asthma essay conclusion

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• Allergy Asthma Clin Immunol
• v.14(Suppl 2); 2018

Jaclyn Quirt

1 McMaster University, Hamilton, ON Canada

Kyla J. Hildebrand

2 University of British Columbia, Vancouver, BC Canada

Jorge Mazza

3 Western University, London, ON Canada

Francisco Noya

4 McGill University, Montreal, QC Canada

Associated Data

Data sharing not applicable to this article as no datasets were generated or analyzed during the development of this review.

Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICS) represent the standard of care for the majority of patients. Combination ICS/long-acting beta 2 -agonist inhalers are preferred for most adults who fail to achieve control with ICS therapy. Biologic therapies targeting immunoglobulin E or interleukin-5 are recent additions to the asthma treatment armamentarium and may be useful in select cases of difficult to control asthma. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. In addition to avoidance measures and pharmacotherapy, essential components of asthma management include: regular monitoring of asthma control using objective testing measures such as spirometry, whenever feasible; creation of written asthma action plans; assessing barriers to treatment and adherence to therapy; and reviewing inhaler device technique. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma in adults and children.

Asthma remains the most common chronic respiratory disease in Canada, affecting approximately 10% of the population [ 1 ]. It is also the most common chronic disease of childhood [ 2 ]. Although asthma is often believed to be a disorder localized to the lungs, current evidence indicates that it may represent a component of systemic airway disease involving the entire respiratory tract, and this is supported by the fact that asthma frequently coexists with other atopic disorders, particularly allergic rhinitis [ 3 ].

Despite significant improvements in the diagnosis and management of asthma over the past decade, as well as the availability of comprehensive and widely-accepted national and international clinical practice guidelines for the disease, asthma control in Canada remains suboptimal. Results from the Reality of Asthma Control in Canada study suggest that over 50% of Canadians with asthma have uncontrolled disease [ 4 ]. Poor asthma control contributes to unnecessary morbidity, limitations to daily activities and impairments in overall quality of life [ 1 ].

This article provides an overview of diagnostic and therapeutic guideline recommendations from the Global Initiative for Asthma (GINA) and the Canadian Thoracic Society and as well as a review of current literature related to the pathophysiology, diagnosis, and appropriate treatment of asthma.

Asthma is defined as a chronic inflammatory disease of the airways. The chronic inflammation is associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise) that leads to recurrent episodes of wheezing, breathlessness, chest tightness and/or coughing that can vary over time and in intensity. Symptom episodes are generally associated with widespread, but variable, airflow obstruction within the lungs that is usually reversible either spontaneously or with appropriate asthma treatment such as a fast-acting bronchodilator [ 5 ].

Epidemiology

The 2003 Canadian Community Health Survey found that 8.4% of the Canadian population ≥ 12 years of age had been diagnosed with asthma, with the prevalence being highest among teens (> 12%) [ 6 ]. Between 1998 and 2001, close to 80,000 Canadians were admitted to hospital for asthma, and hospitalization rates were highest among young children and seniors. However, the survey also found that mortality due to asthma has fallen sharply since 1985. In 2001, a total of 299 deaths were attributed to asthma. Seven of these deaths occurred in persons under 19 years of age, while the majority (62%) occurred in those over 70 years of age [ 6 ].

More recent epidemiological evidence suggests that that the prevalence of asthma in Canada is rising, particularly in the young population. A population-based cohort study conducted in Ontario found that the age- and sex-standardized asthma prevalence increased from 8.5% in 1996 to 13.3% in 2005, a relative increase of 55% [ 7 ]. The age-standardized increase in prevalence was greatest in adolescents and young adults compared with other age groups, and the gender-standardized increase in prevalence was greater in males compared with females. Compared with females, males experienced higher increases in prevalence in adolescence and young adulthood and lower increases at age 70 years or older.

Another recent study of over 2800 school-aged children in Toronto that assessed parental reports of asthma by questionnaire found the prevalence of asthma to be approximately 16% in this young population [ 8 ]. The results of these studies suggest that effective clinical and public health strategies are needed to prevent and manage asthma in the Canadian population.

Pathophysiology and etiology

Asthma is associated with T helper cell type-2 (Th2) immune responses, which are typical of other atopic conditions. Asthma triggers may include allergic (e.g., house dust mites, cockroach residue, animal dander, mould, and pollens) and non-allergic (e.g., viral infections, exposure to tobacco smoke, cold air, exercise) stimuli, which produce a cascade of events leading to chronic airway inflammation. Elevated levels of Th2 cells in the airways release specific cytokines, including interleukin (IL)-4, IL-5, IL-9 and IL-13, and promote eosinophilic inflammation and immunoglobulin E (IgE) production. IgE production, in turn, triggers the release of inflammatory mediators, such as histamine and cysteinyl leukotrienes, that cause bronchospasm (contraction of the smooth muscle in the airways), edema, and increased mucous secretion, which lead to the characteristic symptoms of asthma [ 5 , 9 ].

The mediators and cytokines released during the early phase of an immune response to an inciting trigger further propagate the inflammatory response (late-phase asthmatic response) that leads to progressive airway inflammation and bronchial hyperreactivity [ 9 ]. Over time, the airway remodeling that occurs with frequent asthma exacerbations leads to greater lung function decline and more severe airway obstruction [ 10 ]. This highlights the importance of frequent assessment of asthma control and the prevention of exacerbations.

Evidence suggests that there may be a genetic predisposition for the development of asthma. Several chromosomal regions associated with asthma susceptibility have been identified, such as those related to the production of IgE antibodies, expression of airway hyperresponsiveness, and the production of inflammatory mediators. However, further study is required to determine specific genes involved in asthma as well as the gene-environment interactions that may lead to expression of the disease [ 5 , 9 ].

An extensive literature review undertaken as part of the development of the Canadian Healthy Infant Longitudinal Development (CHILD) study (an ongoing multicentre national observational study) examined risk factors for the development of allergy and asthma in early childhood [ 11 ]. Prenatal risk factors linked to early asthma development include: maternal smoking, use of antibiotics and delivery by caesarean section. With respect to prenatal diet and nutrition, a higher intake of fish or fish oil during pregnancy, and higher prenatal vitamin E and zinc levels have been associated with a lower risk of development of wheeze in young children. Later in childhood, risk factors for asthma development include: allergic sensitization (particularly house dust mite, cat and cockroach allergens), exposure to environmental tobacco smoke, breastfeeding (which may initially protect and then increase the risk of sensitization), decreased lung function in infancy, antibiotic use and infections, and gender. Future results from CHILD may help further elucidate risk factors for asthma development.

Asthma phenotypes

Although asthma has long been considered a single disease, recent studies have increasingly focused on its heterogeneity [ 12 ]. The characterization of this heterogeneity has led to the concept that asthma consists of various “phenotypes” or consistent groupings of characteristics. Using a hierarchical cluster analysis of subjects from the Severe Asthma Research Program (SARP), Moore and colleagues [ 13 ] have identified five distinct clinical phenotypes of asthma which differ in lung function, age of asthma onset and duration, atopy and sex.

In children with asthma, three wheeze phenotypes have been identified: (1) transient early wheezing; (2) non-atopic wheezing; and (3) IgE-mediated (atopic) wheezing [ 14 ]. The transient wheezing phenotype is associated with symptoms that are limited to the first 3–5 years of life; it is not associated with a family history of asthma or allergic sensitization. Risk factors for this phenotype include decreased lung function that is diagnosed before any respiratory illness has occurred, maternal smoking during pregnancy, and exposure to other siblings or children at daycare centres. The non-atopic wheezing phenotype represents a group of children who experience episodes of wheezing up to adolescence that are not associated with atopy or allergic sensitization. Rather, the wheezing is associated with a viral respiratory infection [particularly with the respiratory syncytial virus (RSV)] experienced in the first 3 years of life. Children with this phenotype tend to have milder asthma than the atopic phenotype. IgE-mediated (atopic) wheezing (also referred to as the “classic asthma phenotype”) is characterized by persistent wheezing that is associated with atopy, early allergic sensitization, significant loss of lung function in the first years of life, and airway hyperresponsiveness.

Classifying asthma according to phenotypes provides a foundation for improved understanding of disease causality and the development of more targeted and personalized approaches to management that can lead to improved asthma control [ 13 ]. Research on the classification of asthma phenotypes and the appropriate treatment of these phenotypes is ongoing.

The diagnosis of asthma involves a thorough medical history, physical examination, and objective assessments of lung function in those ≥ 6 years of age (spirometry preferred, both before and after bronchodilator) to document variable expiratory airflow limitation and confirm the diagnosis (see Table  1 ). Bronchoprovocation challenge testing and assessing for markers of airway inflammation may also be helpful for diagnosing the disease, particularly when objective measurements of lung function are normal despite the presence of asthma symptoms [ 5 , 15 , 16 ].

Table 1

Diagnosis of asthma based on medical history, physical examination and objective measurements [ 5 , 15 , 16 ]

FVC forced vital capacity, FEV 1 forced expiratory volume in 1 s, PEF peak expiratory flow (highest of three readings), BD bronchodilator (short-acting SABA or rapid-acting LABA), LABA long-acting beta 2 -agonist, SABA short-acting beta 2 -agonist

a These tests can be repeated during symptoms or in the early morning

b Daily diurnal PEF variability is calculated from twice daily PEF as ([day’s highest minus day’s lowest]/mean of day’s highest and lowest), and averaged over 1 week

c For PEF, use the same meter each time, as PEF may vary by up to 20% between different meters. BD reversibility may be lost during severe exacerbations or viral infections. If bronchodilator reversibility is not present at initial presentation, the next step depends on the availability of other tests and the urgency of the need for treatment. In a situation of clinical urgency, asthma treatment may be commenced and diagnostic testing arranged within the next few weeks, but other conditions that can mimic asthma should be considered, and the diagnosis of asthma confirmed as soon as possible

The importance of labeling asthma properly in children and preschoolers cannot be overemphasized since recurrent preschool wheezing has been associated with significant morbidity that can impact long-term health [ 17 ]. According to a recent position statement by the Canadian Paediatric Society and the Canadian Thoracic Society, asthma can be appropriately diagnosed as such in children 1–5 years of age, and terms that denote either a suggestive pathophysiology (e.g., ‘bronchospasm’ or ‘reactive airway disease’) or vague diagnoses (e.g., ‘wheezy bronchitis’ or ‘happy wheezer’) should be abandoned in medical records [ 17 ].

Medical history

Important questions to ask when taking the medical history of patients with suspected asthma are summarized in Table  2 . The diagnosis of asthma should be suspected in patients with recurrent cough, wheeze, chest tightness and/or shortness of breath. Symptoms that are variable, occur upon exposure to triggers such as allergens or irritants, that often worsen at night and that respond to appropriate asthma therapy are strongly suggestive of asthma [ 5 , 16 ]. Alternative causes of suspected asthma symptoms should be excluded (see “ Differential diagnosis ” section in this article).

Table 2

Key questions to ask when taking the medical history of patients with suspected asthma

A positive family history of asthma or other atopic diseases and/or a personal history of atopic disorders, particularly allergic rhinitis, can also be helpful in identifying patients with asthma. During the history, it is also important to enquire for possible triggers of asthma symptoms, such as cockroaches, animal dander, moulds, pollens, exercise, and exposure to tobacco smoke or cold air. When possible, objective testing for these triggers should be performed. Exposure to agents encountered in the work environment can also cause asthma. If work-related asthma is suspected, details of work exposures and improvements in asthma symptoms during holidays should be explored. It is also important to assess for comorbidities that can aggravate asthma symptoms, such as allergic rhinitis, sinusitis, obstructive sleep apnea and gastroesophageal reflux disease [ 16 ].

The diagnosis of asthma in children is often more difficult since episodic wheezing and cough are commonly associated with viral infections, and children can be asymptomatic with normal physical examinations between exacerbations. In addition, spirometry is often unreliable in patients under 6 years of age, although it can be performed in some children as young as 5 years. A useful method of confirming the diagnosis in young children is a trial of treatment (8–12 weeks of a daily ICS and a short-acting bronchodilator as needed for rescue medication). Marked clinical improvement during the treatment period, as reflected by a reduction in daytime or nocturnal symptoms of asthma, a reduction in the use of rescue bronchodilator medication, absence of acute care visits (e.g., same-day physician appointments or emergency room visits) and hospitalizations for asthma exacerbations, and the absence of rescue oral corticosteroids are all indicators that the daily ICS therapy is working and that a diagnosis of asthma is likely [ 5 , 18 , 19 ]. In a young child who is symptomatic with cough, wheeze, or increased difficulty breathing, a physical examination both before and after administration of a bronchodilator is of extreme value and can be used as a diagnostic tool. If the respiratory symptoms resolve within 10–15 min of bronchodilator administration, a diagnosis of asthma may be established by a physician or other healthcare provider.

The modified Asthma Predictive Index (mAPI) is a useful tool for identifying young children with recurrent wheeze who may be at high risk of developing asthma (see Table  3 ; also available online at: https://www.mdcalc.com/modified-asthma-predictive-index-mapi ). A positive mAPI in the preschool years has been found to be highly predictive of future school-age asthma [ 20 ].

Table 3

Modified Asthma Predictive Index [ 20 ]

Physical examination

Given the variability of asthma symptoms, the physical examination of patients with suspected asthma can often be unremarkable. Physical findings may only be evident if the patient is symptomatic. Therefore, the absence of physical findings does not exclude a diagnosis of asthma. The most common abnormal physical findings are a prolonged expiratory phase and wheezing on auscultation, which confirm the presence of airflow limitation [ 5 ]. Auscultating the chest before and after bronchodilator treatment can be informative as well, with improved breath sounds noted once the small airways undergo bronchodilation.

Among children with asthma, persistent cough is also a positive finding on physical examination since not all children with asthma wheeze. Physicians should also examine the upper respiratory tract (nose, pharynx) and skin for signs of concurrent atopic conditions such as allergic rhinitis, dermatitis, and nasal polyps (also seen in cystic fibrosis) [ 16 ].

In pediatric patients, a scoring rubric called the Pediatric Respiratory Assessment Measure (PRAM) has been developed to assess a patient’s acute asthma severity using a combination of scalene muscle contraction, suprasternal retractions, wheezing, air entry and oxygen saturation (see Table  4 ) [ 21 , 22 ]. This tool has been validated in children 0–17 years of age, and is most commonly used in acute care settings such as emergency departments, pediatric intensive care units and inpatient units.

