The Most Common Disease - Essay Example

Asthma Asthma is one of the commonest of all medical conditions. There are several different patterns of asthma. Many doctors believe that asthma ismore likely to occur in people who have particular combinations of genes which may be "switched on" by events in the environment at any stage of a patient's life. The commonest asthma symptom is wheezy breathlessness which is often worst or most frequently occurs at night or in the early morning. However other patients are more troubled by a cough and may also produce sticky sputum which can even look yellow or green, mimicking a chest infection. A child with a recurrent cough often turns out to have asthma and sometimes it can be difficult for the doctor to make a diagnosis of asthma straight away. Measuring the Peak Flow Rate (a simple breathing test) with a simple meter at home is often very useful in making the diagnosis and monitoring treatment. (Asthma) In patients with asthma there is chronic inflammation in the bronchi (air passages). This makes their walls swell up so that they become narrower and muscles around the air passages become irritated so that they contract, causing sudden worsening of symptoms. The inflammation can also make mucus glands produce excessive sputum which further blocks up air passages which are already narrowed. If the inflammation is not controlled with treatment, as well as causing acute attacks, it can lead to permanent narrowing and scarring of the air passages so that eventually asthma drugs won't relieve the symptoms any more. This process is known as airway remodeling. (Asthma) Most asthma patients are diagnosed and treated by their GP. Most GPs have asthma clinics where the practice nurse will look after patients with asthma. Most asthma patients can expect to live normal lives and have a normal life expectancy. However, deaths and disability can still occur in patients with asthma and this is usually due to a failure to take preventive treatments properly and regularly. The case of Sameena, represents highly allergic sensitivity leading to respiratory as well as skin related problems. Her asthma condition is not well managed at home, and reluctance to abide by the preventive measures in maintaining allergy free home environment, controlling allergic exposure and proper peak flow meter use, has led to conditions where her visits to clinic has increased indicating more dependence on the use of inhalers. There is no cure for asthma at present but modern drugs can control the inflammation to stop it causing symptoms and leading to disability in the future from airway remodeling. The best medicine available at present to control inflammation (and the most important treatment for the vast majority of patients), is a steroid inhaler. It is very important to understand that these medicines need to be used regularly because they are preventers i.e. medicines which protect patients from asthma. Reliever inhalers (e.g. salbutamol) only temporarily relieve the spasm in the airway muscles. This helps to relieve symptoms but does not control the underlying inflammation. Many patients are tempted to rely on their reliever medicine alone. If you have been prescribed a preventer medicine it is very important to use it regularly even when you feel well. (Asthma) The first British guidelines on asthma and management in adults were produced as a result of a joint initiative between the British Thoracic Society (BTS), The Royal College of Physicians of London, the King's Fund Centre and the National Asthma Campaign in 1990. The emphasis of the guideline is on effective administration of the medication, especially inhaled steroid which should be used in milder cases than previously recommended. The guideline reiterates that inhaled steroids are the first choice preventive drug and that a long-acting beta-2 agonist should not be used without concomitant inhaled corticoid steroids (The 2003 recommendation that there should be a trial of other treatments before increasing the inhaled steroid dose above 800mg per day in adult and 400 mg per day obviously still applies). The second step is in increased asthma awareness, focus on individual needs and clinical asthma management training from an expert in asthma management. The educational package should include patients receiving specific advice about recognizing loss of asthma control (assessed by symptoms, peak-flow recording or both). The primary care services should be delivered by clinicians trained in asthma management, leading to improved diagnosis, prescribing, education, monitoring and continuity of care. Regular structured review by health professionals with particular expertise in asthma management is recommended. The special needs of ethnic minority groups and those with social disadvantage and communication difficulty is again stressed. Regarding hospital services, emphasis is on organization and well managed delivery of care and services. The patients admitted in the hospital should be managed by specialists rather than general units. The first British asthma guideline published in 1990 stated, 'as far as possible the patient should be trained to manage their own treatment rather than consult their doctors before making changes'. This message is reiterated in the revised guidelines, but now reinforced by a wealth of published studies demonstrating how such an approach can improve outcomes. (Asthma) All people with asthma should have access to primary care delivered by clinicians with appropriate training in asthma management. In primary care, people with asthma should be reviewed regularly by a nurse or doctor with appropriate training in asthma management. Patients with asthma should be offered self-management education that should focus on individual needs, and be reinforced by a written action plan. Prior to discharge, in-patients should receive individualised asthma action plans, given by clinicians with appropriate training in asthma management. The term 'action plan' is proposed as a replacement to the existing 'self-management plan'. ( Britisth Guideline on the Management of Asthma.) The test of the cultural differences which results in the Impact-on-Family Scale, which helps to make cross-cultural comparisons are important determinants of the psychosocial frame of mind. Chronic childhood illness has considerable consequences for the family system. It is a distressing experience and requires coping and adaptation (Kazak, 1992 ; Kazak, Segal-Andrews, & Johnson, 1995). To determine the effects of chronic childhood illness on the family, Stein and Riessman (1980) developed the Impact-on-Family Scale. Although