Introduction
Asthma is an inveterate lung disease that causes inflammation and narrowing of lung airways. Due to inflammation, the airways become swollen and sensitive.
Asthma affects all people starting mostly in early childhood.
According to the Department of Health (2008), over 22 million people in the United States of America are known to have asthma. This includes 6 million children who are the most susceptible group.
Societal costs are far reaching. According to the Centre for Disease Control (2009), 40,000 people miss school or work due to asthma, 30,000 people have an asthma attack, 5,000 people visit the emergency room due to asthma, 1,000 people are admitted to the hospital due to asthma and 11 people die from asthma every day.
On economic costs, the average annual cost of care for a single patient is $4,912. 65% of this amount covers hospital admissions, medications and doctors’ visits while 35% covers indirect costs like time lost at work (The Journal of Allergy and Clinical Immunology, 2003, pg. 26).
What is Asthma?
Asthma is an inveterate lung disease that causes inflammation and narrowing of lung airways.
Due to inflammation, the airways become swollen and sensitive; therefore, they react strongly to even mild substances that the patient breathes in.
In response to these inhaled substances, the muscles surrounding the airways tighten thus causing the airways to narrow; hence, restricting the flow of air in and out of the lungs.
In severe cases, these muscles tighten further and this causes the cells around the airways to secrete excess mucus; a thick sticky liquid that narrows the airways further thus aggravating the condition.
Effects of asthma are more pronounced mostly at night and early in the morning and this results in lack of sleep.
According to Rose, Mannino and Leaderer ( 2008), asthma prevalence increased between 1980 and 1996. The prevalence then stabilized between 1997 and 2004 after which it decreased gradually until 2008 (p. 23). This data however, puts on record the reported incidences only. There is a probability that the prevalence may be higher than this considering the unreported cases.
Death rates are closely associated with the prevalence and as the prevalence increased, death rates also increased and decreased proportionally to decrease in prevalence.
Signs and Symptoms
The common signs and symptoms of asthma are:
- coughing especially at night and early in the morning.
- wheezing; this is a whistling sound that comes out as one breathes.
- shortness of breath which is accompanied by difficulties in getting air out of lungs.
- chest tightness which feels like something is squeezing the chest.
- rapid breathing
- retractions
- blue lips, pale and sweaty face
- tightening of chest and sometimes neck muscles (Chesney, 2007, p. 200).
Risk Factors
- Children below the age of five years
- Adults around the age of thirty years
- Aged people who are over the age of sixty years
- A family history of asthma
- Atopic personal history
- Allergies
- Continued exposure to second-hand smoke
- Air pollution especially in urban areas
- Obesity
- Relatively low vitamin D levels in the body
- Smoking
- Low birth weight
- Exposure to chemicals especially in work place
- Frequent consumption of fast foods
- Sinusitis
- Use of antibiotics especially in children below a year old
- Those born during winter (Revicki and Weiss, 2006, p. 481-2).
Assessment
Asthma can be assessed through medical history, physical examination or laboratory tests.
On medical history, doctor enquires from the patient whether there has been any individual in that family reported to have asthma or allergy. This is followed by the patient giving detailed medical information concerning how he or she is feeling to determine symptoms of asthma. If asthma is detected at this level, the doctor can determine its severity. During this session also the doctor can establish any possibility of risk factors that the patient may have encountered. This stage is very crucial because a doctor can fail to determine infection especially in mild cases.
The doctor can carry out physical examination by listening to patients breathing to detect any signs of asthma. It is important to note that one can have asthma and still lack any visible signs; therefore, this necessitates diagnostic tests.
In diagnostic test, the doctor carries a spirometry test which establishes how the lungs are functioning. It is a test to establish how much air is breathed in and out. It also measures how fast an individual can breathe out. During these tests, doctors give some medicines and then repeats the test to see whether the primary results have improved (Revicki and Weiss, 2006, p. 485-8).
Other assessment tests includes:
- allergy testing to establish the type of allergens that affect the patient.
- testing the sensitivity of the airways in a test known as bronco provocation test.