Table 4

PRAM scoring table [ 21 , 22 ]

On-line tool is available at https://www.mdcalc.com/pediatric-respiratory-assessment-measure-pram-asthma-exacerbation-severity

PRAM Pediatric Respiratory Assessment Measure, RUL right upper lobe, RML right middle lobe, RLL right lower lobe, LUL left upper lobe, LLL left lower lobe, O 2 oxygen

a In case of asymmetry, the most severely affected (apex-base) lung field (right or left, anterior or posterior) will determine the rating of the criterion

b In case of asymmetry, the two most severely affected auscultation zones, irrespectively of their location (RUL, RML, RLL, LUL, LLL), will determine the rating of the criterion

Objective measurements to confirm variable expiratory airflow limitation

In a patient with typical respiratory symptoms, obtaining objective evidence of excessive variability in expiratory airflow limitation is essential to confirming the diagnosis of asthma (see Table  1 ) [ 5 ]. The greater the variations in lung function, or the more times excess variation is seen, the more likely the diagnosis is to be asthma. Spirometry is the preferred objective measure to assess for airflow limitation and excessive variability in lung function. It is recommended for all patients over 6 years of age who are able to undergo lung function testing [ 5 , 15 ].

Spirometry measures airflow parameters such as the forced vital capacity (FVC, the maximum volume of air that can be exhaled) and the forced expiratory volume in 1 s (FEV 1 ). Lung volumes are not measured with spirometry, and instead require full pulmonary function testing. The ratio of FEV 1 to FVC provides a measure of airflow obstruction. In the general population, the FEV 1 /FVC ratio is usually greater than 0.75–0.80 in adults, and 0.90 in children. Any values less than these suggest airflow limitation and support a diagnosis of asthma [ 5 , 23 ]. Because of the variability of asthma symptoms, patients will not exhibit reversible airway obstruction at every visit and a negative spirometry result does not rule out a diagnosis of asthma. This is particularly true for children who experience symptoms predominantly with viral infections, or who are well controlled on asthma medications. Therefore, to increase sensitivity, spirometry should be repeated, particularly when patients are symptomatic [ 15 , 16 ].

Once airflow obstruction has been confirmed, obtaining evidence of excessive variability in expiratory lung function is an essential component of the diagnosis of asthma. In general, an increase in FEV 1 of > 12% and, in adults, a change of > 200 mL from baseline after administration of a rapid-acting bronchodilator is accepted as being consistent with asthma [ 5 , 23 ]. Other criteria for demonstrating excessive variability in expiratory lung function are listed in Table  1 .

Spirometry must be performed according to standardized protocols (such as those proposed by the American Thoracic Society) by trained personnel. It is commonly performed in pulmonary function laboratories, but can also be performed in the outpatient clinical setting. During spirometry, the patient is instructed to take the deepest breath possible and then to exhale hard and fast and as fully as possible into the mouthpiece of the spirometer for a total of 6 s. Calibration of the spirometer should be performed daily.

Peak expiratory flow (PEF) monitoring is an acceptable alternative when spirometry is not available , and can also be useful for diagnosing occupational asthma and/or monitoring response to asthma treatments. However, PEF is not recommended for diagnosing asthma in children. PEF is usually measured in the morning and in the evening. A diurnal variation in PEF of more than 20% or an improvement of at least 60 L/min or at least 20% after inhalation of a rapid-acting bronchodilator suggests asthma [ 15 ]. Although simpler to perform than spirometry, PEF is more effort-dependent and much less reliable. Therefore, as mentioned earlier, spirometry is the preferred method of documenting variable expiratory airflow limitation and confirming the diagnosis of asthma.

The importance of objective measures for confirming the diagnosis of asthma cannot be overemphasized. The results of a recent multicentre study that included 613 adults with physician-diagnosed asthma from across Canada found that the diagnosis of current asthma was ruled out in 33% of patients; these subjects were not using daily asthma medications or had been weaned off medication [ 24 ]. Compared to subjects whose current asthma diagnosis was confirmed, those in whom the diagnosis was ruled out were less likely to have undergone testing for airflow limitation in the community at the time of the initial diagnosis. These findings suggest that re-evaluation of an asthma diagnosis may be warranted.

Tests of bronchial hyperreactivity

When spirometry is normal, but symptoms and the clinical history are suggestive of asthma, measurement of airway responsiveness using direct airway challenges to inhaled bronchoconstrictor stimuli (e.g., methacholine or histamine) or indirect challenges (e.g., with mannitol or exercise) may help confirm a diagnosis of asthma.

Tests of bronchial hyperreactivity should be conducted in accordance with standardized protocols in a pulmonary function laboratory or other facility equipped to manage acute bronchospasm. Bronchopovocation testing involves the patient inhaling increasing doses or concentrations of an inert stimulus until a given level of bronchoconstriction is achieved, typically a 20% fall in FEV 1 . An inhaled rapid-acting bronchodilator is then provided to reverse the obstruction. Test results are usually expressed as the provocative dose (PD) or provocative concentration (PC) of the provoking agent that causes the FEV 1 to drop by 20% (the PD 20 or PC 20 , respectively). For methacholine, most pulmonary function laboratories use a PC 20 value less than 4-8 mg/mL as the threshold for a positive result indicative of airway hyperreactivity, supporting a diagnosis of asthma. However, positive challenge tests are not specific to asthma and may occur with other conditions such as allergic rhinitis and chronic obstructive pulmonary disease (COPD). Therefore, tests of bronchial hyperreactivity may be most useful for ruling out asthma among individuals who are symptomatic. A negative test result in a symptomatic patient not receiving anti-inflammatory therapy is highly sensitive [ 16 ].

In order to properly assess lung function, patients who have been prescribed a combination of an ICS and a LABA must discontinue these long-acting medications 24 h prior to tests of airway hyperreactivity or testing with spirometry. Tests of bronchial hyperreactivity are contraindicated in patients with FEV 1 values less than 60–70% of the normal predicted value (since bronchoprovocation could cause significant bronchospasm), in patients with uncontrolled hypertension or in those who recently experienced a stroke or myocardial infarction [ 25 ].

Non-invasive markers of airway inflammation

The measurement of inflammatory markers such as sputum eosinophilia (proportion of eosinophils in the cell analysis of sputum) or levels of exhaled nitric oxide (a gaseous molecule produced by some cells during an inflammatory response) can also be useful for diagnosing asthma. Evidence suggests that exhaled nitric oxide levels can be supportive of the diagnosis of asthma, and may also be useful for monitoring patient response to asthma therapy [ 16 ]. It is still not accepted as a standard test for the diagnosis of asthma. Although these tests have been studied in the diagnosis and monitoring of asthma, they are not yet widely available in Canada.

Allergy skin testing

Allergy skin prick (epicutaneous) testing is recommended to identify possible environmental allergic triggers of asthma, and is helpful in identifying the asthma phenotype of the patient. Testing is typically performed using the allergens relevant to the patient’s geographic region. Although allergen-specific IgE tests that provide an in vitro measure of a patient’s specific IgE levels for specific allergens have been suggested as an alternative to skin tests, these tests are less sensitive, more invasive (requires venipuncture), and more expensive than skin prick tests [ 5 , 15 ]. There is no minimum age at which skin prick testing can be performed.

Differential diagnosis

Conditions that should be considered in the differential diagnosis of adults with suspected asthma may include: COPD, bronchitis, gastrointestinal reflux disease, recurrent respiratory infections, heart disease, and vocal cord dysfunction. Distinguishing asthma from COPD can be particularly difficult as some patients have features of both disorders. The term asthma-COPD overlap syndrome (ACOS), though not a single disease entity, has been adopted to describe these patients. A recent population-based cohort study conducted in Ontario suggests that the prevalence of concurrent asthma and COPD is increasing, particularly in women and young adults [ 26 ].

The differential diagnosis of asthma is unique for infants and young children and includes anatomic defects (laryngo- or tracheomalacia, congenital heart defects), physiological defects (primary ciliary dyskinesia) and genetic conditions such cystic fibrosis and primary immunodeficiency, to name just a few conditions. A chest X-ray may be considered in the work-up of a child with suspected asthma, particularly if the diagnosis is unclear or if the child is not responding as expected to treatment. Table  5 lists conditions to consider in the differential diagnosis of recurrent respiratory symptoms in children.

Table 5

Differential diagnosis of recurrent respiratory symptoms in children [ 31 , 36 ]

The primary goal of asthma management is to achieve and maintain control of the disease in order to prevent exacerbations (abrupt and/or progressive worsening of asthma symptoms that often require immediate medical attention and/or the use of oral steroid therapy) and reduce the risk of morbidity and mortality. Other goals of therapy are to minimize the frequency and severity of asthma symptoms, decrease the need for reliever medications, normalize physical activity, and improve lung function as well as overall quality of life. The level of asthma control should be assessed at each visit using the criteria in Table  6 , and treatment should be tailored to achieve control. In most asthma patients, control can be achieved using both trigger avoidance measures and pharmacological interventions. The pharmacologic agents commonly used for the treatment of asthma can be classified as controllers (medications taken daily on a long-term basis that achieve control primarily through anti-inflammatory effects) and relievers (medications used on an as-needed basis for quick relief of bronchoconstriction and symptoms). Controller medications include ICSs, leukotriene receptor antagonists (LTRAs), LABAs in combination with an ICS, long-acting muscarinic receptor antagonists (LAMAs), and biologic agents including anti-IgE therapy and anti-IL-5 therapy. Reliever medications include rapid-acting inhaled beta 2 -agonists and inhaled anticholinergics [ 5 , 15 , 16 ]. Allergen-specific immunotherapy may also be considered in most patients with allergic asthma, but must be prescribed by physicians who are adequately trained in the treatment of allergies (see Allergen-specific immunotherapy article in this supplement) [ 27 – 30 ]. Systemic corticosteroid therapy may also be required for the management of acute asthma exacerbations. A simplified, stepwise algorithm for the treatment of asthma is provided in Fig.  1 .

Table 6

Criteria for assessing asthma control [ 5 , 15 ]

FEV 1 forced expiratory volume in 1 s, PEF peak expiratory flow

A simplified, stepwise algorithm for the treatment of asthma. *LAMAs are not indicated in persons < 18 years of age. ICS inhaled corticosteroid, LTRA leukotriene receptor antagonist, LABA long-acting beta 2 -agonist, IgE immunoglobulin E, IL-5 interleukin 5; LAMA long-acting muscarinic receptor antagonist. Note: Treatments can be used individually or in any combination

The goal of asthma therapy is to treat individuals using the least amount of medications required to control asthma symptoms and maintain normal daily activities. When asthma control has been achieved, ongoing monitoring and follow-up are essential to monitor for side effects, preserve lung function over time, observe for new triggers, and establish the minimum maintenance doses required to maintain control. However, because asthma is a variable disease, treatment may need to be adjusted periodically in response to loss of control (as indicated by failure to meet the control criteria in Table  6 ) [ 5 ]. It is also imperative that all asthma patients be empowered to take an active role in the management of their disease. This can be accomplished by providing patients with a personalized written action plan for disease management and by educating the patient about the nature of the disease, the role of medications, the importance of adhering to controller therapy, and the appropriate use of inhaler devices [ 16 ]. Once a written action plan for management is provided, ongoing follow up should include:

• Reviewing the asthma action plan at each visit to determine if modifications are required based on level of asthma control;
• Observation of inhaler device technique at each visit;
• Counselling patients or caregivers who smoke on smoking cessation;
• Measuring height and weight of children and adolescents to monitor growth velocity and potential corticosteroid side effects;
• Screening for signs and symptoms of adrenal suppression for individuals requiring moderate- to high-dose ICS;
• Asking about food or venom allergies and ensuring that patients with these allergies are prescribed an epinephrine autoinjector and provided with a written anaphylaxis plan. Patients with poorly controlled asthma and food/venom allergy are at greater risk for anaphylaxis upon accidental exposure to their known allergen (see Anaphylaxis article in this supplement).
• Referring individuals who have difficulty achieving asthma control to an asthma specialist (respirologist, allergist or certified asthma educator) for further assessment (see “ Indications for referral ” section in this article).

Avoidance measures

Avoidance of exposure to tobacco smoke is important for all patients with asthma. Avoidance of other relevant allergens/irritants is also an important component of asthma management. Patients allergic to house dust mites should be instructed to use allergen-impermeable covers for bedding and to keep the relative humidity in the home below 50% (to inhibit mite growth). Pollen exposure can be reduced by keeping windows closed, using an air conditioner, and limiting the amount of time spent outdoors during peak pollen seasons. For patients allergic to animal dander, removal of the animal from the home is recommended and usually results in a significant reduction in symptoms within 4–6 months. However, compliance with this recommendation is poor and, therefore, the use of high-efficiency particulate air (HEPA) filters and restricting the animal from the bedroom or to the outdoors may be needed to help decrease allergen levels. Measures for reducing exposure to mould allergens include cleaning with fungicides, de-humidification to less than 50%, and HEPA filtration [ 16 ].

Since these avoidance strategies can be labour-intensive, patient adherence is usually suboptimal. Frequent reassessments, encouragement and empowerment by the treating physician are often required to help promote adherence to these strategies. Furthermore, patients should be advised to use a combination of avoidance measures for optimal results, since single-strategy interventions have demonstrated no measurable benefits in asthma control [ 16 ].

Inhaled medication delivery devices

Inhaled asthma medications come in a variety forms including pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) (Turbuhaler, Diskus, Twisthaler, Ellipta). Not all medications are available in the same delivery devices. Also, some devices have dose counters included and others, such as pMDIs, do not. The most important factor in selecting a medication delivery device is to ensure that the patient uses it properly.

In children, it is recommended that pMDIs always be used with a spacer device since they are as effective as nebulizers; a pMDI with spacer is also preferred over nebulizers [ 31 ]. A spacer with face mask is recommended for children 2–4 years of age, while a spacer with mouthpiece is recommended for children 4–6 years of age. To transition to a spacer with mouthpiece, children must be able to form a seal around the mouthpiece and breathe through their mouths. For children 6 years of age or over, a pMDI plus spacer with mouthpiece or DPI is recommended. Since children must have sufficient inspiratory force to use a DPI, these devices are generally not recommended for children under 6 years of age.

