The main purpose of this assignment is to discuss the topic asthma. The assignment is going to discuss the aetiology, clinical signs, diagnostic methods, and psychosocial effects of asthma and the use of corticosteroids as a drug treatment for Asthma. Asthma UK (2016) states that currently in Northern Ireland 182,000 people are receiving treatment for Asthma, Including 36,000 children and 146,000 adults. So that is around 10 per cent of the population as there is currently around NISRA (2016) 1.86 million people living in Northern Ireland. Greener (2010) suggests that improved care could avoid 75% of hospital admissions and up to 90% of deaths. Therefore all health professionals should have at least a basic understanding of asthma. If they are a health professional who regularly comes into contact with asthmatic patient they should have a good understanding and knowledge of the disease.
Ross and Wilson (2014) defines that Asthma is an inflammatory disease in the airways that has episodes of reversible over-reactivity in the smooth muscle. WHO (2014) states that Asthma is a long term condition where recurrent attacks of breathlessness and wheezing happens. Each person’s attack are individualised in terms of severity and frequency. Ross and Wilson (2014) explains that there are two types of asthma atopic asthma and non-atopic also known as intrinsic asthma and extrinsic asthma.
Diamant (2007) states that atopic asthma usually would start in children or teenagers and is often associated with a family history of allergic diseases. Non-atopic asthma starts later in adult life and there is no history of childhood allergic reactions. Ward (2010) states that in individuals that have atopic asthma they often have an allergic response to allergens such as grass, tree pollen, house dust mite and dander from domestic pets. Holgate and Douglas (2010) explains that someone with atopic asthma exposure to an allergen leads to a release of excessive quantities of immunoglobulin E (IGE) from B Lymphocytes. Ige will bind to cells that are associated with inflammation, which will then stimulate the release of inflammatory mediators that causes bronchoconstriction and inflammation of the airways. Non-atopic can be associated with chronic inflammation of the upper respiratory tract. Ward (2010) states that non-atopic asthma is Ige- independent. Asthma UK (2016)
NHS (2016) clarifies that the exact cause of asthma is unknown. Although there are a number of factors that can increase someone’s risk of developing asthma such as family history, environmental and emotional factors. Rees (2010) says that the chance of developing asthma by the time you are 50, is ten times greater if you have a first degree relative with asthma. Although genetic susceptibility on its own cannot account for the development of the disease it also depends on environmental and emotional factors.
If you are exposed to tobacco smoke as a child or your mother smoked during her pregnancy can be risk factors for Asthma. Another factor could be having another atopic condition yourself or having bronchiolitis as a child could increase your chance of developing asthma. An environmental factor that would worsen asthma would be where an individual lives. A large populated city is more likely to have higher levels of asthma sufferers due to the increased air pollution in the city. Cutajar (1997) suggests how the polluted ozone later irritates the airways and together with acid aerosols can contribute to the worsening of asthma.
Also where someone works can affect your asthma or developing asthma. Asthma UK (2016) explains that there is occupational asthma which means the asthma is caused by your occupation or work you are doing. Your childhood asthma may have come back since you started working in a certain place such as a bakery or a carpet shop. An emotional factor that would worsen asthma would be stress. Stress causes a surge of adrenaline to be released within the body leading to a faster heart rate, tenseness in the muscles and hyperventilation. The change in breathing pattern can put asthma sufferers at a higher risk of attack. Stress can then cause someone to smoke more or take more alcohol which can exacerbate an asthmatic individuals symptoms.
NHS (2016) states that asthma symptoms can often occur in response to a trigger. Common triggers include infections of the upper airways such as colds and flu. Allergens are another trigger that can irritate asthma symptoms such as pollen, dust mites, animal fur or feathers. Airborne irritants such as cigarette smoke, fumes and pollution or medicines particularly painkillers can trigger asthma symptoms. Other triggers include emotions, food additives, weather conditions, indoor conditions, and exercise or food allergies. Asthma UK (2015) states that when your asthma flares up, the usual symptoms are wheezing, coughing and shortness of breath or tightness in the chest. NCBT (2011) explains that wheezing may result from localized or diffuse airway narrowing or obstruction from the level of larynx to the small bronchi. The narrowing of the airway may be cause by bronchoconstriction, mucosal oedema, external compression or partial obstruction by a tumour, foreign body or tenacious secretions.
