Investigations into Asthma - Essay Example

Asthma Introduction Asthma is one of the major diseases which affect our lungs and our breathing passages. According to the National Heart Lung andBlood Institute (“Lung Diseases”) it is a disease where narrow airways become inflamed and later manifests with recurring periods of wheezing, chest tightness, shortness of breath and coughing. It manifests at almost any age but often starts as early as the childhood years. About 22 million people in the United States, with about 6 million of them being children, are afflicted with this disease. In fact it is the most common childhood illness in the United States (Schiffman, et.al., p. 1). This disease often manifests through various patient-specific triggers, the most common of which include airborne allergens like dust mites, cockroaches, cat or dog dander and irritants like tobacco smoke (National Heart Lung and Blood Institute “Lung Diseases”). Asthma is a chronic disease and it can attack any time especially when the patient is exposed to any of the triggers. However, as compared to other chronic lung diseases, asthma is reversible. No treatment for the disease is yet available; nevertheless, it is considered a controllable disease (Schiffman, et.al., p. 1). With early treatment, the chances of controlling this disease are good and with proper treatment, asthmatic patients can actually have fewer and less severe attacks; however without treatment and with more frequent asthma bouts, asthma patients can die from the disease (Schiffman, et.al., p. 1). In the United States and other western nations, reports of increased incidence of this disease have been revealed. Scientists and researchers claim that factors which may have contributed to this increase may include: decreased exposure to infection which has made our immune system more sensitive to infection; more people spending more time indoors where exposure to mold and dust is higher; increased air pollution; sedate lifestyle and increased percentage of obese individuals (Shiffman, et.al., p. 1). Asthma also has a major impact on society as it is the disease which causes work and school absences more than any other disease; it is also the most common cause of emergency department visits and hospitalizations and it costs the US economy about $13 billion each year (Schiffman, et.al., p. 1). Aside from the triggers previously mentioned above, the following are also considered risk factors for asthma: family history of asthma; frequent incidents of respiratory infections as a child; exposure to second hand smoke; exposure to chemicals used in farming, hairdressing, and manufacturing; and low birth weight (Mayo Clinic Staff “Health Information”). Schiffman, et.al., (p. 2) also mentions that environmental conditions such as exposure to cold and dry weather; physical exertion of exercise; gastrointestinal acid reflux; and sulfites can also trigger asthma attacks. Schiffman, et.al. (p. 2) also points out that allergic rhinitis and eczema are risk factors for the development of the disease. The pathophysiology of this disease may be explained using Page’s (p. 2) paper entitled “Asthma Attack.” Page (p. 2) discusses that first and foremost, there is often an extrinsic or intrinsic factor which would trigger a reaction in a person’s airway. Such factors include the different triggers previously mentioned. The trigger would then cause bronchospasm and bronchoconstriction in the person’s airway (Page, p. 2). When the airways are constricted, the patient would then develop an inflammation or edema in his bronchioles. Such edema would cause an increase in the mucus production which would then block the smaller airways (Page, p. 2). The patient would have difficulties in exhaling air because of air trapping; this eventually causes poor gas exchange with hypoxia and hypercarbia. The patient would also experience increased water loss or dehydration. Consequently, the arterial blood gas capnometry would show that the PaCO2 is low (Page, p. 2). The figure above shows the process of collapsed alveoli as the lungs react to the triggers of asthma (Page, p. 2). Assessment findings for asthma include dyspnea during exhalation; anxiety which causes hypoxia and difficulty of breathing; tachypnea; non-productive cough; chest retractions; expiratory wheezes; use of accessory muscles in breathing and use of abdominal muscles in exhaling (Page, p. 2); pulsus paradoxus or when the “1) the inspiratory diminution in arterial pressure exceeds 10 mm Hg, and 2) the inspiratory venous pressure remains steady or increases” (Barach, p. 49); absence of wheezing which may indicate ventilator failure; and lethargy and confusion which may mean respiratory failure (Page, p. 2). Chronic obstructive pulmonary disease (COPD), along with emphysema and chronic bronchitis is often confused for asthma because the symptoms for the above diseases often overlap with each other (Kaliner, p. 44). COPD is different from asthma in the sense that the former is mostly a disease of elderly individuals who have had a long history of tobacco use. The onset of asthma is younger and may attack and manifest at any age; the symptoms of dyspnea are seen only on exertion for COPD patients, and for asthma patients, there