Reliever medications

Inhaled rapid-acting beta 2 -agonists are the preferred reliever medications for the treatment of acute symptoms, and should be prescribed to all patients with asthma. In Canada, several short-acting beta 2 -agonists (SABAs; e.g., salbutamol, terbutaline) and one LABA (formoterol) are approved for this indication. SABAs should only be taken on an as needed basis for symptom relief. Use of an as-needed SABA in the absence of a controller therapy should be reserved for patients with symptoms less than twice per month, without nocturnal wakening in the past month, or an exacerbation within the past year. In children with well controlled asthma, a SABA should be used less than three times per week.

Unlike other LABAs, formoterol has a rapid onset of action and, therefore, can be used for acute symptom relief. Given that LABA monotherapy has been associated with an increased risk of asthma-related morbidity and mortality, formoterol should only be used as a reliever in patients 12 years of age or older who are on regular controller therapy with an ICS [ 5 , 15 , 16 , 23 ].

Short-acting anticholinergic bronchodilators, such as ipratropium bromide, may also be used as reliever therapy. These agents appear to be less effective than inhaled rapid-acting beta 2 -agonists and, therefore, should be reserved as second-line therapy for patients who are unable to use SABAs. They may also be used in addition to SABAs in patients experiencing moderate to severe asthma exacerbations. Short-acting anticholinergic bronchodilator therapy is not recommended for use in children [ 15 ].

Controller medications

Inhaled corticosteroids (icss).

ICSs are the most effective anti-inflammatory medications available for the treatment of asthma and represent the mainstay of therapy for most patients with the disease. Low-dose ICS monotherapy is recommended as first-line maintenance therapy for most children and adults with asthma. Regular ICS use has been shown to reduce symptoms and exacerbations, and improve lung function and quality of life. ICSs do not, however, “cure” asthma, and symptoms tend to recur within weeks to months of ICS discontinuation. Most patients will require long-term, if not life-long, ICS treatment [ 5 , 15 , 16 ].

Since ICSs are highly effective when used optimally, factors other than treatment efficacy need to be considered if ICS therapy is unsuccessful in achieving asthma control. These factors include: misdiagnosis of the disease, poor adherence to ICS therapy, improper inhaler technique, continued trigger exposure or the presence of other comorbidities. If, after addressing such factors, patients fail to achieve control with low-to-moderate ICS doses, then treatment should be modified. For most children, ICS dose escalation (to a moderate dose) is the preferred approach to achieve control, while the addition of another class of medications (usually a LABA) is recommended for patients over 12 years of age [ 15 , 16 , 23 ]. Low, medium and high doses of ICS therapy varies by age and are summarized in Table  7 . Children who fail to achieve control on a moderate ICS dose should be referred to an asthma specialist, such a respirologist, an allergist, an immunologist or a pediatrician. It is also recommended that children receiving daily ICS therapy do not increase their daily ICS dose with the onset of a viral illness [ 23 ].

Table 7

Overview of the main controller therapies used for the treatment of asthma [ 23 , 31 ]

Pediatric dose information adapted from BCGuidelines.ca Guidelines & Protocols Advisory Committee, 2015 [ 31 ]

ICS inhaled corticosteroid, pMDI pressurized metered-dose inhaler, DPI dry powder inhaler, LTRA leukotriene receptor antagonists, IgE immunoglobulin E, IL-5 interleukin 5, bid twice daily, sc subcutaneously, IV intravenously, LABA long acting beta agonist, LAMA long-acting muscarinic receptor antagonist, po oral, prn as needed

Side effects The most common local adverse events associated with ICS therapy are oropharyngeal candidiasis (also known as oral thrush) and dysphonia (hoarseness, difficulty speaking). Rinsing and expectorating (spitting) after each treatment and the use of a spacer with pMDI devices can help reduce the risk of these side effects. Systemic adverse effects with ICS therapy are rare, but may occur at high doses, such as > 500 μg of fluticasone propionate equivalent, and include changes in bone density, cataracts, glaucoma and growth retardation [ 5 ]. Patients using high ICS doses should also be monitored for adrenal suppression [ 32 ]. It is important to note that the potential for side effects with ICS therapy needs to be considered in the context of other steroids (i.e., systemic, intranasal and topical) that may be prescribed for other atopic conditions such as allergic rhinitis or atopic dermatitis.

Combination ICS/LABA inhalers

LABA monotherapy is not recommended in patients with asthma as it does not impact airway inflammation and is associated with an increased risk of morbidity and mortality. LABAs are only recommended when used in combination with ICS therapy. The combination of a LABA and ICS has been shown to be highly effective in reducing asthma symptoms and exacerbations, and is the preferred treatment option in adolescents or adults whose asthma is inadequately controlled on low-dose ICS therapy, or in children over 6 years of age who are uncontrolled on moderate ICS doses [ 15 , 23 ]. Although there is no apparent difference in efficacy between ICSs and LABAs given in the same or in separate inhalers, combination ICS/LABA inhalers are preferred because they preclude use of the LABA without an ICS, are more convenient and may enhance patient adherence. Four combination ICS/LABA inhalers are available in Canada: fluticasone propionate/salmeterol, budesonide/formoterol, mometasone/formoterol and fluticasone furoate/vilanterol (see Table  7 ). Combination budesonide/formoterol has been approved for use as a single inhaler for both daily maintenance (controller) and reliever therapy in individuals 12 years of age and older. It should only be used in patients whose asthma is not adequately controlled with low-dose ICS who warrant treatment with combination therapy [ 5 , 15 , 23 ].

Leukotriene receptor antagonists

The LTRAs, montelukast and zafirlukast, are also effective for the treatment of asthma and are generally considered to be safe and well tolerated. Because these agents are less effective than ICS treatment when used as monotherapy, they are usually reserved for patients who are unwilling or unable to use ICSs. LTRAs can also be used as add-on therapy if asthma is uncontrolled despite the use of low-to-moderate dose ICS therapy or combination ICS/LABA therapy. It is important to note, however, that LTRAs are considered to be less effective than LABAs as add-on therapy in adults [ 5 , 15 , 23 ]. In children, if medium-dose ICS therapy is ineffective, LTRAs are considered the next-line treatment option [ 23 ]. If, however, the child has persistent airway obstruction, the addition of a LABA may be preferred.

Long-acting muscarinic receptor antagonists

The LAMA, tiotropium, administered by mist inhaler can be used as add-on therapy for patients with a history of exacerbations despite treatment with ICS/LABA combination therapy. It is only indicated for patients 12 years of age and older.

Theophylline

Theophylline is an oral bronchodilator with modest anti-inflammatory effects. Given its narrow therapeutic window and frequent adverse events (e.g., gastrointestinal symptoms, loose stools, seizures, cardiac arrhythmias, nausea and vomiting), its use is generally reserved for patients over 12 years of age who are intolerant to or continue to be symptomatic despite other add-on therapies [ 5 , 15 ].

Biologic therapies

The anti-IgE monoclonal antibody, omalizumab, has been shown to reduce the frequency of asthma exacerbations by approximately 50%. The drug is administered subcutaneously once every 2–4 weeks and is approved in Canada for the treatment of moderate to severe, persistent allergic asthma in patients 6 years of age or older. At present, omalizumab is reserved for patients with difficult to control asthma who have documented allergies, an elevated serum IgE level, and whose asthma symptoms remain uncontrolled despite ICS therapy in combination with a second controller medication [ 15 ].

Two monoclonal antibodies to IL-5 have been approved in Canada for patients aged 18 years or older with severe eosinophilia: mepolizumab and reslizumab. These are given every 4 weeks by subcutaneous injection and intravenous infusion, respectively, and are indicated in patients who are uncontrolled despite treatment with high-dose ICS therapy and an additional controller therapy, such as a LABA, and who have elevated blood eosinophils [ 5 ]. Recently, benralizumab, a monoclonal antibody against the IL-5 receptor has also been approved in Canada for the treatment of adult patients with severe eosinophilic asthma.

Table  7 provides a list of the commonly used controller therapies and their recommended dosing regimens. It is important to note that long-term compliance with controller therapy is poor because patients tend to stop therapy when their symptoms subside. Therefore, regular follow-up visits are important to help promote treatment adherence.

Systemic corticosteroids

Systemic corticosteroids, such as oral prednisone, are generally used for the acute treatment of moderate to severe asthma exacerbations. While chronic systemic corticosteroid therapy may also be effective for the management of difficult to control asthma, prolonged use of oral steroids are associated with well-known and potentially serious adverse effects and, therefore, their routine or long-term use should be avoided if at all possible, particularly in children [ 23 ]. Adverse events with short-term, high-dose oral prednisone are uncommon, but may include: reversible abnormalities in glucose metabolism, increased appetite, edema, weight gain, rounding of the face, mood alterations, hypertension, peptic ulcers and avascular necrosis of the hip [ 5 ].

Bronchial thermoplasty

Bronchial thermoplasty involves the treatment of airways with a series of radiofrequency pulses. This treatment may be considered for adult patients with severe asthma despite pharmacotherapy [ 5 ].

Allergen-specific immunotherapy

Allergen-specific immunotherapy involves the subcutaneous or sublingual administration of gradually increasing quantities of the patient’s relevant allergens until a dose is reached that is effective in inducing immunologic tolerance to the allergen. Although it has been widely used to treat allergic asthma, it is not universally accepted by all clinical practice guideline committees due to the potential for serious anaphylactic reactions with this form of therapy [ 28 ].

A Cochrane review of 88 randomized controlled trials examining the use of allergen-specific immunotherapy in asthma management confirmed its efficacy in reducing asthma symptoms and the use of asthma medications, and improving airway hyperresponsiveness [ 27 ]. Similar benefits have been noted with sublingual immunotherapy [ 33 ], which is now available for use in Canada for grass and ragweed allergies, as well as house dust mite-induced allergic rhinitis (see Allergen-specific immunotherapy article in this supplement). Evidence also suggests that allergen-specific immunotherapy may prevent the onset of asthma in atopic individuals [ 34 , 35 ].

At present, allergen-specific immunotherapy should be considered on a case-by-case basis. Allergen-specific subcutaneous immunotherapy may be considered as add-on therapy in patients using ICS monotherapy, combination ICS/LABA inhalers, ICS/LTRAs and/or omalizumab if asthma symptoms are controlled. It should not be initiated in patients with uncontrolled asthma or an FEV 1  < 70% of predicted. For subcutaneous immunotherapy, asthma must be controlled at the time of each injection, and it must be administered in clinics that are equipped to manage possible life-threatening anaphylaxis where a physician is present. Since allergen-specific immunotherapy carries the risk of anaphylactic reactions, it should only be prescribed by physicians who are specialists in allergy [ 5 ].

Indications for referral

In older children, adolescents and adults, referral to a specialist in asthma care (e.g., respirologist, allergist) is recommended when:

• Atypical asthma symptoms are present or the diagnosis of asthma is in question;
• The patient has poor asthma control (poor lung function, persistent asthma symptoms) or severe asthma exacerbations (≥ 1 course of systemic steroids per year or hospitalization) despite moderate doses of ICS (with proper technique and good compliance);
• The patient requires a detailed assessment for and management of potential environmental triggers;
• The patient has been admitted to the intensive care unit (ICU) for asthma.

In young children 1–5 years of age, referral to an asthma specialist is recommended when there is diagnostic uncertainty or suspicion of comorbidity; poor symptom and exacerbation control despite ICS at daily doses of 200–250 µg; a life-threatening event (requiring ICU admission and/or intubation); and/or for allergy testing to assess the possible role of environmental allergens [ 17 ].

Asthma is the most common respiratory disorder in Canada, and contributes to significant morbidity and mortality. A diagnosis of asthma should be suspected in patients with recurrent cough, wheeze, chest tightness and dyspnea, and should be confirmed using objective measures of lung function (spirometry preferred). Allergy testing is also recommended to identify possible triggers of asthma symptoms.

In most patients, asthma control can be achieved using avoidance measures and appropriate pharmacological interventions. ICSs represent the standard of care for the majority of asthma patients. For those who fail to achieve control with low-to-moderate ICS doses, combination therapy with a LABA and ICS is the preferred treatment choice in most adults. LTRAs can also be used as add-on therapy if asthma is uncontrolled despite the use of low-to-moderate dose ICS therapy, particularly in patients with concurrent allergic rhinitis. LAMAs or biologic therapies targeting IgE or IL-5 may be useful in select cases of difficult to control asthma. Allergen-specific immunotherapy is a potentially disease-modifying therapy, but should only be prescribed by physicians with appropriate training in allergy. All patients with asthma should have regular follow-up visits during which criteria for asthma control, adherence to therapy and proper inhaler technique should be reviewed.

Key take-home messages

• A clinical diagnosis of asthma should be suspected in patients with intermittent symptoms of wheezing, coughing, chest tightness and breathlessness.
• Objective measurements of lung function, preferably using spirometry, are needed to confirm the diagnosis. The best time to perform this testing is when the patient is symptomatic. Spirometry can generally be performed in children 6 years of age and older.
• In children < 6 years of age who are unable to perform spirometry, a trial of therapy (8–12 weeks in duration) and monitoring of symptoms can act as a surrogate method to diagnose asthma.
• All asthma patients should be prescribed a rapid-acting bronchodilator to be used as needed for relief of acute symptoms.
• ICS therapy is the standard of care for most patients with asthma.
• Combination ICS/LABA inhalers are recommended for most adult patients who fail to achieve control with low-to-moderate ICS doses.
• LTRAs can also be used as add-on therapy if asthma is uncontrolled despite the use of low-to-moderate ICS doses.
• Tiotropium by mist inhaler can be added in patients 12 years of age or older with an exacerbation history despite ICS/LABA treatment.
• Biologic therapy targeting IgE or IL-5 may be useful in select cases of difficult to control asthma.
• Allergen-specific immunotherapy is a potentially disease-modifying therapy that can be considered in most cases of allergic asthma.
• Regular monitoring of asthma control every 3–4 months, adherence to therapy and inhaler technique are important components of asthma management.

Declarations

Authors’ contributions All authors wrote and/or edited sections of the manuscript. All authors read and approved the final manuscript.

