Widely Spread Allergic Asthma - Case Study Example

Allergic asthma Case study It is d, that asthma takes one of the leading positions among the allergic diseases, so widely spread at present. It is known to be one of the major reasons of chronic complications and disabilities in the world. 'Chronic allergic conditions can significantly decrease quality of life, patient well-being, employee productivity, and school performance and attendance'. (Barbee & Murphy, 1998) Thus, the aim of this work is to provide the basic analysis of the allergic asthma as diagnosis, its management and control on the basis of the real-case study. Prevalence and morbidity associated with allergic diseases In relation to the allergic asthma's discussion, it is worth mentioning the issue of morbidity among patients with chronic allergic asthma. In 2001, 73 people per 1000 were diagnosed to have chronic allergic asthma with the help of the medical professional; this is current prevalence of allergic asthma. What is more interesting to note, is that the prevalence of allergic asthma among minorities is disproportionably higher than among the native population. This may be explained by the social conditions, which often define the general state of health and immune system among patients from ethnic minorities. Asthma was also one of the leading diagnoses in the hospitalizations, and its morbidity was equal to 1.6 per 100,000 of the native population. Thus, accounting the noted information the importance and relevance of the present discussion is not under any doubt. (Adams, Smith & Ruffin, 2001) Diagnosis and assessment of the patient with asthma Asthma is problematic in confirming the diagnosis, and the difficulty of the diagnosis confirmation lies in the following: first of all, the process of diagnosis and its confirmation is clinical, and there are no blood tests, histopathological or radiographic investigations which can be performed to confirm the suggested asthma. Second, the process of the diagnosis and the symptoms are often mixed and dubious. (British Thoracic Society, 1997) Mrs. H addressed the doctor for medical assistance in 2004. The complaints were similar to those which patients with chronic allergic diseases have - she regularly had exacerbations when she had difficulties with breathing, the presence of wheeze during these periods were the signs of the asthma, but for the reasons of her addressing the medical establishment with this problem for the first time, there had been no previous notes in relation to her state. She was 29, and she had used to have such health problems for about 10 years before, but with the exacerbations passing quickly and with long breaks she didn't see the reason for serious medication. Mrs H's family history stated that her both parents had chronic allergic rhinitis. Mrs H herself noted that tobacco smoke worsened her state, as well as dust inhaling; she had never smoked herself. Her social status was favorable, and her profession was accounting, thus she used to work with papers which could often be the sources of dust. She didn't have any signs of breath difficulties after use of aspirin or other medicines. Wheeze was episodic but was becoming more frequent. It is useful to remember, that the symptoms of allergic asthma may sometimes be mixed with the other symptoms, which may make the diagnosis doubtful or wrong; if the patient has difficulties in breathing without wheeze, fixed wheeze, or mentions the weight loss, the chest X-ray is recommended for the determining of the exact diagnosis, which in such case may be either COPD, or tumor, bronchiectasis, etc. As for the family history in diagnosing allergic asthma, it is one of the most important risk factors to account when diagnosing any allergic diseases; 'asthma is linked to both parental and sibling history. The strongest association is with maternal atopy'. (British Thoracic Society, 1997) Diagnosis of asthma with the account of theoretical knowledge Bearing in mind that Mrs H didn't have any additional symptoms which could make the diagnosis doubtful, she was asked to make objective tests, which are traditionally used to confirm allergic diseases, especially asthma. The peak expiratory flow and forced expiratory volume are the two basic tests to analyze the state of the patient with suggested allergic asthma. It is characteristic of asthma to note the variability of PEF and FEV1. With the results of Mrs H analysis, showing the variability of 27% during the five days of investigation, it was stated that the asthma diagnosis was confirmed. This test was essential to define the way the disease should be managed and treated in the long-term period. As for the diagnosing the bronchial responsiveness, this test is rather doubtful, as it may also show the signs of COPD and does not represent the 100% guarantee in determining the asthma diagnosis. (Thiadens & Dekker, 1998) Management of allergic asthma The interrelation between chronic allergic diseases has been known for many years; moreover, it is stated that in case allergic asthma is not treated or controlled properly, it is form easily transits into the severe stage. (Gibson et al, 2001) Controlling or properly managing asthma means that the patient, first of all, should avoid the factors, which make airways irritated and cause exacerbations. The personal action plan should be provided for every patient, and it is also appropriate to teach the family members how to treat the chronic allergic disease on the daily basis. Any patient should have clear information about what medicines he (she) is prescribed, how to recognize that the health state is becoming worse, and what actions should be undertaken in emergency situations. The principal factor here is avoiding the allergic factor; it has been stated that Mrs H felt worse inhaling smoke and dust - thus these are the agents which cause allergy and should be avoided. 