Abstract This paper discusses the condition of asthma, examining its pathology, prevalence, etiology, signs and symptoms. The paper also discusses asthma attacks and what triggers them and then takes a look at both the conventional and complementary treatments available for asthma, with particular attention being paid to massage therapy.
From the Paper "Fanta Cristiano and Haver state that asthma is a chronic disease affecting the airways - the tubes that carry air in and out of the lungs. Specifically, asthma is said to be an inflammation or swelling of the inside walls of the airways, making them extraordinarily sensitive to irritations and allergens. Rosenwasser reports that asthma can develop at any age but is most common in childhood. In childhood the condition affects twice as many boys as girls..."
Abstract This paper looks a a case study article on asthma and its environmental triggers. The aspects of the article to be discussed are: a brief description, the community described within, the means (or lack thereof) to address the concern, ethical issues of not addressing the concern and how the concern relates to Dorothea Orem's nursing model.
From the Paper "As part of the Case Studies in Environmental Medicine series and as an answer for the problematic and growing asthma dilemma in the United States, the Agency for Toxic Substances and Disease Registry (ATSDR) put out an article on asthma in 2002. Entitled "Environmental triggers of asthma," this case study/article lists as its purpose to "discuss the role environmental factors play in the etiology, triggering, and exacerbation of asthma" (ATSDR, 2002, p.1). Lamenting the fact that "over the past decade, the prevalence of asthma in both children and adults has increased in the United States" (ATSDR, 2002, p.1), the study promises to discuss such environmental causes of asthma as allergens, pollutants, and workplace-related substance exposures, realizing that by controlling the environment, control over the impact and progress of asthma can also be had."
Abstract This paper discusses the role of ketamine as a smooth muscle relaxant and antihistamine, which, along with its anesthetic effects proves useful in the treatment of asthma. The paper highlights case studies performed on effectivity along with commenting on the need to exercise caution with asthmatic patients who have co-morbid cardiac disorders.
From the Paper "Nosworthy (1999) states that Ketamine is the induction agent most likely to be chosen when an asthmatic patient requires endotrachial intubation, providing marked patient improvement, possibly due to Ketamine's smooth muscle relaxant and antihistamine effects. Long (2003) tells us that Ketamine is often used as a method of managing bronchial spasms associated with asthma. Galbis-Reig and Rasansky (2004) presented the case of a 47-year-old male asthmatic with co-morbid depression and chronic obstructive pulmonary disease (COPD) presenting to the Emergency Department (ED) with dyspnea and cough that was successfully treated with Ketamine. The patient had been using his albuterol inhaler without significant improvement prior to arriving at the ED, still smoked a pack of cigarettes a day and was taking azmacort, combivent, sertraline and methocarbamol as prescribed (Galbis-Reig & Rasansky, 2004)."
Abstract The paper explains what asthma is, how it affects the body, the factors that could cause or lead to asthma as well as the diagnostic testing that is usually performed to formally diagnose asthma. The paper also discusses the appropriate treatment including alternative treatments and relates the typical prognosis for a patient with asthma. Finally, the paper outlines the patient teaching which would benefit the patient in the case study.
Outline:
The Patient's Diagnosis of Asthma, What Asthma is and How it Affects the Body
The Factors that Could Cause or Lead to Asthma The Diagnostic Testing that is Usually Performed to Formally Diagnose Asthma The Appropriate Treatment Which the Patient may be Prescribed for Asthma Alternative Treatments Which May Also Benefit the Patient
The Typical Prognosis for a Patient With Asthma Patient Teaching Which Would Benefit the Patient in the Case Study
From the Paper "Asthma is a chronic syndrome that manifests with symptoms of airflow obstruction. It may begin in children, but it may recur as adults. The severity of symptoms of this disease depends on the degree or airflow obstruction, bronchial hyperresponsiveness, and airway inflammation (Busse and Lemanske, 2001). It mimics body responses similar to that experienced by a person having an allergic reaction. It is known to affect approximately 300 million worldwide, with 10 to 12% are adults, and 15% of children. In childhood, males are more likely to have asthma than females by two-fold, but by adults, the sex ratio is the same. Many factors can provoke an asthma attack, such as allergens, airborne irritants, viral infections, or occupational exposure to items such as noxious smoke (Adkinson, Yunginger, Busse, Bochner, Holgate, and Simons, 2003)."
Abstract Asthma is an intermittent disorder, which affects the patient from time to time. Resistance to airflow may be triggered by external factors, such as inhalation of substances, or resistance can occur without any external stimuli. The paper explains that the clinical symptoms of asthma include wheezing, chest tightness, and breathlessness. It also shows that, in America alone, there are more than seventeen million people suffering from asthma, and asthma attacks alone are responsible for some 500,000 hospitalizations every year. The paper presents details of the disease and explores treatment options.
