Asthma Management Guidelines in Older Adults - Assignment Example

Clinical Epidemiology 3 Question Asthma Management Guidelines in Older Adults Introduction Asthma has today become a disease affecting all age groups contrary to traditional beliefs that it was a disease that affected children. In fact, Asthma affects elder adults more than it does children and young adults. In short, Asthma in elder adults poses more health risks than it does in younger adults and children. As such, the treatment and management of Asthma in older adults should be done as soon as the diagnosis has been made. This is because Asthma-related deaths are highest in this age group than in all others (Harver & Kotses, 2010). The complexity of the disease is attributed to aging which causes a decrease in the cell immunity, airway diameter, pulmonary functions, sensation of dyspnea, and pulmonary muscle strength. Collectively, these factors make Asthma in adults more complicated than in younger age groups. This in turn calls for effectiveness in treating and managing the disorder. Management Guidelines According to Rance and O’Laughlen (2014), asthma is normally treated and managed using regular inhaled corticosteroid (ICS) treatment and/ or using short-acting beta2agonist (SABA). ICS may be prescribed alone, or at times, depending on the severity of the asthma, additional SABA may be added as needed. The National Asthma Council of Australia, through its Australian Asthma Management Handbook, applies the same treatment and management guidelines in controlling asthma in elder adults. It takes into consideration all the factors that may influence asthma development or persistence and in it provides the most effective asthma management guidelines. They are evaluated below. Short-acting beta2 agonist treatment This treatment method is initiated after diagnosis indicates that the elderly patient has asthma. For SABA treatment to be prescribed, the elder adult should not be using a preventer. SABA treatment is recommended if the patient experiences asthmatic symptoms twice a month or less, and not more. Again, they should not have had any flare-ups which required oral corticosteroids in the last 1 year (12 months). In this case, SABA treatment is given as needed, meaning the physician determines the treatment (National Asthma Council Australia, 2015). Inhaled corticosteroid treatment In the event that the elder adult experiences asthmatic symptoms more than twice a month, regular ICS treatment is prescribed. It is usually initiated at low doses and SABA treatment is added as required. The same treatment is offered if the elder adult has been forced to wake up due to asthmatic symptoms even once in the last 30 days (1 month). In the event that such a patient experiences frequent daytime symptoms of asthma, the physician may prescribe a private prescription of a combination of low dose LABA (long-actingbeta2 agonist treatment) and ICS. There is also the option of prescribing medium to high ICS dose and additional SABA as required (National Asthma Council Australia, 2015). If the elder adult has a history of admission to ICU due to acute asthma or artificial ventilation, they are treated with regular ICS which is initiated as a low dose combined with SABA as required. In this case, close and frequent monitoring is required to assess the effectiveness of the treatment. In the final scenario, if the elderly adult is not currently using a preventer and has very troublesome and/ or uncontrollable symptoms, regular ICS treatment plus SABA is prescribed. This case may also call for a private prescription of combined LABA and ICS treatment. In the case of very uncontrolled asthma such as low lung functionability and frequent night waking, two options of treatment may be considered by the physician. First; oral corticosteroids plus ICS treatments, and second; ICS in high dose which is then down-titrated as the asthma symptoms improve (decrease). How the guidelines were made These guidelines, according to the Australian Asthma Management Handbookwere made after considerable expert opinions and clinical experiences were evaluated (National Asthma Council Australia, 2015). They were also informed by evidence. In elaboration for instance, the physicians who were involved in the creation of the guidelines had prior knowledge regarding asthmatic symptoms in elder adults. As such, they knew the type or stage of asthma and their associated management treatments. For instance, the fact that if the patient experienced asthmatic symptoms twice a month or less would react well to SABA treatment made this an effective guideline. Again, symptoms such as frequent daytime asthma attacks were proven to be improved by a combined ICS and LABA treatment. Therefore, in backing the guidelines with prior evidence that had worked, the National Asthma Council of Australia provided effective asthma management strategies. Question 2: Study onDoctors’ Beliefs, Practices, and Opinions Regarding Asthma Management Background of study Asthma is treated or managed by using clinical interventions such as ICS, SABA, and LABA treatments to keep the symptoms low. This is because asthma attacks have the capacity to interrupt an individual’s day to day life. In a nutshell, asthma management is about keeping the symptoms to the minimal so that they do not interrupt with one’s quality of life such as waking one up at night or interrupting day to day activities. Additionally, the aim of asthma management is to ensure the patients do not need to use their reliever medications more than twice weekly or have daytime symptoms. Following all these objectives of asthma management, asthma specialists have devised different management methods which sometimes match or contradict with those of others. Points of contradiction vary from the type of diagnosis to the prescription of drugs and dosage. The contradictions emerge in the sense that some specialists feel that some management strategies are effective while some feel that they are either ineffective or overdone. Research question In the above revelation, it is revealed that asthma specialists are not in agreement regarding the management or control of asthma. In explanation for instance, some specialists may feel that ICS is the best method for keeping mild asthma symptoms at minimal levels. Similarly, others may feel that low-dose LABA treatment is the best while others may suggest overly