'There is strong correlation between allergic sensitization to common aeroallergens and the subsequent development of asthma.' (Martinez & Helms, 1998) It should be admitted, that not many studies have been devoted to the role of allergen avoidance in managing allergic asthma; such therapy may help in reducing the severity of asthma. Allergen exposure is known to increase asthma symptoms, bronchial reactivity and deterioration in lung function. (Gotzsche, Johansen & Hammarquist, 2001) In relation to the dust being an allergic agent for Mrs H, it is recommended to remove the objects which usually accumulate dust from the places where she stays for continuous periods of time - for example, to remove carpets from bedroom. It should be also recommended to avoid smoking for the family members who smoke, in the same premises with Mrs H; however, it would be more preferable for the patient if family members quit smoking. This part of management plan is called non-pharmacological treatment and in case it is addressed by all family members on the regular basis, it helps to reduce the symptoms and the complications of allergic asthma without any severe pharmacological treatment. However, in case with Mrs H, and her PEV being at the level of 27%, pharmacology is necessary. In the development of the pharmacological management plan it is important to remember the following factors: there are no fixed levels of the lung function which should be achieved, for this factor being individual for every patient separately; the aims of pharmacological treatment are to achieve minimal displays of allergic asthma symptoms with the patient during the day, as well as minimal or, better, no exacerbations through the continuous period of time. In simple words, pharmacology is aimed at giving the patient a chance to live normal life. Mrs H does not have any test results or indices which might tell that she needs medication on the regular basis. With her asthma bearing allergic character, and in case she keeps to the non-pharmacological management plan, the medical treatment may be reduced to the use of mild therapy, which usually includes the use of short-acting bronchodilators, such as inhaled short-acting beta-agonists or theophyllines. The advantages of the inhaled medicines are in the fact that they are delivered directly to lungs and there is no need to use big amounts of drugs to achieve the desirable effect. (Ram & Wright, 2001) Though the inhaler technique should be monitored, but this disadvantage is overweighed by the advantages and is preferable in managing asthma at present. The use of pMDI + spacer will be effective as a means of delivery for Mrs H. 'Using short acting beta agonists as required is at least as good as regular (four times daily) administration. Unless individual patients are shown to benefit from regular use of inhaled short-acting beta agonists, then as required use is recommended'. (Ram & Wright, 2001) The dosage chosen should be neither low, which will be the sign of poorly controlled asthma, nor too high, because this will also cause the need of asthma management to be reviewed. In managing allergic asthma the use of steroids is essential; in case with Mrs H avoidance of allergic agents should be combined with the use of steroids for the better synergic effect and elimination of the symptoms. The level of Mrs H's asthma can be characterized as mild, but with her complaints at the higher frequency of wheezing and exacerbations this state can become moderate, if proper management of the disease is absent. (Martinez & Helms, 1998) It will be reasonable to start with 400 mcg of inhaled steroids, and the dose should be divided into two separate parts, as it has been proven that taking steroids twice per day increases the effectiveness of the medication in general. The best choice of steroids will be the prescription of the BDP, which has been tested clinically and is known for its effectiveness and low side-effects. (Ram & Wright, 2001) Accounting the lifestyle of the patient, it will be important to include self-management into the action plan. Not only should the action plan be written down and given to the patient in details, but self-management should become an integral part of this plan. The results of this self-management should be monitored on the regular basis; the outcomes should be analyzed and used for the amendments in the previously designed plan. (Couturaud & Proust, 2002) Conclusion Management of the allergic asthma at present acquires national scales with the problem of allergic diseases becoming more serious. It is clear, that each patient needs individual approach, though this approach should be based on the general guidelines for the allergic asthma treatment which can be found in literature. This work was based on the theoretical knowledge and the attempt to implement this knowledge into practice. The result of this work has become the development of the action plan for managing allergic asthma with the individual patient. References Adams, RJ, Smith, BJ and Ruffin, RE, 2001. Impact of the physician's participation style in asthma outcomes and patient satisfaction. Ann Allergy Asthma Immunol, 86, pp. 263-271. Barbee, RA and Murphy, S, 1998. The natural history of asthma. J Allergy Clin Immunol, 102, pp. 65-72 British Thoracic society, 1997. The British Guidelines on asthma management. Thorax, 52, pp.1-21 Couturaud, F and Proust, FA, 2002. Education and self-management: a one-year randomized trial in stable adult asthmatic patients. J Asthma, 39, pp. 493-500 Gibson, PC, Coughlan, J, Wilson, AJ et al, 2001. Self-management and regular practitioner review for adults with asthma. In: Cochrane Library, Issue 3. Oxford: Update Software. Gotzsche, PC, Johansen, HK and Hammarquist, C, 2001. House dust mite control measures for asthma. In: The Cochrane Library, issue 3. Oxford: Update Software. Laor, A and Danon, YL, 1993. Effects of time, sex, ethnic origin and area of residence on prevalence of asthma. BMJ, 307, pp. 83-95 Martinez, FD and Helms, PJ, 1998. Types of asthma and wheezing. Eur Respir J Suppl, 27, pp. 3-8 Ram, FS and Wright, J, 2001. Systematic review of clinical effectiveness of pressurized metered dose inhalers versus other hand held inhaler devices for delivering beta agonists bronchodilators in asthma. BMJ, 323, pp. 901-905 Thiadens, HA and Dekker, FW, 1998. Value of measuring diurnal peak flow variability in the recognition of asthma: A study in general practice. Eur Resp J, 12, pp. 842-847 Read More