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October 20, 2020
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Asthma: A systematic approach to symptom management.

 

Asthma was recorded to have first occurred in China, in 2600 BC. This was referred to as a respiratory disease characterised by “wheezing” or “noisy breathing”.

Hippocrates (400 BC), a Greek physician of the Age of Pericles, and one of the most outstanding figures in the history of medicine, was the first to use the term, “asthma” – a Greek word for panting and respiratory distress.

Asthma is a chronic (long term) condition that affects the airway, leading to a reversible narrowing of the bronchioles (tubes that carry air into and out of the lungs). During times of attack, the airways narrow and constrict, producing mucus plugs that make breathing very difficult.

Individuals of any age can be affected by asthma, but most cases are seen in early childhood, with adult females developing adult onset or late asthma.

Asthma presents with symptoms such as wheezing, coughing, shortness of breath or feeling some level of chest tightness. These range from mild to severe and can happen in the morning, daily, weekly, nightly, some nights, or only once in a while.

Asthma triggers are those things, such as exercise, a viral infection, cold air or environmental factors that can set off or worsen asthma symptoms. They are often brought about by the immune system in response to any substance, also called allergens that irritate the lungs. Asthma attacks result when these symptoms get severe, and may vary from person to person in severity.

The immune system is designed to protect the body from any invaders, or any substance that might be considered “toxic” or infectious to the body. Upon sensing the presence of these allergens, an inflammatory process is triggered. This inflammatory process causes the airways to swell, hence becoming narrow, producing more mucus and reducing the available passageway of air. This consequently makes it very difficult for breathing to occur. The muscles around the airways may also tighten, which is called a bronchospasm.

Certain factors can increase an individual’s risk for developing asthma. These include environmental factors such as exposure to cigarettes, a moldy environment, dusty rugs and carpets, chemicals or irritants, industrial waste products, etc. or occupational factors. They can also be racial or ethnic factors as is seen in African-Americans, Puerto Ricans and Hispanics, factors surrounding sex -as seen in younger boys and older women, and genetic factors or as seen in individuals with a family history of asthma.

There are certain other medical conditions that can increase an individual’s risk of developing asthma, such as allergies, obesity, and some respiratory infections.

There is no standard screening for asthma, but the Pulmonary Function test which determines the Forced Expiratory Volume in one second (FEV1), using a spirometer, has been found to assist in determining variable airflow limitation. The frequency of signs and symptoms of asthma may depend on how severe, or intense, the asthma is, and whether or not the individual is exposed to allergens. While certain individuals have daily symptoms, others, occasionally. These symptoms can be so severe, enough to interfere with the individual’s ability to carry out their daily functions effectively. Worthy of note is, frequently occurring or uncontrolled asthma can cause severe damage to the airways in the lungs.

Asthma is classified and treated using a stepwise approach, according to the level of severity.

Asthma severity is divided into four groups: intermittent, persistent-mild, persistent-moderate, and persistent-severe.

Individuals with intermittent asthma have symptoms occurring less than two days per week; are awakened less than two nights per month; use long term control medicine less than two days per week; have no limitation with daily activities, and have a normal FEV1 ranging between 80 and 100 per cent.

Individuals with persistent mild asthma have symptoms occurring greater than two days per week (but not daily); are awakened three to four nights per month; use long term control medicine for more than two days per week, but not more than once per day; have minor limitation to daily activities, and have an 80 per cent of predicted FEV1.

Individuals with persistent moderate asthma have daily symptoms; are awakened more than one night per week- but not nightly, use long term control medicine daily;  have some level of limitation with daily activity; and have a greater than 60 per cent, but less than an 80 per cent FEV1.

Individuals with severe persistent asthma have symptoms occurring throughout the day, are awakened about seven days per week; use long term control medicine daily, are severely limited in being able to perform daily activities, and have less than 60 per cent of predicted  FEV1.

Using this classification, healthcare providers are able to apply the stepwise approach towards instituting treatment plans for the individual with asthma. This process involves the systematic Step up or Step down of asthma medication according to the level of symptom severity. Most people are given daily controllers for long term treatment, in addition to an inhaler that provides a short term relief in the case of an attack.

The goal is to prevent occurrence, control symptoms and to prevent long term damage to the lungs.

If you have asthma, always remember to take your long-term control medicine, whether you have symptoms or not. In collaboration with your healthcare provider, an asthma action plan can be designed to help you to identify symptoms, and what to do in the case of an emergency.

Declan is an Oncology Certified Registered Nurse, and an Adjunct Nursing Professor at the Houston Community College, at the Texas Medical Centre.edithdeclan@yhaoo.com.

 

 

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