According to the Centers for Disease Control and Prevention (2011), Asthma continues to be a serious public health problem. Asthma is a syndrome characterized by paroxysmal or persistent symptoms such as breathlessness, chest tightness, wheezing and cough. It associates with variable airflow limitation and airway hyper responsiveness in response to endogenous and exogenous stimuli. Inflammation and its resultant effects on airway structure are the main mechanisms leading to the development and persistence of asthma. This paper will discuss asthma given the position of Centers for Disease Control and Prevention (2011) that the condition is still a serious health problem affecting many people. The paper will discuss the condition, its incidents and prevalence, the risk factors associated with it, and its treatment.
Air goes in through the nose and mouth when one breathes. It flows down the windpipe, through the large and small airways and into the air sacs. During an asthma episode, the muscles around the airways tighten, making the airways small. Besides, the lining of the airways becomes swollen. This leads to the formation of thick mucus that block the small airways. As a result, one experiences one or all of the following symptoms: Coughing, thick mucus, wheezing, and swollen lining. There is also shortness of breath, chest tightness and tight muscles (American Lung Association, 2010).
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The presence of a wheeze does not mean that one has asthma. When there is suspicion of asthma from clinical features, one confirms the diagnosis of asthma by objective measures of variable airflow obstruction and assessments of severity. In most cases, a 12 percent improvement in forced expiratory volume in children and adults would suffice as objective evidence of variable airflow obstruction. Besides, a 20 percent change after administration of a bronchodilator would signify the presence of asthma. Typically, pulmonary function normalizes after administration of a bronchodilator in asthmatic patients. When there is some probability of asthma and the above tests are nondiagnostic, tests that may diagnose asthma include methacholine challenge, exercise challenge and inhaled corticosteroid trial (American Lung Association, 2010).
According to the American Lung Association (2010), an estimated 25.7 million people, including approximately 7.1 million children, have asthma. The Association also notes that the prevalence of Asthma is high among persons with family income below the poverty level. Almost 13 million people report having an asthma attack in the past year. Asthma is responsible for over 15 million physician office, and hospital outpatient department visits and nearly two million hospital emergencies each year. African Americans continue to have higher rates of asthma emergency department visits, hospitalizations, and deaths than do Caucasians. In fact, the rate of emergency department visits is high by 330%, the hospitalization rate is high by 220%, and the asthma death rate is high by 190% (Akinbami, 2010).
Besides, approximately three million Hispanics in the U.S. have asthma, and there is a disproportionate impact on Puerto Ricans. The rate of asthma among Puerto Ricans is 113% higher than that of non-Hispanic white people and 50% higher than that of non-Hispanic black people. The prevalence of asthma attacks is highest among Puerto Ricans (Akinbami, 2010). Moreover, according to the Centers for Disease Control and Prevention (2011), Asthma is one of the most common chronic diseases of childhood. It is the third-ranking cause of hospitalization among children under 15. An average of one out of every 10 school-aged children has asthma. The annual economic cost of asthma, including direct medical costs from hospital stays and indirect costs such as lost school and workdays, amount to more than $56 billion annually (Centers for Disease Control and Prevention, 2011).
The incidence of asthma in British Columbia (B.C.) for patients between 5 and 54 years has remained constant since the year 2000, with an age standardized incidence rate for 2007/08 of 0.61% (Centers for Disease Control and Prevention, 2011). This amounts to almost 24,000 new cases of asthma in B.C. The prevalence of asthma in B.C. has increased steadily since 2000 with an age standardized prevalence rate for 2007/08 of 8.78%, or an estimated 390,000 prevalent cases. Hospital and Medical Services Plan costs in 2007/08 attributed to asthma patients (5-54 years of age) amount to $490 per patient and $552 per patient respectively, amounting to over 400 million dollars (Akinbami, 2010).