Page and McKinney (2012) explains how an asthmatic individual’s body reacts when it has exposure to an allergen. Inflammation starts and then the airway becomes obstructed. Obstructed airway can cause airflow obstruction in the lungs which can make an individual wheeze. The capillaries become more permeable, which leads to oedema of the lining of the airways, then creating a decrease in the airway diameter. The smooth muscle around the airway contracts causing even further narrowing of the airways. Exposure to an allergen also cause increased mucus production with someone with asthma because of histamine which can then plug bronchi. Rees (2010) Asthma can affect the trachea, the bronchi and the bronchioles, the disease causes bronchoconstriction or abnormal narrowing of the airways due to epithelial damage, over production of mucus, oedema, bronchospasm and muscle damage. Rees (2010) the epithelium can become damaged and peel away, epithelial peeling away can contribute to airway hyper-responsiveness. Ward et al (2010) asthma will cause mucus-secreting cells to multiply in the airways and the mucous glands to expand.
NCBT (2011) states that cough variant asthma (CVA) is a form of asthma which only symptoms is a cough. Rees J (2015) claims that coughing is one of the body’s natural defence mechanisms and therefore can be helpful for someone with asthma. A productive asthmatic will expel phlegm and mucus from the lungs although with most cases of asthma the cough is non-productive. It’s a response to an irritant that forces the bronchial tubes to spasm. Asthma swells the airways and there is a constriction in the airways when asthma occurs, which then prompts the non-productive cough.
Asthma UK (2016) suggests that dyspnoea in Asthma is usually caused by the narrowing of the airways. The airways can become narrow for one or both of these reasons because the muscle that surround the airways tighten up or inflammation makes the airways swell and fill with mucus. Coke F (2013) claims that in asthma the air passages in your lungs swell up, narrowing the pathway that air enters your lung through. The lack of proper air and the inflammation in the lungs can cause your chest to feel tight. Chest tightness in people with asthma can be a decrease in pressure within the lungs. When your lungs are deflated this is when someone with asthma may experience chest tightness because the muscles around your lungs will press against them. With no air in the lungs, these muscles won’t be supported properly and can contribute greatly to the feeling of chest tightness. Chest tightness is usually a chronic issue that is made worse by certain activities of environmental factors.
McMurray (2010) suggests that it can be very difficult to diagnose asthma because there are no blood tests or definitive radiological investigations that can be done. First of all in diagnosis of asthma you will need a family history but as well as that you will need to obtain some support for the diagnosis. A spirometry test and a peak flow measurement can help in supporting the diagnosis of asthma. Baker, John F (2015) suggests that spirometry measures how much air you can breathe in and out in one breath, so measuring lung volumes and airflows. Spirometry is attest that takes place with all individuals with suspected asthma. The individual performs a forced respiratory manoeuvre, this then measures forced expiratory volume (FVC) and forced vital ratio. Although due to the nature of asthma spirometry may be normal. BTs and sign (2011) spirometry is the main test for diagnosing and monitoring patients with asthma because it show any airflow obstruction. Obstructive spirometry traces are seen in people who have asthma or COPD. Asthma UK (2016) If a spirometry test isn’t successful then an airway responsiveness test can be carried out. In this test the individual will be asked to breathe in a substance that could irritate their airways. This will show how your airways react and trigger asthma symptoms, Feno testing can be used to measure your levels of nitric oxide when you breathe out. Nitric oxide is produced in your lungs when they become inflamed because you are allergic to something that you are breathing in. If you breathe out a high level of nitric oxide then this could be a sign you have inflamed airways and that you have asthma.
Booker (2007) says that PEF stands for Peak Expiratory flow and it measures the maximum flow of air available in the lungs from a forced expiration, starting from a position of maximum lung inflation. Peak flow test might be used to see how open your airways are, maybe when you first tell your doctor you are experiencing asthma symptoms or the test can be used to monitor your asthma using a peak flow diary. This test will be testing how quick you can breathe out. An arterial blood gas test may also be taken to figure out how much oxygen is in your blood or the severity of an asthma attack. Page and McKinney (2012) states that decreased pressure of partial carbon dioxide and increase PH levels. The respiratory muscles become exhausted and CO2 retention and respiratory acidosis is present. This will all be present in a blood gas analysis of a severe asthma attack individual.
BNF (2016) states that corticosteroids are a drug used in Asthma, they help by reducing airway inflammation, reducing oedema and secretion of mucus in the airways. This would then make it easier for asthmatic individual to breathe. As they help control the inflammation and the narrowing in the bronchial tubes. Inhaled corticosteroids do actually have fewer side effects than oral corticosteroids. The side effects are uncommon and usually only occur with higher doses. The side effects can be sore mouth, sore throat, hoarseness, and cough, spasms in the bronchi or fungus infections in the mouth. Other side effects could be decreased bone thickness or clouding of the lens.
So in conclusion we can see that asthma is a disease of the airways