different asthma management strategies (Kriner et. al, 2003; Boluyt et. al, 2012). In the light of this, this study acknowledges that the issue of asthma management is controversial amongst asthma specialists and seeks to answer the research question Do all asthma specialists agree on the existing asthma management strategies? The approach Previous quantitative studies have proven that indeed, asthma management is a matter of urgency in the health care fraternity. This is supported by the fact that multiple asthma management strategies have been proposed to address the issue. Additionally, previous studies have shown that several asthma management strategies exist and that they differ in terms of effectiveness, application, and acceptability. However, none has considered the opinions, practices, and beliefs amongst asthma specialists regarding asthma management. As such, the controversy that exists within the asthma specialists has not been offered the criticality it requires. Following this and other revelations, this study will seek to not highlight the varying practices, opinions and beliefs within the asthma specialists. In this, the study acquires its effectiveness. In answering the stated research question, this study will seek to reveal the exact opinions and beliefs of asthma specialists. In doing so, and to acquire the most relevant and accurate information, the study will not rely on previous studies or sources but will conduct one-on-one interviews with the asthma specialists. The one-on-one interviews will target asthma specialists that have existed in the health care context for at least ten (10) years. This will ensure that they have sufficient experience with asthma management. This experience will in turn enable the study to derive accurate and informed information from them. The interviews will utilize a questionnaire prepared in advance with open-ended questions and also investigate questions that require explanations. For example, the open-ended questions may go, “do you believe in any one asthma management strategy?” On the investigate questions, statements such as, “please explain why you believe that ICS is an effective asthma management strategy” will apply. Why this approach? The one-on-one questionnaire-assisted interview approach with asthma specialists is chosen for multiple reasons. First, it does not rely on previous findings meaning that the data collected will be updated and relevant. Second, the fact that the interview derives direct answers from the specialists themselves and not third parties adds to the credibility and accuracy of the study’s findings. This is because third parties may distort or misreport their findings. In a nutshell, the expected findings will be first-hand. Third and finally, since the specialists have been in the health care context for long enough, they are likely to provide the most accurate information which is informed by their experience. Therefore, this study expects to provide accurate and well-informed findings. Collecting data Several health care institutions that provide asthma treatment will be selected for the study. Fifteen (15) minute appointments will be booked prior to the interviews. This will prevent surprise visits which may not augur well with medical practitioners who are always busy. Again, the duration will not utilize too much of their time. Data will be recorded in the questionnaires as the respondents provide their answers. Analyzing data The filled questionnaires will be collected and each question’s response recorded. All the question “1s” will have their responses grouped together, same as all the other questions. After this, the responses will be evaluated and counted. In the first case, the most mentioned asthma management strategies will be revealed. In the second case, percentages will be used to analyze the “yes”, “no” and related responses. From these, final conclusions will be deducted regarding the opinions, practices, and beliefs of asthma specialists regarding existing asthma management strategies. From these conclusions, the study will reveal whether or not asthma specialists agree or disagree with the existing asthma management strategies. Ethical considerations In achieving a successful study, several [applicable] ethical considerations will be made. These are meant to ensure a moral analysis framework for analysis is followed and that the decisions and/or conclusions made will be justifiable under the health care context. The first ethical consideration that this study will make is that the information provided is derived strictly through the respondent’s consent. This consent will be made after the respondent is told what the study is all about and what id expected of them. Again, the respondent must give the consent freely, that is, no coercion should be utilized. The second ethical consideration to be made is the confidentiality of the information given. This will be assured to the respondent before the interview begins (Rogers & Draper, 2003). In this, the respondent might provide information that might otherwise be termed confidential or classified and should not be exposed. Again, if it is to be exposed, the respondent might request not to be mentioned. Such considerations will be considered and adhered to fully. References Boluyt, N., Rottier, B., Jongste, J., Riemsma, R., Vrijlandt, E., & Brand, P. (2012). Assessment of Controversial Pediatric Asthma Management Options Using GRADE. Pediatrics, 130(3), 658-668. Harver, A., & Kotses, H. (2010). Asthma, Health and Society: A Public Health Perspective. New York: Springer. Kriner, P., Bernal, Y., Binggeli, A., &Ornelas, I. (2003). Attitudes, beliefs and Practices Regarding Asthma care Among Providers and Adult Asthmatics in Imperial County. Californian Journal of health Promotion, 1 (2), 88-100. National Asthma Council Australia. (2015). Process for development of Content. Retrieved on June 3, 2015 from http://www.asthmahandbook.org.au/about/methodology/development National Asthma Council Australia. (2015). Starting treatment and reviewing Response in Adults. Retrieved on June 3, 2015 from http://www.asthmahandbook.org.au/diagnosis/adults/starting-treatment Rance, K., & O’Laughlen, M. (2014). Managing Asthma in Older Adults. The Journal for Nurse Practitioners, 10 (1), 1-9. Rogers, W., & Draper, H. (2003). Confidentiality and the Ethics of Medical Ethics. Journal of Medical Ethics, 29 (4), 220-224. Read More