Risk factors for asthma include wheezing, coughing, difficulty breathing, and chest tightness -particularly if these are frequent and recurrent. The symptoms may be worse at night and in the early morning. They might occur in response to, or are worse after, exercise, allergen exposure, cold or damp air, or with emotions or laughter. In addition, of crucial notice is personal or family history of atopic disorders or asthma. Another symptom is a wheeze heard on auscultation. A history of improvement in symptoms or lung function in response to adequate therapy might also signify the presence of asthma.
Triggers are the things that cause asthma episodes. Each patient may have different triggers. Triggers can be colds, smoke, allergies, or exercise. It is crucial for people to learn what triggers their asthma so that they can avoid such things. According to the Centers for Disease Control and Prevention (2011), indoor and outdoor environmental factors can trigger asthma attacks. These might include dust mites, molds, cockroaches, pet dander, and secondhand smoke. Dust mites, molds, cockroaches, pet dander, and secondhand smoke trigger asthma attacks. Exposure to secondhand smoke can cause asthma in pre-school aged children. Exposure to dust mites can cause asthma to both adults and children. Ozone and particle pollution can cause asthma attacks. In addition, when ozone levels are high, more people with asthma have attacks that require a doctor’s attention (Centers for Disease Control and Prevention, 2011). People exposed to ozone become sensitive to asthma triggers such as pet dander, pollen, dust mites, and mold.
In the treatment of asthma, control of airway hyper responsiveness is the key to success. Most people with asthma should have minimal to no impact on their quality of life. There should be an evaluation and assessment of impact and exposure to allergens and irritants in individual patients. Physicians also recommend complete cessation of smoking and avoidance of environmental tobacco smoke.
Pharmacological management of asthma involves the use of various drugs. If expiratory flows are normal and there is control of the symptoms, an inhaled short-acting beta agonist is useful as advised by the physician. If there is a requirement for a rescue beta agonist in more than two times per week (excluding preventative use prior to exercise) or if lung function is abnormal, an inhaled glucocorticosteroid is the next step. Technically, the most efficient way to maximize inhaled drug delivery to the lungs is through a metered dose inhaler (pMDI) and spacing device. However, for adults, a dry powdered inhaler (DPI) has demonstrated efficacy and is more convenient for most people. If using an inhaled corticosteroid pMDI, a spacer device, in addition to usual oral hygiene, will minimize the risk of oral thrush (Akinbami, 2010).
Patients should start treatment at the step most appropriate to the initial severity of their asthma. At each step, there should be a review of medication adherence, inhaler technique, and patient education. There should be the reconsideration of diagnosis if there will be no or poor response to therapy. If symptom control continues for over 3 months, the patient should consider stepping down to the least medication necessary to maintain control.
Besides, the patient is to develop an asthma action plan with the doctor. The asthma action plan is a plan for how to manage asthma on a daily basis as well as what to do when asthma gets worse. The plan will include the triggers of asthma and the way to avoid them. It will also include the medicine to take every day (green zone), and early warning signs of an asthma episode. There is also the way to treat it (yellow zone) and the time to call the doctor (the red zone). The green zone is when the patient has no symptoms. In this phase, the patient should take his/her medicine each day. On the other hand, the yellow zone is when there might be warning signs such as a cough with cold. This phase calls for the patient to start taking the rescue medicine. The red zone is when the patient might be coughing all the time and experiences hard time breathing. This requires the patient to take the medicine and call the doctor immediately (American Lung Association, 2010). The goal of treatment is to be in the green zone. Asthma is under control if the patient can sleep all night, does not cough or wheeze during the day or at night, is active and does not miss school or work. It is advisable for the asthma patient to see his/her doctor every six months, follow his asthma action plan, have refills for medicine, and share the asthma plan with school or daycare.
As above discussed, the persistent symptoms of asthma are breathlessness, chest tightness, wheezing and coughing. An estimated 25.7 million people, including about 7.1 million children, have asthma. There are different triggers for asthma in each patient. This might be colds, smoke, allergies, or exercise. Control of airway hyper responsiveness is the key to success in the treatment of asthma. Besides, drugs are useful in the control of asthma. It is crucial to note that the individual effort is extremely crucial in the management of asthma.
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