Acknowledgements

This article is an update to the Asthma article that originally appeared in the supplement entitled, Practical Guide to Allergy and Immunology in Canada, which was published in Allergy, Asthma & Clinical Immunology in 2011 (available at: https://aacijournal.biomedcentral.com/articles/supplements/volume-7-supplement-1 ). The authors would like to thank Julie Tasso for her editorial services and assistance in the preparation of this manuscript.

Competing interests

Dr. Jaclyn Quirt has received honoraria from AstraZeneca, Merck, Meda Pharmaceuticals and Sanofi. Dr. Kyla J. Hildebrand is the Section Chair of Pediatrics for the Canadian Society of Allergy and Clinical Immunology, and was an expert panel member for the development of the BCGuidelines.ca publication, Asthma in Children—Diagnosis and Management (2015). Dr. Jorge Mazza has received consulting fees and honoraria from AstraZeneca, GlaxoSmithKline, Graceway Pharmaceuticals and Novartis. Dr. Francisco Noya has received honoraria from Sanofi Pasteur and Pediapharm, and clinical trial grants from Sanofi Pasteur. Dr. Harold Kim is Vice President of the Canadian Society of Allergy and Clinical Immunology, Past President of the Canadian Network for Respiratory Care, and Co-chief Editor of Allergy, Asthma and Clinical Immunology . He has received consulting fees and honoraria for continuing medical education from AstraZeneca, Aralez, Boehringer Ingelheim, CSL Behring, Kaleo, Merck, Novartis, Pediapharm, Sanofi, Shire and Teva.

Availability of data and materials

Consent for publication.

Not applicable.

Ethics approval and consent to participate

Ethics approval and consent to participate are not applicable to this review article.

Publication of this supplement has been supported by AstraZeneca, Boehringer Ingelheim, CSL Behring Canada Inc., MEDA Pharmaceuticals Ltd., Merck Canada Inc., Pfizer Canada Inc., Shire Pharma Canada ULC, Stallergenes Greer Canada, Takeda Canada, Teva Canada Innovation, Aralez Tribute and Pediapharm.

About this supplement

This article has been published as part of Allergy, Asthma & Clinical Immunology Volume 14 Supplement 2, 2018: Practical guide for allergy and immunology in Canada 2018. The full contents of the supplement are available online at https://aacijournal.biomedcentral.com/articles/supplements/volume-14-supplement-2 .

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Asthma essay full guide: Introduction, outline, examples

This essential guide to writing an asthma essay will help any student master the craft of producing a successful written work. From researching and outlining your ideas on the subject to developing an argument and ensuring the paper is correctly formatted, this article outlines the key steps of creating a great essay about asthma.

What is Asthma

Asthma is a chronic lung condition that causes difficulty breathing, wheezing, and coughing. It is an inflammatory disorder of the airways that affects 10-15% of the population worldwide and most commonly occurs in children and adolescents. In those affected by asthma, their airways will become swollen, constricted, and filled with mucus, making it difficult to breathe normally.

When someone experiences an asthma attack, also known as an exacerbation or flare-up, their symptoms can worsen, resulting in further difficulty breathing and other physical changes such as a rapid heartbeat or chest tightness. Common triggers for asthmatic attacks include exercise, dust mites, strong smells, or cigarette smoke. The severity of these asthma attacks can range from mild to life-threatening, depending on the individual’s sensitivity to triggers.

Causes of Asthma

The most common causes of asthma are allergies and environmental triggers such as smoke or air pollution. Allergens like pollen, pet dander, and dust mites can induce an allergic reaction in some individuals, leading to inflammation in their airways.

Exposure to tobacco smoke has been shown to increase the risk of asthma in children who have not yet developed the condition. Other environmental pollutants , such as cleaning products or aerosol sprays, may also trigger an attack by irritating a person’s lungs.

Symptoms of Asthma

Common symptoms of asthma include

• Wheezing, which sounds like a whistling noise when you breathe; chest tightness – feeling like something heavy is pressing on your chest;
• Coughing – either dry or wet coughs that are worse at night
• Difficulty breathing – feeling out of breath when doing everyday activities such as climbing stairs or walking uphill

Other less common signs may include fatigue, loss of appetite, anxiety or panic attacks, facial swelling, and excessive mucus production in your throat.

Asthma assessment and plan

An asthma assessment includes collecting information about the patient, such as their symptoms, triggers, medications, and lifestyle factors that may influence their condition. This information helps healthcare providers develop an effective treatment plan for each individual patient.

The plan may include lifestyle changes such as avoiding allergens or physical activity; taking preventive medications; or emergency treatments if needed. An effective asthma management plan should also include regular follow-up appointments with healthcare providers to review progress, adjust medications if necessary and ensure the patient is managing their condition properly.

Treatments for Asthma

Following an asthma assessment and diagnosis, inhaled medications are often used for daily management and quick relief when experiencing an attack. Inhaled corticosteroids reduce inflammation in the airways, while long-acting bronchodilators help keep airways open for up to 12 hours after use. Oral medications can control asthma symptoms and may be prescribed when inhalers do not suffice.

Writing an asthma essay

Writing an asthma assignment can be daunting, especially if you are unfamiliar with the condition. Asthma is a chronic respiratory disorder that affects your breathing and can make it difficult to do even simple activities such as walking or talking.

To write a successful essay on asthma, it is essential to understand the basics of the condition and its effects.

• Research what causes asthma and who is at risk of developing it
• Familiarize yourself with the treatments available for managing symptoms and preventing attacks
• Brainstorm ideas for your essay
• Consider writing about how the condition has impacted your life or someone close to you personally or professionally
• You could also focus on how recent advancements in medical technology have improved treatment options for people living with this condition

Asthma essay outline

Writing an asthma essay can be challenging, but having a well-defined outline can make the task much easier. An outline will help you organize your essay and ensure it covers all essential aspects of the condition. Here are some tips to help you create an effective strategy for your asthma essay.

• Start by deciding on a thesis statement for the essay. This should provide an overview of what you plan to cover in the paper and guide your argument throughout
• Begin organizing information into main points or ideas that support each argument. These points should be clearly stated and supported with evidence from reliable sources such as research studies or medical journals
• Write out detailed sub-points to further explain each main point or idea in greater detail. Include quotes and examples to support each point or argument effectively.

Asthma essay introduction

The introduction should begin by grabbing the reader’s attention. Use exciting facts or questions related to asthma to help engage the audience in your work. It is also important to provide background information regarding asthma, so readers understand why this topic is essential. Be sure to include reliable data, such as statistics on mortality rates or prevalence among different populations.

Asthma essay body paragraphs

The first step when writing an asthma essay body paragraph is to determine what your main points are going to be and how you plan on presenting them in the body of your essay. Once you have selected this, you’ll need to research and collect information about these points. This could include articles, studies, statistics, or any other sources that may be relevant.

It is vital to organize your thoughts logically, so they flow together nicely when writing the actual body paragraphs. Start each paragraph with an introductory sentence that introduces the perspective you will discuss in that particular paragraph.

After this, provide evidence and supporting details for your argument, which should come from the research gathered earlier. Finally, conclude each paragraph by summarizing the main points and tying them together into one solid conclusion or argument.

Asthma essay conclusion

The primary goals of an asthma essay conclusion are to summarize your main points, draw a valid conclusion based on those points, and provide a sense of closure for your reader. Start by briefly summarizing each point you made throughout your paper. Then clearly state your overall conclusion about the topic in one or two sentences.

This is where you provide a final perspective or opinion on the issue you discussed in the body of your paper. Finally, end with a thought-provoking statement or idea that will leave readers reflecting on their views on asthma and its treatments or implications.

 Reflective essay on asthma

A reflective essay on asthma is an insightful and personal exploration of the experience of living with the condition. Reflecting on how this condition has impacted your life can bring a greater understanding and acceptance.

When writing a reflective essay on asthma, consider your personal experience with the condition, including symptoms they may have experienced in times of exacerbation and any treatments they may have pursued to alleviate those symptoms. You should also reflect upon how this condition has affected them physically and mentally, highlighting both positive and negative aspects.

Tips on how to write a Reflective essay on asthma

Writing a nursing essay on asthma can be an eye-opening experience for many. It allows the writer to reflect on their experiences with asthma and how it has impacted their life and will enable them to share that experience with others. Here are some tips on how to write a reflective essay about asthma:

• It is crucial to understand what an asthma attack feels like and its effects to communicate the experience in writing effectively
• Consider what aspects of your experience with asthma you would like to focus on. Are there specific events that stand out as particularly pivotal? Do you want to discuss the impact of living with this condition? Or perhaps explore how your lifestyle has changed since having asthma?
• Think deeply about any emotions associated with this topic
• Writing down what you feel physically and emotionally during an attack can help develop a more personal account of their experience
• Try to keep a journal throughout the writing process in which you record any thoughts or observations related to asthma that come into your head
• Consider researching treatments or therapies that have worked for others who have had asthma. This will give them a better understanding of how they can manage their symptoms while also giving readers insight into the treatment options available

Asthma essay topic ideas

• The impact of asthma on one’s lifestyle and day-to-day activities
• Various treatments available for controlling asthma symptoms
• The different types of asthma and their symptoms
• The psychological effects of living with asthma
• Air pollution as a factor in causing or worsening existing cases of asthma in specific populations
• Advances in technology and new devices available to help asthmatics manage their conditions
• The current state of knowledge about asthma research, emerging treatments, technologies, and management strategies
• The impact of better diagnosis methods and medications
• The impact of poverty on access to medical care
• How society views those who suffer from this illness

Bottom line

Asthma is a severe respiratory condition affecting millions of people worldwide. It can be managed with lifestyle changes, medications, and other treatments. This guide has provided an overview of asthma, including helpful information on its cause, symptoms, diagnosis, and treatment options, and how best to write an asthma essay.

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Asthma Essay

Type of paper: Essay

Topic: United States , Asthma , Environment , Environmental Issues , Family , Nursing , Medicine , Children

Words: 1700

Published: 11/14/2019

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Introduction

Asthma is one of the common respiration complications which are known to affect a substantial number of people all over the world. It is a chronic inflammatory complication which is known to affect the patient’s air channels within the respiratory chambers. It is usually characterized by diverse symptoms which may be persistence or recurring in nature. According to scientific and other medical researches which have been carried out in a number of developed countries, they have shown that asthma is not linked to any parasitic element emanating from the external environment (WHO. 2008). However, it is a general complication which develops as a consequence of tissue or cell inflammatory responses. Two main factors are known to cause or induce the occurrence of asthma to any individual. They include the environment under which a person has been operating together with the genetic links to parents or family members who had a history of asthma. Consequently, since these causative factors have been in existence since time immemorial, asthma has lived with man for a long period of time. In the ancient Egypt, history of asthma has been identified but proper documentation of asthma was done by Greek philosophers who identified the most prone group to be affected by this condition as tailors and those who worked in metal work industries (Wollan, Bertram & Yawn, 2008, p 67).

Types of asthma

Various types of asthma have been identified and clustered according to the level of their severity, complexity and diversity of symptoms linked to this complication. According to medical reports and practices, the classification of asthma is based on the frequency at which symptoms manifest themselves in any given patient. Another form or platform through which classification of Asthma is based is the client’s forced respiratory volume a process which is usually clinically carried out. This forced respiratory volume is based on a specified period of one second a process which is used to generate or develop the peak expiratory flow rate for that individual patient. Consequently, Asthma can be grouped as either atopic also known as extrinsic or as a non-atopic also termed as intrinsic form of asthma. Such classifications are based on whether the given form or class of asthma under question is based on allergen induction or not. Despite asthma being a chronic obstructive health state, medical researchers have not classified it as a subject of chronic obstructive pulmonary ailment since by subjecting asthma under this group; it literally combines asthma under other irreversible respiratory complications such as bronchiectasis, emphysema and chronic bronchitis among others of which their occurrence in any individual is a permanent irreversible process (Tippets, 2009, p 5).

Nevertheless, some researchers have been opting to include asthma under this group since a prolonged negligence of not attending to asthma condition can result to a subsequent development of a permanent irreversible obstruction of the air channels in a human being. The common types of asthma which have been witnessed in a substantial number of patients in the United States of America include the Brittle asthma which comprised two clusters of asthma. These two forms of asthma are based on vividly manifested severe attacks which recur at a given rate. Brittle asthma type 1 manifests a wide peak in the flow variability despite the administration of considerably sufficient medication. Type 2 of brittle asthma has less of these manifested symptoms hence it is much easily controlled and managed than type 1 of brittle asthma.

Causes of asthma

Asthma is known to be caused by various causative factors which mainly emanate from the environment under which a particular person is living. Apart from environment causative elements, asthma has also been linked to genetic elements or lineage of a person. According to statistical researches which have been carried out in the United States of America, they have shown that approximately sixty percent of asthma complications are caused by environmental factors (Fanta, 2009, p 1007). The remaining forty percent is linked to genetic factors which are linked to family lineages of a person. In addition, studies which have been carried out over asthma related diseases such as eczema and hay fever have vividly and comprehensively revealed some of the crucial risk factors which might induce the occurrence level of asthma in an individual.

All the same, some of the key risk factors for being attacked by asthma include the issue of atopic diseases in one’s life time or even related family members. Atopic diseases are known to substantially boost the occurrence levels of hay fevers by approximately five times as well as the occurrence of asthma by approximately four times. This is based on scientific research studies which have been carried out in the United States of America. These studies have also shown that in children who are out of their tender age and get diagnosed to have a allergies through positive skin tests as well as having an increased levels of immunoglobulin E are more likely to develop asthma complications (Yawn, 2008, p 150). a) Environmental factors: Risk factors emanating from the environment have been Identified and linked to the development of asthma especially in children. One of the risk factors is maternal tobacco smoking which usually occur before the delivery of a child. According a number of conducted surveys, they have shown that this habit increase the development of asthma like symptoms to the born infant. These symptoms include wheezing, unregulated bronchial contraction as well as respiratory infections. Other environmental factors which might expose someone to the development of asthma included traffic pollutions, poor ventilation and increased air pollutants to mention but a few.

b) Genetic factors: asthma has been linked to some chromosomal elements which can be transferred to offspring with a subsequent development of asthma in the children of the affected parents (Schiffman, 2009, p 4).