is wheezing, dyspnea, and coughing especially at night (Kaliner, p. 44). Vocal cord obstruction (VCD) can also be mistaken for asthma. However, VCD usually affects adolescents and young adults; it is localized in the throat; it manifests with difficulty in inspiration instead of expiration; and there is no sputum production and no nocturnal worsening with VCD (Kaliner, p. 46). The acute EMS management or pre-hospital care of asthma can be started by the EMS team by giving supplemental oxygen and inhaled bronchodilators to the patient. The bronchodilators mostly consist of inhaled beta-agonists given through hand-held nebulizers or through the metered-dose inhaler with spacer (Brenner, “Treatment”). Absent these delivery means, subcutaneous epinephrine or terbutaline can be given to the patient with severe manifestations of the disease. After administration of the initial bronchodilation measures, the EMS should not waste time in delivering the patient to the nearest hospital. While in transit, if necessary, repeated bronchodilator treatments may be administered to the patient (Brenner “Treatment’). And when the transport of the patient is delayed, repeated bronchodilator treatments may prove to be necessary. In the hospital, asthma can be managed by first categorizing the severity of the patient’s condition from category 1, where the patient would require immediate attention, up to category 5, where he would require the least urgent attention (Clinical Epidemiology and Health Service Evaluation Unit, p. 4). After such categorization, the medical assessment would now follow. The patient’s history and physical examination would follow. The Peak Expiratory Flow measurements as well as gas exchange would then be measured in the patient; further diagnostic tests like chest x-ray (where there are complications suspected only) may also be conducted (Clinical Epidemiology and Health Service Evaluation Unit, p. 4). Beta-agonists are given to the patient with doses of salbutamol 5 mg via nebulizer every 15 minutes; in patients with severe manifestations of the disease, continuous nebulization is required (Clinical Epidemiology and Health Service Evaluation Unit, p. 4). Oxygen therapy is also immediately started on patients and in some instances; corticosteroids are also administered to adults (Clinical Epidemiology and Health Service Evaluation Unit, p. 4). Hospital admission and ongoing treatment may follow based on the patient’s condition and response to treatment. The long-term implications for EMS care in asthma patients involve the improvement of EMS capability and skills in managing non-urgent to severe asthma attacks. In order to improve the management of asthma in the prehospital setting, the EMTs must be equipped with the medical skills, not just in assessing the patient’s condition but also in immediately administering patient remedies. The EMS must also be properly equipped with the necessary equipment to manage the patient’s symptoms in transit and in order to allow early management of symptoms. Conclusion Asthma is one of the most common respiratory afflictions all across the globe. It affects people of all ages, manifests at any age, and afflicts many children. Family history, frequent bouts of respiratory disorder, exposure to second hand smoke, exposure to chemicals and having a low birth weight are some of the risk factors of this disease. Triggers in patients include exposure to dust and molds which cause the alveoli in the lungs to constrict and cause difficulty in breathing. Assessment findings for this disease include hypoxia, expiratory wheezes, pulsus paradoxus, and difficulty of breathing. The EMS management often involves immediate nebulization and oxygen therapy. Such management is further continued in the hospital based on patient’s response to the treatment. In order to allow for a thorough and effective management of asthma, more skills training among EMS staff is needed, along with improved equipment for emergency management. Works Cited Barach, P. “Pulsus Paradoxus”. pp. 49-50. January 2000. Turner-White.com. 01 February 2010 from http://www.turner-white.com/pdf/hp_jan00_pulsus.pdf Brenner, B. “Asthma: Treatment & Medication”. Treatment. 2 July 2009. eMedicine. 01 February 2010 from http://emedicine.medscape.com/article/806890-treatment Clinical Epidemiology and Health Service Evaluation Unit. “Evidence Based Guidelines Royal Melbourne Hospital: Hospital Management of Acute Asthma”. p. 4. October 1999. Melbourne Hospital. 01 February 2010 from www.mh.org.au/royal_melbourne_hospital/.../downloadfile.asp?fileid.. Kaliner, M. “Current Review of Asthma”. pp. 44-46. 2003. Pennsylvania: Current Medicine, Inc. Mayo Clinic Staff. “Asthma: Risk factors”. Health Information. 31 May 2008. Mayo Clinic. 01 February 2010 from http://www.mayoclinic.com/health/asthma/ds00021/dsection=risk-factors Page, B. “Asthma Attack: Pathophysiology”. pp. 1-15. 2004. Michigan EMS Expo. 01 February 2010 from http://homepage.mac.com/edutainment/.Public/%20Asthma%20Attack.doc Schiffman, G., Stoppler, M., Rubins, J. “What Causes Asthma?”. Lung Diseases. 27 March 2009. National Heart Lung Blood Institute. 01 February 2010 from http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_Causes.html Read More