Asthma Research Paper

Asthma is one of the most common chronic diseases, which inflames and narrow the airway of the lung. It affects people from all age groups, often starting during childhood and it is a global health problem. In USA, it is known that more than 25 million people have asthma where 7 million of then are children. This chronic disease seriously confines child’s activity, often has exacerbation that result in emergency department visits and hospitalization. It is allied with at least 4,000 deaths per year and it account for 10 million school absences per year (American Academy of Allergy Asthma & Immunology).

This disease causes periodic period of symptoms that can vary from episode to episode in the same child. Some signs and symptoms of asthma

to look for may include recurrent coughing spells, which may happen during play, at nighttime, or while laughing. It is very important to know that sometimes child may have asthma with only cough present as a symptom. They may present with less energy while they are playing, or pausing to catch breath during play, rapid or shallow breathing, complaint of chest tightness, whistling sound when breathing in or out. This whistling sound is called wheezing, shortness of breath and some more symptoms.
Drug such as Steroids and other anti-Inflammatory drugs and bronchodilators are the two main medication used in asthma treatment. An anti-inflammatory drug, especially inhaler steroid is the most important treatment for the patient with asthma. They prevent asthma attack and reduce the swelling and mucus production in the airways. Bronchodilator relieves the symptoms of asthma by soothing the muscles that can strengthen around the airways. Short-acting bronchodilator inhaler is called a rescue inhaler because they are used to quickly relieve the cough, wheeze, chest tightness, and shortness of breath caused by asthma. They may also be used prior to exercise for people with exercise-induced asthma.
According to British Medical Journal “Guided self management of asthma-how to do it” published by Lahdensuo A. on Sept 18, 1999, about 75% of patient that are admitted to the hospital with asthma are avoidable, and hypothetically preventable factors are common in deaths from asthma. Due to lack of education or information, at least 40% of people with asthma do not know how to respond correctly when their symptoms worsen, and over 50% of patients admitted with acute asthma have had alarming symptoms for at least a week before admission. During self-management, patients are expected to make therapeutic, behavioral, and environmental changes in agreement with advice given by healthcare educator. Directed education on asthma self-management is a treatment technique in which patients are educated to act suitably when the signs of asthmas exacerbation appears.
Although there are many positives outcome and reasons for starting a self-management asthma education program, it is not always easy mission for the patient to start. It may be culturally demanding for the nurse educator to give asthmatic patient and their family member more responsibility and independence. There is also a poor enthusiasm of patient or their family member to make decision in their own asthma care. There is a need for motivation and education of nurse educator and patient for a successful self-management. The good results achieved with self-management program should be emphasized and shown, and information supplied should be kept as clear and simple as possible.
Extended education of patient with asthma has shown to augment the chance of long-term control and has vital importance for successful management of all type of asthma. Member of health care team has being using different educational programs for patients with asthma, however they differ largely in respect to content, design, intensity and duration, varying mainly on the quality of educator. The main goal of asthma education and management is to attain and preserve disease control. Even with employment of asthma management guideline around the world and use of highly effective medication, asthma remains poorly controlled. Poor control may be due to the fact that patients are not being prescribed the right or unsuitable medication or they are using the prescribed medication not correct. In addition to prescription and providing pharmacological treatment, education and direction on asthma self-management have recently become recognized as aspects that must also be addressed within their clinical context. Various types of asthma education programs have been implemented and there is a formalized asthma educational program for patients and their parents by a certified asthma nurse educator and the old-fashioned hospital discharge education. The outcomes of those two education programs differ in terms of approach, treatment setting, and outcomes of interest (Lahdensuo A., 1999).
The main goal of asthma management beyond the initial management of the critical situation is to prevent re-hospitalization, prevent patients from exacerbations prophylactic.