Signs and symptoms of Asthma

The common signs and symptoms which vividly manifest themselves in an asthma patient include wheezing, chest tightness, shortness of breath and coughing. Apart from these main and common symptoms of asthma, the patient may manifest state of confusion, state of depression and other physical changes which are usually associated with low oxygenated blood in the body. Extreme cases of asthma manifest themselves through rapid and painful contraction of bronchial units in the lungs (Fanta, 2009, p 1014).Due to these rapid painful contractions, the affected person may fall on the ground or seek for support due to poor functioning of the skeletal muscles in the body. The asthma mental effect is associated with burled vision, state of confusion and even loss awareness due to poor oxygenated blood in the brain.

Transmission of asthma

Asthma is a health complication associated with the breathing system of a person. Nevertheless, its transmission from one person to another can only take place through genetic links or chromosomes. A person who emanate from a family lineage which is known to have a persistence history of asthma cases is more likely to develop asthma and asthma related complications (De Lara & Noble, 2007, p 150). This is due to genetic linkage of some chromosomal genes to asthma complications. Consequently, such genes are transferred to offspring who may or may not develop asthma complications.

Prevention and treatment for Asthma

Asthma cases can be treated through administration of drugs such as salbutamol and fluticasone propionate through inhalation. These drugs are known to open the contracted brochial muscles as well as making the lung muscles to relax. Subsequently, the pain associated with asthma is substantially reduced to recommendable levels (Dipiro, 2008, p 525). According to medical practitioners from the US, recent medications which are used in treatment of asthma are clustered in two main groups; quick-relief and long-term control measures. For quick-relief, beta2-adrenoceptor agonists (SABA) the like of salbutamol are used in its treatment while for long term control, glucocorticoids have been highly recommended as the best form of its treatment. Asthma can be prevented through control of external environmental factors such as air pollutants which might induce asthma (Boulet 2009, p 890).

Some of these conditions associated with asthma can be treated through specific therapeutic techniques as well as control and preventive programs. Someone suffering from asthma can be treated through administration of suitable drugs such as salbutamol or fluticasone propionate basing on the extent and type of asthma in question. Asthma is a chronic inflammatory complication which is known to affect the patient’s air channels within the respiratory chambers. Asthma is usually characterized by diverse symptoms which may be persistence or recurring in nature. According to scientific and other medical researches which have been carried out in a number of developed countries, they have shown that asthma is not linked to any parasitic element emanating from the external environment.

Bibliography

Boulet L.P 2009. "Influence of Comorbid conditions on asthma". Eur Respir Journal 33 (4): 897–906.

Dipiro J.T. et al.2008. Pharmacotherpay. A pathophysiologic approach (7 ed.). pp. 524.

De Lara, C, Noble .A (2007). "Dishing the dirt on asthma: What we can learn from poor hygiene". Biologics 1 (2): 139–150.

Fanta, CH .2009. "Asthma". New England Journal of Medicine 360 (10): 1002–14. doi:10.1056/NEJMra0804579. PMID 19264689.

Schiffman, G. 2009. "Chronic Obstructive Pulmonary Disease". MedicineNet.retrived on 17/5/2011 from http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm.

Tippets B, G. 2009. "Managing Asthma in Children: Part 1: Making the Diagnosis, Assessing Severity". Consultant for Pediatricians 8 (5).

WHO. 2008. Asthma. Who.int. 2008-06-03. Retrieved on 16/5/2011 from http://www.who.int/mediacentre/factsheets/fs307/en/.

WHO. 2007. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Retrieved on 16/5/2011 from http://www.who.int/gard/publications/GARD_Manual/en/index.html.

Wollan, P., Bertram, S., and Yawn, B.P. (2008). Introduction of Asthma APGAR tools improve asthma management in primary care practices. Journal of asthma and allergy .Rochester: Dove Medical Press Ltd.

Yawn, BP 2008. "Factors accounting for asthma variability: achieving optimal symptom control for individual patients". Primary Care Respiratory Journal 17 (3): 138–147.

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• Asthma , Medicine , Respiratory System

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Asthma, a chronic disease process, affects approximately 18 million people in the United States. While asthma can be reversible, failure to control symptoms and provide adequate and timely treatment can lead to a decrease in respiratory function, which ultimately increases the risk of death (Durham, Fowler, Smith, & Sterrett, 2017). Accurate and timely nursing care can help patients manage their symptoms and increase their quality of life while decreasing hospitalizations and related costs (Keep, Reiffer, & Bahl, 2016).

• 1 Disease Condition
• 2 Pathophysiology and Etiology
• 3 Risk Factors
• 4 Signs and Symptoms
• 5 Disease Diagnosis
• 6 Laboratory Tests
• 7 Radiologic Studies
• 8 Diagnostic Studies
• 9 Treatment
• 10 Preventative Treatment and Education
• 11 Medical Management of Acute and Chronic Phases
• 12 Nursing Care Plan
• 13 Ineffective Airway Clearance
• 14 Impaired Gas Exchange
• 15 Readiness for Enhanced Health Management

Disease Condition

Pathophysiology and etiology.

Asthma is a disorder that affects the bronchioles in the lungs. When triggered by either allergic or nonallergic stimuli, an immune reaction occurs (Alhassan, et al., 2016). When an asthma exacerbation occurs, mast cells release histamine, leukotrienes, interleukins, and prostaglandins, which cause mucus to be produced and spasms in the smooth muscles within the bronchiole walls. This action decreases the size of the bronchioles and, in turn, decreases inspiratory and expiratory air flow (Keep, et al., 2016). While airway obstruction is potentially reversible, failure to avoid asthmatic flares can lead to a decrease in overall respiratory function, increase the risk of death, and can cause chronic airway remodeling with only partially reversible airflow obstruction (Durham, et al., 2017).

Risk Factors

Risk factors that can trigger an asthmatic response can both modifiable and nonmodifiable. Obesity, particularly childhood obesity, is a modifiable risk factor for adult asthma. Both a child’s sedentary lifestyle and decreased physical activity lead to central obesity, which increases the risk for asthma. Weight reduction is encouraged due to positive effect on lung function. Another modifiable factor is occupational exposure. This can include jobs that involve animals, plants, or insects or irritants such as gases, fumes, or dust (Alhassan, et al., 2016.) additional modifiable factors include exercise, stress, smoke, medications and pets. There are also nonmodifiable factors that can trigger asthma. These can include a family history of atopic dermatitis, allergies, and asthma, which all can lead to an increased risk of developing asthma, especially if the family history includes a first-degree relative with a history of asthma. Additional nonmodifiable triggers include a gastroesophageal reflux disease, nasal polyps, rhinitis, and sinusitis (Durham, et al., 2017).

Signs and Symptoms

Asthmatic signs and symptoms vary between individuals. The general signs and symptoms include recurrent shortness of breath, wheezing, coughing, and chest tightness. These symptoms can respond to a bronchodilator (Alhassan, et al., 2016). The most frequent finding is expiratory wheezing. Physical findings can include hyper expansion of the chest, use of accessory muscles, prolonged expirations, and retractions (Durham, et al., 2017). These signs are due to the excessive mucus production and the spasm of the smooth muscle of the bronchioles, which reduce the diameter of the airway (Keep, et al., 2016).

Disease Diagnosis

Diagnosis is based on the symptoms and categorized into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent (Henry, 2016). To determine the category, a thorough personal and family history as well as a physical examination, laboratory, and diagnostic testing can be performed (Durham, et al., 2017).

Laboratory Tests

Laboratory testing can be performed related to a potential diagnosis of asthma. Such laboratory studies can include arterial blood gases (ABGs) to determine the presence of hypoxemia, hypocarbia (can occur in the early phase of an asthma attack), and hypercarbia (can occur in the later phase of an asthma attack). This study is used to evaluate respiratory function and acid-base balance, which would be altered if the exchange of oxygen and carbon dioxide are impaired secondary to excess mucus or constriction in the bronchioles (Van Leeuwen & Bladh, 2015, pp. 293-307). In addition, sputum cultures can be performed to rule out bacterial causes for the symptoms (Henry, 2016).

Radiologic Studies

In addition to laboratory studies, a chest x-ray can also be performed, although not routinely performed in the diagnosis of asthma (Durham, et al., 2017) . A chest x-ray may show hyperinflation or changes in chest structure over the long term (Henry, 2016).

Diagnostic Studies

There are various diagnostic testing that can be performed to assist in diagnosing asthma. These are referred to as pulmonary function studies and they can evalute types of lung disease and assess effectiveness of treatments and medications (Van Leeuwen & Bladh, 2015, pp. 1328-1334). One test is called spirometry. This test is the best diagnostic tool available to objectively assess obstruction of air flow and to evalute the bronchial response to treatment. Spirometry is strongly recommended to confirm an asthma diagnosis. Testing can be performed in the physician’s office or an outpatient pulmonary function laboratory. There are two measurements that are needed: forced vital capacity (FVC), which is the maximum amount of air exhaled after a deep breath, and the forced expiratory volume in one second (FEV1), which is the amount of air expelled during the first second of expiration after FVC. FEV1 is the most standardized measurement to evalute for airflow limitation. Spirometry also assesses for reversibility of asthma. Spirometry is performed pre- and post-bronchodilator use to measure the amount of improvement after bronchodilator use, thereby proving reversibility of asthma. (Alhassan, et al., 2016). In asthmatics, the FEV1 is 15 to 20% lower than the expected values (Henry, 2016). To qualify as reversible, at least 12% improvement and 200 mL in FVC and/or FEV1 after use of the bronchodilator or four weeks anti-inflammatory treatment (Alhassan, et al., 2016).

Peak expiratory flow (PEF) can be measured during spirometry and can be helpful in monitoring asthma, although not nearly as reliable as spirometry. PEF is the greatest flow of air during forced exhalation. This can be measured easily with a small device the patient can keep with them. PEF monitoring can be a useful tool in assessing the patient’s response to therapy (Alhassan, et al., 2016). Bronchial provocation, also known as bronchial challenge testing, is another useful tool, especially in patients with suspected asthma but a normal spirometry result. This test can determine airway hyperresponsiveness (AHR) by measuring the amount of airway constriction that occurs when exposed to a trigger (Alhassan, et al., 2016). However, while a positive result can be indicative of asthma, it may also indicate other diagnoses such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or allergic rhinitis. If the test is negative, it can rule out the diagnosis of asthma (Durham, et al., 2017) .

Other challenge tests include methacholine challenge testing (MCT). This specific test is the most common provocative test to evaluate for hyperresponsiveness. MCT can only be performed in a laboratory setting using nebulized methacholine. As MCT has a high sensitivity for asthma but it can also show false positive results in the presence of COPD, cystic fibrosis, or allergic rhinitis (Alhassan, et al., 2016).

Allergy testing, while not diagnostic of asthma, can identify sensitivities to triggers that may cause an asthma attack (Durham, et al., 2017) .

Preventative Treatment and Education

Preventative treatment and education are a critical first step in management of asthma. Patients should be made aware of ways to avoid known triggers, such as smoking cessation (both the patient and the family), avoiding pets, limiting carpeting in the home, and the use hypoallergenic pillows (Durham, et al., 2017). Avoiding and Controlling Your Asthma Triggers, a form created by the American Lung Association, can help patients identify triggers and offers advice to avoid or reduce triggers and covers topics such as smoking, pets, pollen, strong odors, dust, and even strong emotions, all of which can trigger an attack. Journaling is also a useful tool to teach asthma patients and one they can also share with their physicians to track day-to-day triggers and symptoms (Keep, et al., 2016).

Motivational interviewing (MI) has been found to be effective in patients to self-manage their asthma. This teaching method is a client-centered therapeutic method to explore and resolve resistance to change. MI encourages patients to identify positive and negative results related to changing or not changing their behaviors. Identification of barriers and solutions enables patients to become independent in their management care and has been found to significantly improve medication compliance and make healthy lifestyle changes (Keep, et al., 2016).

In addition to patients knowing their triggers and how to avoid them, an Asthma Action Plan should be completed for every asthma patient and even comes as a small card that can be kept in a wallet. This plan has green, yellow, and red zones that correlate to the patient’s current symptoms. The green zone indicates a patient has well-controlled asthma symptoms without coughing or wheezing and can complete all normal activities. The goal is to stay in the green zone at all times, indicating good control over asthma. The yellow zone indicates difficulty carrying out normal activities due to coughing, wheezing, shortness of breath, or chest tightness. In the yellow zone, medication changes may be necessary, such has using a rescue medication. The yellow zone provides instructions on administering the rescue medication and next steps to take if the rescue medication is not effective. If medication changes in the yellow zone are not effective, it becomes the red zone, which is a medical emergency. Instructions are provided in this action plan regarding medication, contacting the physician, and calling 9-1-1 for emergency services. Additionally, if a peak flow meter is being used by the patient, the physician can set guidelines for the peak flow in each zone to further delineate control or action needed (Keep, et al., 2016).

Medical Management of Acute and Chronic Phases

While prevention methods, such as avoiding the triggers of asthma, are helpful in managing asthma, however, medications may also be necessary. Asthma medications include two categories short-term symptom relief with rescue medications and long-term symptom relief with controllers. Often, a combination of the two are necessary for good control (Durham, et al., 2017) .

Short-term symptom relievers are used for acute asthma symptoms. These include short-acting beta2 agonists (SABA), such as albuterol, and short-acting muscarinic antagonists (SAMA) ipratropium. These medications are bronchodilators, which reduce bronchoconstriction and allow for improved air flow. They have an onset of five minutes, peak in 30 to 60 minutes, and last for four to six hours (Alhassan, et al., 2016). While they quickly act to reduce asthmatic symptoms and have minimal symptoms, adverse side effects such has tachycardia, dysrhythmia, or tremors can occur. SAMA medications can be used in addition to SABA medications or as a replacement when SABA medications are not well-tolerated. In addition to SABA and SAMA use, systemic corticosteroid bursts can also be added to SABAs and SAMAs for short term relief depending on the severity of symptom exacerbation (Durham, et al., 2017) .