- testing to determine presence of other diseases that may have similar symptoms to asthma like sleep apnea and vocal chord dysfunction.
- carrying out a chest x-ray to determine whether other diseases may be symptoms
Screening Guidelines
Screening processes often depend on results obtained from the assessment tests.
The most applied screening procedures include; spirometry, peak flow meter, bronchial provocation among other tests.
Spirometry is the most reliable way to screen individuals for asthma. It measures the amount of the air entering and leaving the lungs.
A spirometer is a measuring device attached to disposable mouthpiece cardboard. The patient breathes in and out deeply and after sealing his or her lips around the mouthpiece, he or she forcefully empties all the air from lungs for as long as possible. The exhalation should take at least six seconds.
If the amount of air expelled in the first second is not proportional to that exhaled in the other seconds, then the individual has an obstruction.
A patient with chronic asthma may give a normal spirometer reading; therefore, to overcome this Peak Expiratory Flow (PEF) is used to monitor reversible air obstruction. PEF test takes about two weeks as the patient records expiratory flow after waking up in the morning before taking bronchial-dilation medicines. During the day the patient has to take up to three PEF tests and record them for follow up purposes. A variability of over 20% is an indication of reversible air obstruction.
Finally, bronchial provocation can be used to determine mild airway obstruction that cannot be detected through spirometry or PEF. In this case a patient is given histamine or methacholine to trigger hyper-responsiveness. Where there is hyper responsiveness resulting to increment of over 20% of spirometry after taking histamine, there is no asthma infection.
Everyone should be screened for asthma because it is a disease that affects all people. However, emphasis should be put on children under five years and old people over 65 years of age because they are more prone to asthma than any other group. This does not mean the rest of the population should not be screened; no, it is advisable for everyone to be screened.
People should be screened for asthma at least once in two years or when one experiences difficulties in breathing (John Hopkins Medical Institutions, 2009).
Primary/tertiary non-pharmacological intervention
Primary prevention of asthma involves maintaining clean working environment. This implies keeping the environment void of pollution starting with personal cleanliness.
People should avoid exposure to known irritants or allergens by wearing protective clothing like gloves and masks (Newman, 2004, p. 35).
Avoid predisposing practices like smoking.
Tertiary non-pharmacological prevention include flu vaccination (Newman, 2004, p. 35).
Keep a regular screening habit to detect asthma as it arises.
Keep children healthy to ensure that predisposing conditions are eliminated.
Monitor one’s breathing especially after exercise or in cold weather. This is because these there are forms of asthma triggered by such conditions.
Conclusion
Asthma is a disease of the lungs which causes blockage of airways.
It is fatal but preventable and curable.
Its prevalence and incidence has been on the decrease from late nineties to date.
Common symptoms include wheezing; however, there is need to go through assessment and diagnosis to determine if one is affected.
There are different screening procedures depending on the stage of the infection. These include spirometry, peak expiratory flow and bronchial provocation.
Prevention is always better than cure; therefore, people should avoid all predisposing conditions.
References
Centre for Disease Control (2009). Asthma Facts and Figures. 56(8):16-18. Web.
Chesney, M. (2007). Magnesium’s Role in Pediatric Asthma. Air Medical Journal.
Department of Health. (2008). Adult Asthma Prevalence in the United States and New York State.
Johns Hopkins Medical Institutions (2009). Mother’s Depression a Risk Factor in Childhood Asthma Symptoms. ScienceDaily. Web.
Newman, D. (2004). Guidelines for the Prevention, Identification and Management of Occupational Asthma: Evidence Review and Recommendations. Web.
Revicki, D., & Weiss, R. (2006). Clinical Assessment of Asthma Symptom Control: Review of Current Assessment Instruments. 43(7): 481-487
Rose, D., Mannino, M., & Leaderer, P. (2006) Asthma prevalence among US adults, 1998–2000: Role of Puerto Rican ethnicity and behavioral and geographic factors. Am J Public Health. 96:880–8.
The Journal of Allergy and Clinical Immunology, 2003. Web.