Education is way to increase awareness of patient, family members, healthcare professional, and the public that asthma is a chronic condition; ensure patients and family members recognize the symptoms; ensure a partnership among patient and health care professional in order to have an effective control of asthma; educating family members and patient how to do home inspection, recognize asthma triggers and preventing asthma attack; Asthma is chronic and variable disease, there is a need for patient and family members to learn how to make a lifestyle change and follow drug therapy for a long period of time, even when the symptoms is not present. They need to be capable of making rapid decision about symptoms severity, self-medication and when to contact the health care team based on the severity of

symptoms.
Among hospitalized pediatric patients with asthma does a formalized asthma educational program for patients and their parents by a certified asthma nurse educator compared to traditional hospital discharge education result in increased knowledge of asthma and its triggers, increased adherence to daily medication management and/or rescue plan, increased school attendance, increased quality of life.
Nurses and medical doctors still carry out the greatest parts of patient’s education in spite of recommendation for cooperation and multidisciplinary tactic in education of asthma patients. However, there is an increase importance about combination of individual and group of education. According to article “Patient Education and Counseling” there is an high evidence that perpetual education of patients helped in better control and more successful treatment of asthma because of inspiration of effectual self care in achieving the firm management aims ( Levy et al., 2000).
A clinical control study done on children hospitalized with asthma reveal that fewer children was readmitted when their parent had received nurse education about led home management education when compared with children who received only a traditional discharge recommendation and education.

When nurse thought patient, they improved their use of inhaled corticosteroids, and they automatically decreased use of albuterol, and reached higher level and less variable peak flow rate. When nurses specialist used consistent 2 hour asthma education, there was a decrease in hospitalization, less missed activity over six months and when they have an education on led it demonstrated to have greater outcome such as reduction in asthma symptoms, less restriction in activity, and the inflammation of airway drastically decreased (Levy et al., 2000). During education nurses need to have a reliable, consistent experience and also a supporting materials is needed to ensure that education surely happens in order to have a better outcome.

On the other hand when patient is hospitalized, during discharge is an opportunity to address patient’s unique and only urgent learning need and it may be affective for a short term goal asthma management. According to the article “A clinical study on asthmatic patients who were readmitted after a short period of discharge” by Hoshino K., 2001, 59 % of pediatric patient who were discharged where re-admitted within 1-2 months after discharge. Child who received

only the discharged education was mostly to be readmitted to emergency department, increased number of absence in school.
On the other hand nursing specialist education is fundamental to offer patients the abilities necessary to control asthma and improve outcomes. For example we know that effective allergen avoidance requires complex and comprehensive method, so individual steps alone are less likely to be effective. So, asthma education programs done during or after discharge from the hospital are very effective in improvement of self-management of asthma. Patients are thought how to inhaler and after they are assessed how they use inhaler techniques and nurses reinforce correct technique. Also patients are provided with a written asthma action plan that includes daily management and some technique how to recognize and what action to take when worsening asthma. Nurses also ensure patients have appropriate referrals (Allergist, Public Health Nurse, Social Service, Community classes).
“Self management education program reduced hospital admissions (odds ratio 0.57, 95% confidence interval 0.38 to 0.88), emergency room visits (0.71, 0.57 to 0.90), unscheduled visits to the doctor (0.57, 0.40 to 0.82), days off work or off school (0.55, 0.38 to 0.79), and nocturnal asthma (0.53, 0.39 to 0.72). Self management program that contained a written action plan showing patients how to act in early exacerbations showed a greater reduction in admissions to hospital than did program without a plan (0.35, 0.18 to 0.68)” (Rodrigues CD Effects of an outpatient education program in patient with uncontrolled asthma, May 2013 ).
An outpatient education program for asthma patients are shown to improves the level of asthma control, increased knowledge of asthma and its triggers, increased adherence to daily medication management and/or rescue plan, decreased ED visits, increased school attendance, and increased quality of life. On the other hand the discharge teaching was effective, however, child is more frequently to be readmitted within 1-2 months of discharge due to de fact that they do not have adequate information on how to control/prevent the asthma properly.