Long-term symptom relief can be obtained through long-acting beta2 agonists (LABA) medications meant to control inflammation related to chronic asthma and help prevent an asthma attack. LABA medications promote a decrease in symptoms, decreased risk of exacerbations, decreased asthma-related hospitalizations, improved lung function, improved quality of life, and lower risk of asthma-related deaths (Durham, et al., 2017). LABA medications typically last more than 12 hours and include medications such has salmeterol, formoterol, and vilanterol. These medications have similar side effects as SABA medications. Although LABAs are strong bronchodilators, they must not be used as a single therapy. It is recommended that LABAs be used with inhaled corticosteroids (ICS) to decrease the risk of severe exacerbations and death (Durham, et al., 2017).

In addition to SABA and LABA medications, leukotriene receptor antagonists (LTRAs) such has montelukast and zafirlukast can be used to treat chronic, long-term asthma. These medications have a steroid-sparing effect and also work well preventing exercise-induced bronchospasms (Durham, et al., 2017). Lastly, long-acting muscarinic receptor antagonists (LAMAs) and tiotropium can be added to medication therapy when asthma is still uncontrolled even with the use of two or more controller medications.

Nursing Care Plan

Developing a plan of care is of great importance to successfully control asthma and prevent exacerbations. Three important issues that need to be addressed are ineffective airway clearance, impaired gas exchange, and readiness for enhanced health management.

Ineffective Airway Clearance

Impaired gas exchange.

A patient in an acute phase of asthma would also suffer from impaired gas exchange. It would be important to monitor respiratory rate, depth, and ease of same. Assess for nasal flaring or use of accessory muscles to monitor for signs of respiratory distress. Auscultate lungs everyone to two hours to monitor for crackles and wheezes and assess for diminished lung sounds or air trapping. Monitor for changes in mental status, confusion, restlessness, or lethargy, as these can be signs of impaired gas exchange. Oxygen saturation should be closely monitored along with possible blood gases to assess the need for supplementation oxygen. Observation of the skin, especially around the mouth, tongue, and oral mucosa, for cyanosis. A bluish coloration can signal underventilated or unventilated alveoli. Position the patient at a 30 to 45 degree angle in bed to promote lung expansion. Administer medications as ordered and assess for efficacy post-administration in a timely manner associated with the onset, peak, and duration of the medication (Ackley, et al., 2017, pp. 404-407).

Readiness for Enhanced Health Management

A patient in a chronic phase of asthma should have readiness or enhanced health management. Promotion of knowledge regarding asthma is critical at this point. Review factors/triggers that need to be avoided and way to do so. This will provide the patient and family with ways to potentially avoid asthma attacks. Discuss and review appropriate medications using teach-back method to ensure the patient has understood the medication information relayed to them. Provide written materials to reinforce teaching so the patient will have something to refer to at home. Ensure an Asthma Action Plan is completed and updated regularly. Remind the patient to refer to the Plan to guide their therapy and warn them when emergency help may be needed (Ackley, et al., 2017, pp. 451-454).

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104 Asthma Research Topics & Essay Examples

📝 asthma research papers examples, 🏆 best asthma essay titles, 🎓 simple research topics about asthma, ❓ asthma research questions.

• Childhood Asthma Management and Patient Education The issue of childhood asthma remains a major concern for the community. It is critical to deploy the program aimed at educating patients and their family members.
• Asthma and Hypertension Pathogenesis Asthma and arterial hypertension have important pathological features in common, including inflammation, smooth muscle contraction, and remodelling.
• Respiratory System Assessment in Children An 8-year-old child presents for continuous wheezing during the last year. This paper provides differential diagnoses, treatment options, and an education plan for the patient.
• Asthma Education for Children: Clinical Research Question The identification of a threat to a patient’s health and the location of possible hazards should be deemed as necessary abilities.
• Respiratory Diseases After Motor Vehicle Accident To prove pleural effusion as the main cause of respiratory problems, the patient should take a CT scan or ultrasound. The doctor may ask to repeat the blood test.
• African American Pediatric Patients with Asthma The lack of proper asthma control in African countries is a significant incentive to carry out the necessary research with the implementation of an action plan.
• Asthma: Pediatric Treatment Recommendations Diagnosing children, it is crucial to consider their age as this factor impacts the majority of processes that happen in their bodies.
• Pediatric Asthma Readmission: Nursing Program The hospitals involved in the project will report the asthma-related readmissions of the patients to evaluate the rate of readmission as the primary outcome of the study.
• The Effect of Asthma Education Program Asthma is the disease that should be constantly monitored, and complications are to be avoided to obviate the threat of life.
• Asthma in African American Children This paper discusses asthma and suggests that proper education and management measures could improve this condition’s symptoms in African American children’s lives.
• Asthma Management Education in African American Children Asthma management is crucial for patients on the whole and children in particular. Specific attention should be paid to African American children who are at a higher risk of having asthma.
• Teaching Sessions for Children With Asthma: Research Critique and PICOT Statement The problem of child asthma management and the provided strategy for managing it with teaching sessions are interrelated, with recent studies supporting the idea of patient education.
• Asthma Medications for a Patient-Runner The purpose of this post is to discuss the medications appropriate to address symptoms of asthma in a patient, a 21-year-old male who is interested in running.
• Epidemiology of Asthma This paper aims to describe an implementation plan and project for asthma management intervention designed for children.
• Behavioral Interventions to Improve Asthma Outcomes for Adolescents The chosen article addresses a clearly focused issue, namely, health outcomes in young asthma patients after behavioral interventions.
• The Effects of Asthma on Children Most children struggle with asthma, especially in cases where the condition exacerbates due to failure to adhere to treatment regimens.
• Teaching Sessions for African American Children: Addressing the Asthma Issue While the target population of African-American children has high risks of getting asthma, patient education as a tool has not been explored in regards to this group.
• Asthma in Evidence-Based Practice In patients with asthma, the disease causes the inflammation of air passages followed by the significant narrowing of airways.
• Discharge Plan and Readmission in Asthmatic Children The PICOT question is: In asthmatic children, does the development of a discharge plan decrease the readmission rate by 10% within three months?
• Various Respiratory Problems and Their Medication The paper devotes itself to respiratory problems, their varieties, causes, common patient complaints, and their medication.
• Medication Compliance in Pediatric Asthmatic Patients Digital programs that help control taking anti-asthma drugs simplify medication compliance control and allow children to understand the importance of a strikt treatment model.
• Improving Asthma Control in Children Using Teach-to-Goal Method Asthma in patients under 18 is a significant health issue. Therefore, improving disease control among children is a health outcome of high priority.
• IgE Mediated Allergic Rhinitis and Asthma IgE is involved in allergic responses caused by chronic exposure of the airways to allergens. IgE-mediated immune responses lead to early allergic reactions.
• Asthma Discharge Plan: Mini Case Study In this case, develops a complete discharge plan for the patient with asthma that included all the specified components and focused on patient education.
• Asthma: A Case Study of the Patient This paper reviews asthma through a case study of patient Y, a seventeen-year-old, pathophysiology and clinical manifestations, patient management, and interventions.
• The Differential Diagnosis Case Mr. Michael Smith is a 71-year-old Caucasian male, who came to the hospital complaining of trouble when breathing, short breath, and recurrent wheezing.
• Reactive Airway Disease Overview Reactive Airway Disease is similar to asthma but is caused by different agents. The only way to differentiate the conditions is by finding out their causes.
• The Effectiveness of Inhaled ß2 Agonists This research proposal aims to evaluate the effectiveness of Inhaled ß2 agonists in the management of asthma in children.
• Asthma: Corticosteroids Use in Children and Side Effects This research focuses on systemic side effects of corticosteroids since these can be the most drastic and significantly impact the patients' ultimate quality of life.
• Blood and Salivary Amphiregulin Levels as Biomarkers for Asthma
• The Genetic and Environmental Components of Asthma
• Asthma and How Medication Allows for Increased Performance
• Relationships Between Asthma and Air Pollution
• Macrophage Phagocytosis and Allergen Avoidance in Children With Asthma
• Risk Factors for Childhood Asthma Development
• Assessment Data-based Decision Making The Individuals with Disabilities Education Improvement of 2004 and No Child Left Behind of 2001 have been added to the US Federal Laws to provide ample support to schoolchildren.
• Aerobic Exercise Reduces Asthma Phenotype by Modulation of the Leukotriene Pathway
• Asthma Control During the Year After Bronchial Thermoplasty
• Asthma Etiology Diagnosis and Treatment
• Lung Function and the Effects of Asthma
• Allergic Asthma Biomarkers Using Systems Approaches
• Urban Children and Asthma Care Barriers
• Patient and the Family Education in Self-Care Management The question is about evaluating if education is important in enhancing knowledge to help improve the health of asthmatics.
• Acupuncture for Asthma Fact or Fiction
• Asthma and Current Treatment Available in Australia
• Obesity and Asthma and Other Health Hazards
• Treating Pediatric Asthma According Guidelines
• Factors Into the Development of Asthma
• Asthma: Definition, Etymology, Symptoms, and Treatment
• First Aid Education in Saudi Arabia Schools In Saudi Arabia, much attention is paid to the development of health education and first-aid care. The increase in activities was initially observed during the 1990s.
• Asthma Control and Treatment in Racial and Ethnic Minorities Research Paper
• Respiratory Disorders: Asthma, Bronchitis, Emphysema, Cystic Fibrosis
• Asthma and Its Effects on Those Residing in Boston as well as the Overall State of Massachusetts
• Childhood Asthma and African American Children
• Asthma Attack Treatment Thanks to Hypnosis
• Health Variations for Acute Severe Asthma
• Saudi Arabia Schools: Perspectives on Adding First Aid Education as a Mandatory Class In this paper, the background for the development of first-aid curriculum guidelines will be offered through a thorough evaluation of first-aid knowledge and skills.
• Asthma, Food Allergy, and How They Relate to Each Other
• The Characteristics and Treatment of Asthma, a Respiratory Disease
• Albuterol vs. Levalbuterol: The Preferred Treatment for Asthma
• Molecular Targets for Biological Therapies of Severe Asthma
• Asthma and Allergic Rhinitis Co-Morbidity Factors Involved Biology Essay
• Respiratory Therapy Case Study Asthma
• Pediatric Asthma and Interventions of Public Health Peer Education
• Early Lung Function and Future Asthma
• Clinical Research: Budget Development The development of budget for a clinical research can be regarded as a set of activities that include search for the information about partners and estimation of HR needs.
• Children Face Asthma Risk if Mothers Exposed to Pollutants
• The Diagnosis and Treatment of Otitis Media and Asthma
• Link Between Air Quality and Asthma Severity
• The Most Effective Treatment for an Asthma Exacerbation
• Cellular and Humoral Immunity of Virus-induced Asthma
• Rhinovirus Inducing Wheezing and Asthma Exacerbation
• Buteyko Breathing for Bronchial Asthma
• Asthma: Differential Diagnosis and Comorbidities
• What Are the Latest Asthma Research?
• What Is the Relationship Between Asthma and the il23 r381q Receptor?
• Why Are Children With Married Parents Healthier? The Case of Pediatric Asthma
• How To Cope With COPD and Asthma in Adults?
• Asthma and Food Allergy in Children: Is There a Connection or Interaction?
• What Are the Main Causes of Asthma?
• What Are the Most Common Asthma Triggers?
• What Are the Different Triggers for Asthma?
• Helping Your Kids Cope With Asthma?
• Why Does Asthma Top the List of Childhood Diseases?
• What Happens to the Respiratory System in Asthma?
• What Are the Goals for Childhood Asthma Prevention?
• What Causes Asthma and How Can You Manage It?
• What Is the Correlation Between Asthma and Anxiety?
• How Asthma Affects the Airway and Lungs?
• What Can Parasites Tell Us About the Pathogenesis and Treatment of Asthma and Allergic Diseases?
• What Are the Effects of a Mediterranean Diet on Allergies and Asthma in Children?
• What Are the Asthma Nurse Interventions?
• What Are the Main Limitations That People With Chronic Asthma Suffer From?
• How Asthma Affects Your Body?
• What Are Some Natural Asthma Remedies?
• How Is Asthma Management Different in Older Patients?
• How Can Acid Reflux Worsen Your Asthma?
• What Are Asthma Symptoms?
• What Are the Triggers of Asthma and How To Control Them?
• Clinical Hypnotherapy for Asthma?
• What Are the Most Common Types of Asthma?
• What Should You Know About Exercise-Induced Asthma?
• What Is the Relationship Between Cystic Fibrosis and Asthma?
• Understanding Asthma: What Patients Need To Know About Asthma?

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State plan to make polluters pay must be fair

LIPA's E.F. Barrett Power Plant in Island Park. The region is home to more than 30 power plants and garbage-burning facilities between Island Park and Montauk. Credit: Allislandaerial.com/Kevin P. Coughlin

As the Department of Environmental Conservation and New York State Energy Research and Development Authority develop the state’s pollution-pricing program due by year's end, some Long Island communities are overburdened with air pollution from fossil fuels, which causes chronic illnesses like asthma and cancer. But we have yet to hold the biggest culprits accountable. From Island Park to Montauk, the region is home to more than 30 power plants and garbage-burning facilities. For too long, these polluters have operated without accountability for the damage they’ve caused our planet and our people. But now we have the chance to change that.

As a part of our state’s ambitious climate change law, New York is developing a “cap-trade-and-invest” program — a set of policies that limit pollution emissions. The new policy would create permits that businesses could purchase that would allow them a predetermined amount of emissions. As this proposal is being finalized, it is vital that Gov. Kathy Hochul's administration build an equitable system that serves all communities on Long Island.

Done right, an emissions cap program would make corporate polluters pay for their toxic legacy, raising billions of dollars to create good, green union jobs to develop renewable energy infrastructure; direct money to Black, brown, indigenous, and working-class communities through direct grants or investments in pollution reduction in those communities; and lower energy costs for all. Reducing emissions would lower rates of asthma, heart disease and stroke, and increase New Yorkers’ life expectancy. This means longer, healthier lives and lower prescription drug costs and medical bills. 

Done wrong, New York’s cap program could repeat mistakes made by other states — like California, where emissions have been either concentrated in or lowered much more slowly in Black, brown, and working-class communities than in wealthy, white ones. A University of Southern California study found that during the first three years of the program, in-state greenhouse gas emissions actually increased — and pollutant levels rose most in disadvantaged communities and neighborhoods with higher concentrations of people of color.