Table of Contents:
Introduction
What is Asthma?
Asthma and the Immune System
Diagnosis of Asthma Radioallergoabsorbent Test [RAST]
Prick Tests
Treatment
Steroids
Bronchodialators
Conclusion
Bibliography
From the Paper "Our lungs are equipped with elaborate defense methods to guard against the potential invasion of foreign bodies. The tiny hair like protrusions called the cilia, constitutes the first line of defense. The cilia pushes the trapped particles (along with the mucus) into the mouth which we swallow and the pathogens are destroyed by the action of the digestive enzymes. The bronchioles constitute the second line of defense."
Abstract In this article, the writer notes that asthma is one of the most common chronic diseases of childhood. The writer maintains that treatment is based on as many factors as possible and also is based on a holistic view of the child since asthma may be a possible risk factor and linked with psychosocial development. The writer points out that assessment must be focused on what triggered the asthma episode, and treatment is always aimed at control, but control denotes giving the child long-term control over his/her life. The writer concludes that treatment for asthma is on a continuum and is aimed at control or management.
Outline:
Introduction
Asthma as a Current Issue
Pathophysiology of Asthma Treatment
Summary
From the Paper "Treatment of asthma is not directed at cure but at control. Control of asthma leads to reduced and infrequent symptoms and allows the child to have an active life as well as quality of life. The optimal management of asthma requires adequate evaluation of the child and his or her environment. Asthma control is achieved through assessment based on specific criteria. The nurse practitioner must be able to identify the symptoms of asthma accurately because symptoms often are mistakenly prioritized. Wheezing, for instance, is commonly regarded as the most common characteristic of asthma. However, coughing is present even in hidden asthma, and frequent coughing or respiratory infections indicate the likelihood of asthma. Coughing which follows running or crying may indicate asthma as well as a recurrent night cough. Recurrent night cough is common, as asthma is often worse at night. Chest tightness and shortness of breath are symptoms of asthma that may be observed alone or in combination with other symptoms. Other common symptoms are nasal flaring, fatigue or irritability."
Abstract This paper provides a literature review on the subject of asthma in racial and ethnic minorities. The review focuses on the risk factors that contribute to greater asthma prevalence and poorer asthma control and treatment in racial and ethnic minorities.
Outline:
Introduction
Asthma Prevalence, Morbidity, and Mortality
Factors Contributing to a Higher Prevalence of Asthma in Minorities
Disparities in Asthma Control and Treatment
Conclusions
From the Paper "Minorities, the poor, adult women, and children under the age of 18 are disproportionately affected by asthma (ALA, 2007a). According to the Kaiser Family Foundation (2007) African American children had a 17% prevalence of asthma, compared to 12% in Non-Hispanic Whites, 10% in Hispanics, 10% in Native Americans, and 6% in Asians. In adults however, Native Americans had the highest rates of asthma, with a 16% prevalence compared to 11% in African Americans, 10% in Whites, 8% in Asians, and 8% in Hispanics. Puerto Rican adults had a higher prevalence of asthma than most races, with an 11.6% prevalence (CDC, 2004). This fact is masked by the lower rates of asthma in other Hispanic subgroups.
Regardless of age, African Americans were more likely to be hospitalized and to die because of asthma complications compared to all other races, even when taking into account the higher prevalence rates of asthma in this group. Compared to Whites, African American children were 4-5 times more likely to be hospitalized due to asthma, while African American adults were 3-4 times more likely to be hospitalized, and they were also five times more likely to use the emergency department (ED) to seek asthma care (KFF, 2007). African Americans were disproportionately represented in deaths due to asthma even when socioeconomic status was accounted for --they represent only 12.1% of the population, but they account for 25% of all asthma deaths (ALA, 2007a)."
Abstract A thorough study of the basic guidelines on asthma management which includes avoidance of triggers, education aimed at prevention and control of the condition, regular follow-ups, and an action plan that relies on symptoms and lung function measurements for the monitoring of disease severity. The paper explains that the goals of these guidelines are to reduce asthma-related illness and death and to enhance the quality of life of asthma patients. The paper tries to determine if there is a relationship between physician compliance with asthma guidelines and the number of asthma episodes reported by caregivers of asthmatic children as well as the frequency of clinic visits.
From the Paper "In addition to the foregoing, asthma accounts for total annual care costs of more than $6 billion dollars per year in America as well as 15 million physician visits per year (one third of which are made by persons under age 20 years), and over 100 million days of restricted activity. Nearly 5,000 people die from asthma episodes each year, and hundreds of thousands more suffer frightening episodes of coughing, wheezing, chest tightness, and loss of breath (Higgins, 1997).