they considered positive effects, they focus on negative effects. Negative influences of illness are conceptualized in terms of losses : financial burden, restrictions in social life, decreased interaction with significant others, less time for other family members, and increased subjective distress or strain. This study aimed to investigate the suitability of the Impact-on-Family Scale for use with Italian mothers of children with chronic illnesses. Our main interests were (1) the replicability of the original factor structure of the Impact-on-Family Scale, (2) the degree of internal consistency of the subscales, the extent of homogeneity of the items of each scale, and the age independence of impact scores. Subsequently, we investigated (3) whether there are cultural differences in impact-scores. (M. Kolk,Schipper,Hanewald,Casari,Fantino.) There are two key questions regarding asthma and ethnic minority groups, especially Asians. (1) Does the prevalence of asthma vary between ethnic minorities such as South Asians living in the UK (2) Are the outcomes for asthma care worse for these groups and, if so, why and how do we improve the situation (In what way may race, ethnicity or culture influence asthma outcomes) In studies in India mothers have expressed concern and denial when confronted with a diagnostic label of asthma but there is very little other substantiated data on cultural barriers to good care. Linguistic difficulties because the intervention was offered in English, Punjabi, Hindi, or Urdu and backed up with translated documents. Further research is therefore now needed to determine whether there is some cultural barrier in patients from the ISC to taking control of their own condition, or whether self-management training needs to be offered in a different way to these patients than to others. Perhaps reading levels (literacy) were not equivalent in the two groups and this has been related to a poorer knowledge of both asthma and inhaler usage.31 The fact that there was a trend towards improvement, even in those from the ISC, suggests that a more intensive programme might have been more helpful. Management of a child with asthma also involves significant financial costs. Direct costs include the costs of medication, medical bills, and cost of health service utilization such as clinic visits and hospital admissions. Indirect costs include the adverse economic impact of the disease on the family. While the management of childhood asthma has improved significantly with time, it still has significant impact on child's activities, schooling, family life and family's finances. It is important to assess these aspects so as to improve quality of care. (Kabra) The analysis of the factors and statistics above, reveal clear picture that the impact of Asthma would be significant on Sameena (the patient) and Saba (the care provider-mother). Their characteristics match that of ISC countries where there is stigma related to the disease, along with extra financial and emotional burden, which is further worsened by some of the linguistic barriers which come in the way of effective management of the disease. Asthma is slightly more common in South Asians and there is likelihood of it being under diagnosed and under treated. The frequency of clinical visits and the dependence on the use of the inhaler further suggests that self management action plans are not adhered to. It is a reflection of less patient education and self-management training being offered to these patients. There is tendency to unrealistic belief that the patient may outgrow and should be encouraged to be less dependent on the medication, this leads to uncontrolled asthma, as in case of Sameena. This can strain the mother daughter relationship as there would be severe restrictions related to diet and tendency to postpone use of therapeutic measures to prevent the onset of Asthma. The emotional and psychological aspects of the relationship may also get overburdened. There is a great chance that the mother may not be well informed about self-management practices. The standard of living conditions and the lifestyle may not help the prevention in timely and effective manner. The episodic nature of asthma as a chronic disease presents challenges for self-management as patients lose interest in their condition once they are asymptomatic. An important consideration in educational programs is to have a sustained effort by personnel who maintain frequent contact and provide reassurance, comfort, and consistency to the patient. (Davis and Bailey ) Our system should provide the financial support for self-management to be effective. Despite increased asthma education efforts, state-sponsored asthma management initiatives, and safe and effective medications for prevention and control, asthma continues to be the most prevalent chronic childhood disease. "Develop a partnership with the patient and family," Burack says, "and at every visit emphasize that there will be a next visit and further refine the responsibilities of both patient and provider. With communication sensitive to the unique issues that face poor and urban children with asthma, pediatricians may be able to decrease the incidence of asthma-related emergency room visits and hospitalizations each year." (Communication and understanding keys to asthma treatment) Works Cited "Asthma" Working for better lungs. British Thoracic Society. 10 Mar 2007 .(Communication and understanding keys to asthma treatment) (Asthma) "British Guideline on the Management of Asthma." SIGN. 2001-2005. Scottish Intercollegiate Guidelines Network. 10 Mar 2007 . ( British Guideline on the Management of Asthma.) "In what way may race, ethnicity or culture influence asthma outcomes." Thorax Online. 2000. BMJ Publishing Group Ltd & British Thoracic Society. 10 Mar 2007 . (In what way may race, ethnicity or culture influence asthma outcomes) M. Kolk, Schipper, Hanewald, Casari, Fantino., "The Impact-on-Family Scale : A Test of Invariance Across Culture." The Journal of Pediatris Psychology. 2000. Society of Pediatric Psychology. 10 Mar 2007 . (M. Kolk, Schipper, Hanewald, Casari, Fantino.) Kabra, S.K. "Social and Economic Impact of Childhood Asthma." Indian Pediatrics. 2003. Indian Pediatric. 10 Mar 2007 . (Kabra) Davis and Bailey , Jennifer J. and William C.. "Teach a Man to Fish and You Have Fed Him for a Lifetime." CHEST. 2006. American College of Chest Physician. 11 Mar 2007 . (Davis and Bailey ) "Communication and understanding keys to asthma treatment." Children's Health . 2007. Children's Hospital Boston. 11 Mar 2007 . (Communication and understanding keys to asthma treatment) Read More