This could have dire consequences for areas like Brentwood, Central Islip and North Bellport which, like California's San Joaquin Valley or the Los Angeles metro region, have higher concentrations of state-defined disadvantaged communities, low-income residents and people of color. Brentwood is home to multiple power plants, while both Central Islip and North Bellport are near large landfills. Under a flawed cap program, these areas could see pollution increase as in   California.

A cap program must be implemented justly. It must have a strict emissions cap with aggressive penalties for companies that exceed levels. It must avoid loopholes that companies can exploit or systems that let corporations trade their greenhouse gas and co-pollution emissions permits. The program must not exempt some of the worst corporate actors from paying for their emissions or give them a free pass to dump toxic pollution in disadvantaged neighborhoods. And the program's proceeds must be used to reduce energy costs for low-and -moderate-income households.

While Long Island is on the front line of impacts, we’re also on the front line of solutions, with planned offshore wind farms and accompanying job training facilities, high rates of residential solar adoption alongside utility-scale solar farms, and ongoing investment in energy efficiency, ground-source heat pumps, and electrical vehicle charging stations. An equitably designed cap-and-invest program could boost these efforts, hold polluters accountable, invest in our communities, and create a better future for our Island. Let’s get it right.

This guest essay reflects the views of Phil Ramos, deputy speaker of the state Assembly, and Ryan Madden, sustainability organizer for the Long Island Progressive Coalition.

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For Biden, Who Neither Fought in Vietnam Nor Protested War, Trip Offered Opportunity

While others of his generation were scarred by the conflict, President Biden forged a strategic partnership on his first visit to the country, framing it in pragmatic terms.

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By Peter Baker

Reporting from Hanoi, Vietnam, where he is traveling with the president.

As he wrapped up a two-day trip to Hanoi , his first visit to Vietnam, President Biden on Monday made a point of stopping by a memorial to his old friend, Senator John McCain, the famed prisoner of war who was later instrumental in forging reconciliation with a onetime enemy.

Mr. Biden brought John Kerry, another combat veteran turned senator who ultimately joined Mr. McCain to normalize relations between Washington and Hanoi in 1995. For Mr. McCain and Mr. Kerry, the bloody battles of Vietnam changed their lives, leaving scar tissue so indelible that it shaped their thinking and careers for decades.

Mr. Biden’s relationship to Vietnam and the war, however, was drastically different. While a contemporary of his two veteran friends, Mr. Biden never served in uniform, yet neither did he protest the war along with others of his age. He was too busy, he has said, getting an education, starting a family and entering politics. While he opposed the war, it did not define him, and he brought little baggage when he landed in Hanoi on a diplomatic mission this week.

For Mr. Biden, then, agreeing to a new strategic relationship with Vietnam during his trip was more about countering China than about exorcising ghosts of the past. It was a pragmatic geopolitical calculation: Vietnam wants more distance from Beijing, and the United States wants more friends in the region.

The fact that a large bust of Ho Chi Minh looked on as he sealed the deal with Vietnam’s Communist leader, Nguyen Phu Trong, went unremarked on. So did the many tons of American bombs that once fell on this colonial city. For that matter, the repression of the current government barely rated a couple of boilerplate sentences from the president.

But Mr. Biden paused for a moment of reflection during a meeting with corporate executives on Monday. “I looked out the window of my hotel today and I thought to myself, you know, I was a young man in college and all of my friends and I were assuming we were coming to Vietnam — not to visit,” he said. “Look what’s changed.”

The two sides highlighted that change with an exchange of items symbolizing how they have moved on. Two American veterans returned a diary recovered on the battlefield in 1967 to the Vietnamese soldier who wrote it. Vietnamese officials presented Secretary of State Antony J. Blinken with identification cards of U.S. troops still missing in action.

To the extent that the Vietnam War influences Mr. Biden today, it is a cautionary tale of misguided use of force overseas — one that most recently informed his decision to pull American forces out of Afghanistan after 20 years. As it happened, the chaotic withdrawal from Kabul in 2021 reminded many of the searing image of an American helicopter taking off from the roof of a Saigon building in 1975, the symbol of an ignominious ending to a disastrous war.

“I think he learned to dig in hard to find out what’s really going on and what the facts are and don’t necessarily take conventional wisdom, but be suspicious,” Mr. Kerry, a Democrat who represented Massachusetts and now serves as Mr. Biden’s climate envoy, said in an interview. “He’s made comments to me about feeling the responsibility to make sure that as president you don’t get yourself into an unwanted war.”

Former Senator Chuck Hagel, a Republican from Nebraska and another Vietnam veteran who served with Mr. Biden in Congress, said in a separate interview from the United States that the future president often contemplated the enduring meaning of that war.

“Biden and I spoke often about Vietnam and its consequences,” said Mr. Hagel, who also served with Mr. Biden in President Barack Obama’s administration as defense secretary. “How we disastrously drifted into a needless war that cost America over 58,000 lives and caused political chaos in the U.S.”

“Lessons learned,” he added. “I think those lessons have very much underpinned Biden’s foreign policy thinking and philosophy: Caution. Careful analysis.”

Mr. Biden is the fourth member of the Vietnam generation to be president and the fourth who did not serve in the war, but the first for whom it has not been much of a political headache. Bill Clinton, George W. Bush and Donald J. Trump were all attacked for the ways they avoided Vietnam.

Mr. Biden, four years older than each of those men, received five student deferments while at the University of Delaware and Syracuse University College of Law. As he was about to graduate in 1968, he was classified 1-Y after a medical exam, a designation meaning he was not fit for service except in a national emergency. A spokesman in 2008 attributed that classification to asthma .

In that sense, Mr. Biden’s record was not that different from that of Mr. Trump, who received four student deferments and then was also classified 1-Y in 1968 because of what he said were bone spurs in his foot. But Mr. Trump’s diagnosis came as a favor from a foot doctor in Queens who rented an office from Mr. Trump’s father, two of the doctor’s daughters told The New York Times . Mr. Trump once said that “ my personal Vietnam ” was avoiding sexually transmitted diseases while dating.

Mr. Biden received little criticism for his medical classification even though he played college football despite any asthma. That may reflect the evolution of the politics of Vietnam: Today’s electorate is far less dominated by voters with personal memories of that era who are attentive to whether candidates served or not.

While Mr. Biden never put on a uniform, he likewise did not pick up a protest sign. In the past, he has talked disdainfully of student protesters who took over a university office at Syracuse. “We looked up and said, ‘Look at these assholes,’” he recalled in “Promises to Keep,” his 2007 memoir. “That’s how far apart from the antiwar movement I was.”

He did not see the war as a question of principle. “I didn’t argue that the war in Vietnam was immoral,” he wrote. “It was merely stupid and a horrendous waste of time, money and lives based on a flawed premise.”

In 1987, when Mr. Biden was taking his first shot at the White House, he distanced himself from both sides of the war debate. “I’m not big on flak jackets and tie-dye shirts,” he told reporters . “Other people marched. I ran for office.”

On the campaign trail and in office, though, he was a voice against the war. He railed against it during a speech at the Delaware Democratic Convention in 1972 in his first race for the Senate when he was 29. “The soul of America rises in torment, and a generation of Americans believe that ‘foreign policy’ means only body counts and rubble in what were once peaceful hamlets,” he said, an early use of the soul-of-America phrase that is a regular staple of today’s speeches in a different context.

Once in the Senate, Mr. Biden voted against aid for South Vietnam, a move criticized in later years by Republicans who viewed it as a betrayal of an ally. “That was part of the deal when we pulled out of South Vietnam, to try and help them survive,” Robert M. Gates, who served as defense secretary under Mr. Obama before Mr. Hagel, said in a 2014 interview on NPR criticizing Mr. Biden’s national security judgment.

Over the years, Mr. Biden sponsored legislation to help Vietnamese refugees and supported moves led by Mr. Clinton, Mr. McCain and Mr. Kerry to establish normal relations with Vietnam .

“He always tended to defer to McCain and Kerry on Vietnam issues” possibly “because his lack of service made him politically shy to engage,” said Frank Jannuzi, a longtime Asia adviser to Mr. Biden in the Senate. “But he had pretty strong views.”

To Mr. Biden, Vietnam showed the futility of committing vast resources to a war that cannot be won. “The ‘we can’t fight harder for them than they are willing to fight for themselves’ ethos was reinforced in Biden’s mind,” said Mr. Jannuzi, citing a regular line used by Mr. Biden. “And I think you saw this decades later in his decision not to reverse Trump’s Afghan pullout plan.”

Ron Klain, the president’s first White House chief of staff, said questions of war and peace were also personal for Mr. Biden. While he did not serve in Vietnam, the president experienced the burdens of war on a family when his son Beau Biden was deployed to Iraq.

“He’s always aware that others in his generation served in that war and he didn’t,” Mr. Klain said. “And aware that the burden of service falls on a small percentage of families in this country — of which the Bidens became when Beau served in Iraq. It impacts his view about sending Americans into harm’s way and why he insists on there being a clear and compelling rationale to do it.”

Peter Baker is the chief White House correspondent and has covered the last five presidents for The Times and The Washington Post. He is the author of seven books, most recently “The Divider: Trump in the White House, 2017-2021,” with Susan Glasser. More about Peter Baker

Asthma Essay With Conclusions

Asthma is one of the major chronic respiratory conditions which alter the respiratory function of the body. The World Health Organisation or WHO (2012) defines asthma as a chronic inflammatory disease of the airways characterised by frequent episodes of breathlessness and wheezing. This difficulty in breathing is caused by the swelling and constricting of the airways. Exposure to allergens, pollutants, cold air, infection and exercise can increase the risk of asthmatics having an attack (Funnel, Koutoukidis and Lawrence 2009). This essay will discuss on the pathophysiology, diagnosis, medical management and clinical manifestations of asthma . It will also cover the client education needed to provide for those with asthma, asthma’s risk factors and its prognosis. According to the National Asthma Council of Australia or NACA (2006) more than 2.2 million Australians are suffering from asthma. This essay will therefore also describe how asthma impacts on its victims and their life style.

Kaufman (2011) describes the pathophysiology of asthma as a pathologic condition which affects the lower respiratory tract by narrowing the airways as a result of epithelial damage, excessive mucus production, oedema, bronchoconstriction and muscle damage. In asthma the cells in the epithelium layer can be destroyed and peel away, making the respiratory tract more susceptible to allergens and infections, thereby contributing to airway hyper-responsiveness (Kaufman 2011). Asthma also triggers the development of mucus cells and mucus glands. This increases mucus production, thus forming mucous plugs which can obstruct the airways (Monahan et al. 2007). Airway oedema is another change that occurs in the respiratory tract due to asthma. It involves the dilation and leaking of capillaries in the airway walls which limits airflow (Kaufman 2011). Monahan et al. (2007) add that increased capillary permeability and leakage can obstruct the airways due to swelling. They also explain that the inflammatory agents such as histamine, tryptase, leukotriences and prostaglandins act on smooth muscles of airway walls and cause bronchoconstriction which restricts the airflow to alveoli.

Brown and Edwards (2012) write that wheezing, breathlessness, chest tightness and cough are the most common clinical manifestations of asthma. They can occur especially at night and in the early morning and can vary from person to person. It is not necessary to have all the symptoms at once as different symptoms can occur at different times. According to NACA (2006) frequent cough, feeling weak, wheezing after exercise, shortness of breath and sleeping difficulties can be early signs of asthma while severe wheezing, continuous cough, rapid breathing, anxiety, chest pain, blue lips and fingernails are the symptoms of severe asthma attacks.

Diagnosing asthma can be done by obtaining a detailed history, performing physical examinations, pulmonary function testing, and laboratory assessments (Ignatavicius and Workman 2010) According to Ignatavicius and Workman (2010) it is important to ask patients about any experiences of having shortness of breath, cough, chest tightness, wheeze and increased mucus production as well as about their smoking habits and any family history of asthma. The same source write that physical examinations can be performed by listening to the patient’s chest for any wheezing sounds and observing respiratory effort by assessing the respiratory rate and examining whether the patient is using any accessory muscles to breathe. They add that the shape of the chest also needs to be examined, as a barrel-shaped chest can be a sign of prolonged asthma. In addition, the oral mucosa and nail beds need to be examined for any bluish tinge (Ignatavicius and Workman 2010).

Ignatavicius and Workman (2010) write that pulmonary function tests (PFTs), usually using spirometry, are the most accurate tests that can be performed to diagnose asthma. According to the National Heart Lung and Blood Institute (2012) this test measures how much air the patient can breathe in and out as well as how fast the patient can exhale it. Christensen and Kockrow (2011) add that PFTs determine the reversibility of bronchoconstriction which helps to diagnose asthma. In addition, arterial blood gases testing (ABGs) and sputum for culture testing are both laboratory tests that can be used to diagnose asthma further. The results of ABGs are used to assess the oxygen and carbon dioxide levels in the blood during an asthma attack, while the presence of eosinophils is assessed in sputum testing (Monahan et al. 2007). Finally, chest X-rays can be used to track any changes in chest structure such as hyperinflation, mucous build up and lung collapse (Brown & Edwards 2012).

There is no known cure for asthma. Its medical management therefore involves managing its symptoms, either by maintaining stability with long term medications or quickly relieving symptoms of an attack (Brown & Edwards 2012). Christensen and Kockrow (2011) write that maintenance drugs aim to prevent and minimize asthma’s symptoms but need to be taken regularly. According to Tiziani (2010) these drugs are called symptom controllers. They include salmeterol and formoterol, (catergorised as long acting beta-2-agonists), and inhaled corticosteroids such as fluticasone and budesonide. Leukotriene modifiers are also used for the treatment of chronic asthma (Christensen and Kockrow 2011).

Symptom relievers, on the other hand, are used for the immediate treatment and relief of symptoms in an acute asthma attack. They include short-acting beta-2 agonists (Salbutamol, terbutaline), oral or IV corticosteroids and epinephrine (Christensen and Kockrow 2011). According to Christensen and Kockrow (2011) short-acting beta-2-agonists are the most effective drugs for relieving asthma symptoms. They add that epinephrine can be administered subcutaneously and intramuscularly when asthma’s symptoms cannot be relieved by beta-2-agonists. Oxygen therapy is also an essential immediately treatment for an acute asthma attack, write Christensen and Kockrow (2011).