One way in which the medical system has responded to this dire health problem has been the development of national and international guidelines for the diagnosis and management of asthma patients (see: National Institutes of Health, Updated Asthma Guidelines, 1997). These guidelines provide clinicians with several recommendations which are organized into four components of therapy: measures of assessment and monitoring, control of factors contributing to asthma severity, pharmacologic therapy, and education for a partnership in asthma care. The recommendations were formulated based on current information in the available scientific literature and the consensus of an expert panel."
An in-depth study into whether the use of peak flow meters, which measure possible obstruction to the breathing tubes in asthma patients, prevents attacks and subsequent hospitalization.
Abstract This paper examines whether the use of a peak flow meter is a good indicator of an impending crisis in asthma patients. The hypothesis for this study is that use of a peak flow meter would give both the patient and the doctor early warning and allow treatment adjustments and so avoid hospitalization, emergency room visits, absenteeism and activity limitations in asthma patients. To test this hypothesis, a survey was conducted of asthma patients, doctors, respiratory therapists, nurses and pharmacists to determine the distribution and use of these meters and if they did prevent hospitalizations, emergency room visits, absenteeism and activity limitations in asthma patients.
Table of Contents
Statement of Problem
Introduction
Background
Research Hypothesis
Materials
Methods
Limitations of Study
Results
Discussion
Figures and Tables
References
From the Paper "Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular mast cells, eosinophils, T lymphocytes, neutrophils and epithelial cells (Asthma Diagnosis and Management, 2001). In individuals who are susceptible, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.
In the United States, asthma is the third leading cause of preventable hospitalizations, and is responsible for an estimated 470,000 hospitalizations and 5,500 deaths each year (Asthma Diagnosis and Management, 2001; White and Roughan, 2000). Undertreatment and inappropriate therapy are the major contributors to asthma morbidity and mortality in the United states (Asthma Diagnosis and Management, 2001). Less than half the patients hospitalized in two large metropolitan area emergency departments were found to be receiving inflammatory therapy as recommended in the Expert Panel Report-2 (EPR-2), and only 28 percent of the adult patients hospitalized for asthma had written action plans that told them how to manage their asthma and control exacerbations. The goal of the EPR-2 is to serve as a comprehensive guide to diagnosing and managing asthma. While implementation of EPR-2 recommendations may initially increase some costs of asthma care because it will require an increase in the number of primary care visits and the use of asthma medications, environmental control products and services, and equipment, in the long run asthma diagnosis and management are expected to improve and this should reduce the number of hospitalizations, lost work and school days, emergency department visits and deaths from asthma. The four components of asthma management in the longterm are: assessment and monitoring; pharmacological therapy; patient education and partnership in asthma care; and control of contributing factors."
Abstract This paper presents a detailed case of a child with asthmatic symptoms that are discovered to be exacerbated by Parainfluenza A, which contributed to the onset of his asthma. The author points out that the severity of asthma varies greatly from child to child, from a cough associated with exercise or at night to a catastrophic shortness of breath that leads to death. The paper points out that the inability of endogenous, circulating, catecholamines to induce reversal of bronchoconstriction may reflect one or more defects in the patient with asthma. Figure: Asthma Mechanisms
Table of Contents
CC
Pt. Introduction
Admission to System
Pt. Physical Assessment
Lab Data
Isolated for parainfluenza
Diagnostic Data
Medications-Previous
Medications Ordered
Singular
Flovent MDI
Albuterol MDI
Solumedrol
Ranitidine
Ceftriaxone
Treatment
Clinical Course
Pathophysiology of CC
Lab Data
Diagnostic Data
Medications
Summary
From the Paper "The primary mechanical effects of asthma on the lung as a result of BMP are increased work of breathing to overcome airway obstruction and hyperinflation attributable to progressive air trapping results from a ball-valve effect in the airways and causes ventilation/perfusion (V/Q) mismatch and right-to-left shunting of unoxygenated blood through the lungs. V/Q mismatch and the increased oxygen demand on the respiratory muscles as they work to overcome airway obstruction result in significant hypoxia early in the course of a wheezing episode. This hypoxia stimulates tachypnea, which partially compensates for the V/Q mismatch and is reflected by significant hypocarbia. If airway obstruction is not rapidly reversed, air trapping and V/Q mismatch can progress till decreased ventilation occurs, Pco2 rises, and ultimately respiratory failure ensues."
Abstract This report discusses the issue of asthma and how it affects children, also defining asthma and giving some notion of its signs and symptoms. The report also looks at issues in diagnosis and effective treatment of asthma. The report looks at alternative techniques such as using psychology and education of self-management to children with asthma, in terms of their relative effectiveness. The paper then moves onto concluding remarks, including positing ideas and avenues for future
research.
