway instability, medication necessity for routine control of asthma, medication initiation for exacerbation and the recognition of life-threatening symptoms that need immediate medical attention (Gershwin & Eugene, 2001). References Anthony Seaton, Douglas Seaton, Andrew Gordon Leitch, Sir John Crofton,(2000).Crofton and Douglas's respiratory diseases, Volume 2 .Wiley-Blackwell. Australian Bureau of Statistics, (2005).Year book, Australia, Issue 87. Bureau of Statistics. Bret A. Boyer, M. Indira Paharia, (2007).Comprehensive handbook of clinical health psychology. John Wiley and Sons. Dawn J. Dore-Stites, Western Michigan University, (2007).Evaluation of a school-based program targeting pediatric asthma self-management skills in an urban population. ProQuest. DIANE Publishing Company, (1996).Global Strategy for Asthma Management and Prevention. DIANE Publishing. Don M. Roberton, M. J. South, (2007).Practical paediatrics. Elsevier Health Sciences. Dr. O P Jaggi, (2005).Asthma And Allergies: Causes, Prevention And Treatment. Orient Paperbacks. Jo Gulledge, Shawn Beard, Health and Administration Development Group ,(1998).Asthma management: clinical pathways, guidelines, and patient education Aspen chronic disease management series. Jones & Bartlett Learning. Judith Peacock, (2000).Asthma Perspectives on Disease and Illness Series. Capstone Press. M. Eric Gershwin, Timothy Eugene Albertson, (2001).Bronchial asthma: principles of diagnosis and treatment. Humana Press. Michael A. Kaliner, (2003).Current review of asthma. Birkhäuser. Michael A. Kaliner, Peter J. Barnes, (1991). Asthma: its pathology and treatment. Dekker. Michael Puisis, (2006).Clinical practice in correctional, Elsevier Health Sciences. Peter J. Barnes, (2002).Asthma and COPD: basic mechanisms and clinical .Academic Press. Roger Jones (Prof.), (2004).Oxford textbook of primary medical care, Volume 1 Oxford Textbook of Primary Medical Care, Roger Jones (Prof.), .Oxford University Press. Wendy Votroubek, Aaron Tabacco, (2009).Pediatric Home Care for Nurses: A Family-Centered Approach, Jones & Bartlett Learning. Read More