Because of the absence of a cure and a need for its management, client education on managing asthma is an important role undertaken by health care professionals. Clients should be educated about the signs and symptoms of asthma and its triggers, in order to lessen and prevent asthma attacks (Monahan et al. 2007). According to Ignatavicius and Workman (2010) clients should also be educated to assess their respiratory status, take their medication at the correct dosage and determine when to see their health professionals. Clients therefore need to be educated about the method of using peak flow meters, metered dose inhalers and inhalers with spacers. Monahan et al. (2007) add that a nurse should teach relaxation exercises to patients and the importance of not smoking. Ignatavicius and Workman (2010) describe that patients also need to be educated to have adequate rest and sleep, proper nutrition and fluid intake.

According to NACA (2012) the risk factors of asthma are allergens, pollutants, drugs, infections, smoking, occupational factors, exercise and temperature change. Allergens known to trigger asthma include house dust mites, animal fur, moulds, pollens, tobacco smoke, bushfire smoke, paint fumes, household cleaning products and air pollutants (National Asthma Council Australia 2012). Asprin, other NSAIDs and complementary medicines can trigger asthma as well, according to Brown and Edwards (2012). Cold and flu can act as infection triggers while dust, chemicals and stress are considered occupational factors that can trigger an attack.

The prognosis of asthma, however, is generally good because it can be managed by proper and timely treatment. According to Harvey (2011) most deaths from asthma are preventable, while mild to moderate asthma can be improved with proper management, making some adults symptom-free. Severe episodes also can be managed, depending on the treatment and the degree of obstruction in the airways. On the other hand, asthma causes irreversible problems in lung function for about 10% of patients even though it is well treated while poor treatment and control can lead to prolonged asthma and permanent disabilities (Harvey 2011).

Other relevant information about asthma includes 235 million people suffering from it globally, with most asthma-related deaths occurring in lower and middle income countries (WHO 2012). In addition, the prevalence of asthma increases with the age and it is also more common in females than males after the teenage years (AIHW 2012). According to Andrews (2010) fruits and vegetables in the diet improve lung function while foods rich in Omega 3, (such as fish, sardines and salmon), helps to prevent asthma’s symptoms.

Asthma is a disease which affects people physically, psychologically and socially as well. Gelfland (2008) writes that its coughing, breathlessness, wheezing and chest tightness affects the wellbeing of the client, limiting their involving in normal day to day activities. He also states that the condition keeps some children from going to school and some adults from work. According to the Australian Centre for Asthma Monitoring or ACAM (2004) 20% of children with asthma report not being involved in any physical activities such as playing and riding bicycles and of feeling anger, frustration and social isolation. Asthma’s limiting of activities means life is felt to be more difficult as assistance is needed for activities such as shopping and housework. The National Sleep Foundation (2011) describes how most people with asthma suffer from coughing, wheezing and short of breath in night which prevents them getting enough sleep and makes them more anxious and weak.

The effects during an asthma attack can also be serious. Fear and anxiety can rise, even the fear of dying due to the experience of shortness of breath. Fear of an attack can cause constant anxiousness among some asthmatics (University of Chicago Department of Medicine 2007). Asthma’s discomfort and stress can also make some persons more aggressive, or to lose control of their lives, leading to less self care in general (University of Chicago Department of Medicine 2007). ACAM (2004) adds that an asthmatic can feel embarrassment over taking their medications and can also develop stress and confusion as they try to understand their asthma. ACAM (2004) also describes an Australian study that showed children and adolescents with asthma having lower self esteem, more behavioural problems, poor physical and mental status and worse sole functioning dimensions than others without it.

In addition, asthma can socially isolate people by restricting their participation in social events, limiting their working and other activities, taking more sick days at work and engaging in avoidance behaviour that impairs relationships with family, friends, relatives and colleagues (ACAM 2004). Asthma can also create financial problems due to long term work limitations and decreased education. Sufferers are therefore more likely to experience anxiety, stress and depression (ACAM 2004).

In conclusion asthma can be described as a chronic respiratory condition which can be identified by breathing difficulty, wheezing, cough and chest tightness. Narrowing and swelling of the airways and increased mucus production are the major episodes looked for to establish an asthma condition. Physical examinations, pulmonary function tests, blood tests and chest X-rays are also used to determine asthma. The medications used to manage asthma long term are symptom preventers and symptom controllers. Symptom reliever medications are used for the immediate control of its symptoms. Inhalation or ingestion of allergens and pollutants, exposure to cold weather, exercises, infections and occupational factors such as dust and chemicals can be considered asthma’s risk factors, and healthcare professionals need to provide client education in order to prevent and minimize asthma attacks. Chronic asthma conditions affect client physical, psychological and social wellbeing.

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Asthma Essay With Conclusions

Asthma is one of the major chronic respiratory conditions which alter the respiratory function of the body. The World Health Organisation or WHO (2012) defines asthma as a chronic inflammatory disease of the airways characterised by frequent episodes of breathlessness and wheezing. This difficulty in breathing is caused by the swelling and constricting of the airways. Exposure to allergens, pollutants, cold air, infection and exercise can increase the risk of asthmatics having an attack (Funnel, Koutoukidis and Lawrence 2009). This essay will discuss on the pathophysiology, diagnosis, medical management and clinical manifestations of asthma. It will also cover the client education needed to provide for those with asthma, asthma’s risk factors and its prognosis. According to the National Asthma Council of Australia or NACA (2006) more than 2.2 million Australians are suffering from asthma. This essay will therefore also describe how asthma impacts on its victims and their life style.

Kaufman (2011) describes the pathophysiology of asthma as a pathologic condition which affects the lower respiratory tract by narrowing the airways as a result of epithelial damage, excessive mucus production, oedema, bronchoconstriction and muscle damage. In asthma the cells in the epithelium layer can be destroyed and peel away, making the respiratory tract more susceptible to allergens and infections, thereby contributing to airway hyper-responsiveness (Kaufman 2011). Asthma also triggers the development of mucus cells and mucus glands. This increases mucus production, thus forming mucous plugs which can obstruct the airways (Monahan et al. 2007). Airway oedema is another change that occurs in the respiratory tract due to asthma. It involves the dilation and leaking of capillaries in the airway walls which limits airflow (Kaufman 2011). Monahan et al. (2007) add that increased capillary permeability and leakage can obstruct the airways due to swelling. They also explain that the inflammatory agents such as histamine, tryptase, leukotriences and prostaglandins act on smooth muscles of airway walls and cause bronchoconstriction which restricts the airflow to alveoli.

Brown and Edwards (2012) write that wheezing, breathlessness, chest tightness and cough are the most common clinical manifestations of asthma. They can occur especially at night and in the early morning and can vary from person to person. It is not necessary to have all the symptoms at once as different symptoms can occur at different times. According to NACA (2006) frequent cough, feeling weak, wheezing after exercise, shortness of breath and sleeping difficulties can be early signs of asthma while severe wheezing, continuous cough, rapid breathing, anxiety, chest pain, blue lips and fingernails are the symptoms of severe asthma attacks.

Diagnosing asthma can be done by obtaining a detailed history, performing physical examinations, pulmonary function testing, and laboratory assessments (Ignatavicius and Workman 2010) According to Ignatavicius and Workman (2010) it is important to ask patients about any experiences of having shortness of breath, cough, chest tightness, wheeze and increased mucus production as well as about their smoking habits and any family history of asthma. The same source write that physical examinations can be performed by listening to the patient’s chest for any wheezing sounds and observing respiratory effort by assessing the respiratory rate and examining whether the patient is using any accessory muscles to breathe. They add that the shape of the chest also needs to be examined, as a barrel-shaped chest can be a sign of prolonged asthma. In addition, the oral mucosa and nail beds need to be examined for any bluish tinge (Ignatavicius and Workman 2010).

Ignatavicius and Workman (2010) write that pulmonary function tests (PFTs), usually using spirometry, are the most accurate tests that can be performed to diagnose asthma. According to the National Heart Lung and Blood Institute (2012) this test measures how much air the patient can breathe in and out as well as how fast the patient can exhale it. Christensen and Kockrow (2011) add that PFTs determine the reversibility of bronchoconstriction which helps to diagnose asthma. In addition, arterial blood gases testing (ABGs) and sputum for culture testing are both laboratory tests that can be used to diagnose asthma further. The results of ABGs are used to assess the oxygen and carbon dioxide levels in the blood during an asthma attack, while the presence of eosinophils is assessed in sputum testing (Monahan et al. 2007). Finally, chest X-rays can be used to track any changes in chest structure such as hyperinflation, mucous build up and lung collapse (Brown & Edwards 2012).

There is no known cure for asthma. Its medical management therefore involves managing its symptoms, either by maintaining stability with long term medications or quickly relieving symptoms of an attack (Brown & Edwards 2012). Christensen and Kockrow (2011) write that maintenance drugs aim to prevent and minimize asthma’s symptoms but need to be taken regularly. According to Tiziani (2010) these drugs are called symptom controllers. They include salmeterol and formoterol, (catergorised as long acting beta-2-agonists), and inhaled corticosteroids such as fluticasone and budesonide. Leukotriene modifiers are also used for the treatment of chronic asthma (Christensen and Kockrow 2011).

Symptom relievers, on the other hand, are used for the immediate treatment and relief of symptoms in an acute asthma attack. They include short-acting beta-2 agonists (Salbutamol, terbutaline), oral or IV corticosteroids and epinephrine (Christensen and Kockrow 2011). According to Christensen and Kockrow (2011) short-acting beta-2-agonists are the most effective drugs for relieving asthma symptoms. They add that epinephrine can be administered subcutaneously and intramuscularly when asthma’s symptoms cannot be relieved by beta-2-agonists. Oxygen therapy is also an essential immediately treatment for an acute asthma attack, write Christensen and Kockrow (2011).

Because of the absence of a cure and a need for its management, client education on managing asthma is an important role undertaken by health care professionals. Clients should be educated about the signs and symptoms of asthma and its triggers, in order to lessen and prevent asthma attacks (Monahan et al. 2007). According to Ignatavicius and Workman (2010) clients should also be educated to assess their respiratory status, take their medication at the correct dosage and determine when to see their health professionals. Clients therefore need to be educated about the method of using peak flow meters, metered dose inhalers and inhalers with spacers. Monahan et al. (2007) add that a nurse should teach relaxation exercises to patients and the importance of not smoking. Ignatavicius and Workman (2010) describe that patients also need to be educated to have adequate rest and sleep, proper nutrition and fluid intake.

According to NACA (2012) the risk factors of asthma are allergens, pollutants, drugs, infections, smoking, occupational factors, exercise and temperature change. Allergens known to trigger asthma include house dust mites, animal fur, moulds, pollens, tobacco smoke, bushfire smoke, paint fumes, household cleaning products and air pollutants (National Asthma Council Australia 2012). Asprin, other NSAIDs and complementary medicines can trigger asthma as well, according to Brown and Edwards (2012). Cold and flu can act as infection triggers while dust, chemicals and stress are considered occupational factors that can trigger an attack.

The prognosis of asthma, however, is generally good because it can be managed by proper and timely treatment. According to Harvey (2011) most deaths from asthma are preventable, while mild to moderate asthma can be improved with proper management, making some adults symptom-free. Severe episodes also can be managed, depending on the treatment and the degree of obstruction in the airways. On the other hand, asthma causes irreversible problems in lung function for about 10% of patients even though it is well treated while poor treatment and control can lead to prolonged asthma and permanent disabilities (Harvey 2011).

Other relevant information about asthma includes 235 million people suffering from it globally, with most asthma-related deaths occurring in lower and middle income countries (WHO 2012). In addition, the prevalence of asthma increases with the age and it is also more common in females than males after the teenage years (AIHW 2012). According to Andrews (2010) fruits and vegetables in the diet improve lung function while foods rich in Omega 3, (such as fish, sardines and salmon), helps to prevent asthma’s symptoms.

Asthma is a disease which affects people physically, psychologically and socially as well. Gelfland (2008) writes that its coughing, breathlessness, wheezing and chest tightness affects the wellbeing of the client, limiting their involving in normal day to day activities. He also states that the condition keeps some children from going to school and some adults from work. According to the Australian Centre for Asthma Monitoring or ACAM (2004) 20% of children with asthma report not being involved in any physical activities such as playing and riding bicycles and of feeling anger, frustration and social isolation. Asthma’s limiting of activities means life is felt to be more difficult as assistance is needed for activities such as shopping and housework. The National Sleep Foundation (2011) describes how most people with asthma suffer from coughing, wheezing and short of breath in night which prevents them getting enough sleep and makes them more anxious and weak.

The effects during an asthma attack can also be serious. Fear and anxiety can rise, even the fear of dying due to the experience of shortness of breath. Fear of an attack can cause constant anxiousness among some asthmatics (University of Chicago Department of Medicine 2007). Asthma’s discomfort and stress can also make some persons more aggressive, or to lose control of their lives, leading to less self care in general (University of Chicago Department of Medicine 2007). ACAM (2004) adds that an asthmatic can feel embarrassment over taking their medications and can also develop stress and confusion as they try to understand their asthma. ACAM (2004) also describes an Australian study that showed children and adolescents with asthma having lower self esteem, more behavioural problems, poor physical and mental status and worse sole functioning dimensions than others without it.

In addition, asthma can socially isolate people by restricting their participation in social events, limiting their working and other activities, taking more sick days at work and engaging in avoidance behaviour that impairs relationships with family, friends, relatives and colleagues (ACAM 2004). Asthma can also create financial problems due to long term work limitations and decreased education. Sufferers are therefore more likely to experience anxiety, stress and depression (ACAM 2004).

In conclusion asthma can be described as a chronic respiratory condition which can be identified by breathing difficulty, wheezing, cough and chest tightness. Narrowing and swelling of the airways and increased mucus production are the major episodes looked for to establish an asthma condition. Physical examinations, pulmonary function tests, blood tests and chest X-rays are also used to determine asthma. The medications used to manage asthma long term are symptom preventers and symptom controllers. Symptom reliever medications are used for the immediate control of its symptoms. Inhalation or ingestion of allergens and pollutants, exposure to cold weather, exercises, infections and occupational factors such as dust and chemicals can be considered asthma’s risk factors, and healthcare professionals need to provide client education in order to prevent and minimize asthma attacks. Chronic asthma conditions affect client physical, psychological and social wellbeing.