Paper Outline:
Issue
Diagnosis and Treatment
Alternative Therapies
Summary
Recommendations
Bibliography
From the Paper "In terms of appropriate psychological interventions for asthma sufferers, it is important for healthcare workers, including nurses, to realize that people with asthma may be more likely than other individuals to have psychological problems such as anxiety disorder and depression. This comes from the anxiety of having to live with unpredictable asthma attacks, and in many cases the depression that comes with having an illness that is uncertain in terms of definition and causal motivation."
Abstract This paper studies the respiratory disease asthma, one of the oldest and most common diseases to affect mankind. The paper explains that asthma is characterized by breathing difficulty, which the person experiences due to the wide variations in the air flow in the intra-pulmonary airways. The paper begins with a definition of asthma and how it effects the body's immune system. The paper then offers an explanation of how the illness is diagnosed and the most common test known as the Radioallergosorbent Test(RAST). The paper concludes with a look at the treatments for this disease.
From the Paper "It is understood that asthma is the result of a hypersensitive response of the immune system. People who are asthmatic are over sensitive to allergens that leaves most people unaffected. However asthma may also result from non-allergic reactions such as exposure to cold air. [British Medical Journal, Jan 1994]. It is essential that we understand the two important defense mechanisms of the lungs before we go into the immune response that causes asthma. Our lungs are equipped with elaborate defense methods to guard against the potential invasion of foreign bodies. The tiny hair like protrusions called the cilia, constitutes the first line of defense. The cilia pushes the trapped particles (along with the mucus) into the mouth which we swallow and the pathogens are destroyed by the action of the digestive enzymes."
Abstract This paper begins with an examination of the etiology of asthma and then looks at the possible signs and symptoms of the disorder. The paper then discusses the pathogenesis of asthma and its diagnosis. The treatment of asthma and the chronic disorder treatment are examined.
From the Paper "The complete causes of asthma are unknown. Heredity does seem to play a role, as do allergens and environmental factors. According to the latest Expert Panel Report (EPR) in 2002 from the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program, "Atopy, the genetic predisposition for the development of an IgE-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma."
There are two categories of asthma: allergic or extrinsic and idiosyncratic or intrinsic. Allergic asthma is a result of an antigen\antibody reaction on mast cells in the respiratory tract. This reaction causes the release of inflammatory mediators from mast cells, which elicit the clinical response associated with an asthma attack. Idiosyncratic asthma is a result of neurological imbalances in the Autonomic Nervous System (ANS) in which the alpha and beta-adrenergic as well as the cholinergic sites of the ANS are not properly coordinated."
Abstract This paper provides a critical assessment of the 1999 article by Jalaludin, et al., which was published in the Australian and New Zealand Journals of Public Health, entitled "Risk Factors For Asthma Deaths: A Population-Based Case-Control Study". It looks at how the objectives of the paper by Jalaludin, et al. were to investigate risk factors for deaths from asthma, using a case-control study design with two control groups and how the study was prompted by a bout of deaths from asthma in New Zealand in 1970 for which the cause was unknown, but suspected to be fenoterol.
From the Paper "The Mitchell et al. (2002) questionnaire requested information on demographics, age at first diagnosis of asthma, duration of symptoms before diagnosis, self-assessment of severity, symptom frequency, medication use (by broad category and specific names), history of allergy, exposure to asthma triggers, the asthma trigger for the index episode, and feelings of vulnerability (Mitchell et al., 2002). The article under discussion was, again, not so thorough in terms of the rigor of the questionnaire used, and again, any conclusions drawn from such a questionnaire need to be looked at from the point of view of this caveat."
Abstract This paper examines how nitric oxide (NO), once generally viewed only as hazardous to humans, has now become a promising means of identifying and treating respiratory diseases such as asthma. It looks at how several studies have indicated the usefulness of nitric oxide in monitoring and managing asthmatic patients, particularly children.
Outline
Introduction
Nitric Oxide and the Human Body
Mechanism and Metabolism
Functions
Nitric Oxide and Asthma Mechanism of Nitric Oxide and Asthmatic Attacks
Nitric Oxide and Treatment of Asthma Conclusion
References
From the Paper "Nitric oxide is a highly reactive, prevalent gas in human chemical activity. It can be found in neurons as n NOS or NOS1, in macrophages as iNOS or NOS-2, and in endothelial cells as eNOS or NOS-3 (Bor-Kucukatay, 2005). Nitric oxide is cellularly synthesized by the enzyme nitric oxide sythases denoted by NOS from arginine, molecular oxygen and NADPH. Nitric oxide interacts rapidly molecularly and disperses through cell membranes acting in a paracinic or autocrinic behavior . "
