Asthma is a disease of increasing magnitude in the UK (LAIA 2002) where the incidence is now among the highest in the world. There is little evidence that this will change in the future (ISAAC 2005). There has been an increase in both the prevalence and incidence of asthma and, although this could in part be attributed to improved diagnostic skills (European Community Respiratory Health Survey 2003), this is not the sole reason for the increase (ISAAC 2005).
British Heart Foundation (2003) statistics show that mortality from coronary heart disease is falling significantly, and, although the number of asthma deaths is small by comparison, the static nature of asthma mortality rates is alarming especially because asthma deaths are probably more preventable than those from direct cardiac causes are.
Asthma is defined as narrowing of the airways, which is reversible either spontaneously or because of treatment. The well-known symptoms of asthma are shortness of breath, wheeze and cough which may develop suddenly, in an acute attack, or over a period. Nurses need to be aware that adult people with asthma who experience breathlessness associated with activities of daily living, such as putting out washing or walking up stairs, may discount these symptoms and put them down to old age and lack of fitness, when in fact it may be their asthma becoming increasingly active and uncontrolled.
The Stages of an Acute Attack are very terrible for the affected patients. These symptoms often start out similar to a usual attack; coughing, wheezing, shortness of breath and recession (drawing in the flesh between the ribs and sternum). In an acute attack, however, the symptoms persist, and become more marked or even change in nature.
The asthmatic often becomes quiet and withdrawn, focusing on the struggle to breathe. The patient sits hunched over, which enables the muscles of the upper body to help expand the chest and consequently the lungs.
Breathing becomes laboured. The expiration is longer, the wheeze becomes louder, and the inspiration is a short harsh gulp. Recession will become marked.
Inflammation can be identified by mucosal infiltration with inflammatory cells, oedema of the bronchioles, hypertrophy of smooth muscle and damaged epithelium. Therefore, asthma is a combination of bronchoconstriction and inflammation of the bronchioles.
Some major asthma-related issues need to be addressed, particularly for adults. Asthma associated mortality has decreased in all age groups except for people over 65 (LAIA 2001) and it is of concern that adults are not benefiting from this general trend.
Interestingly, the admission rate to secondary care for asthma has declined by 27 per cent from 2000/92 to 2002/00 (LAIA 2001) across all age groups. This would indicate that acute exacerbations of asthma requiring secondary care are reducing. The associated morbidity of asthma, however, does not follow this pattern (Kim et al 2002).
There is strong evidence (Braman 2003) that a large proportion of people with asthma experience significant signs and symptoms of poorly controlled disease (Yernault 2001). There are probably many reasons for this, including a lack of diagnosis of asthma (Dow 2005), limited access to appropriate health care (Enright 2002) and poor patient understanding of signs and symptoms (Ekici et al 2001).
Davies-Gray (2000) suggests that 'for many years asthma was viewed by the ...
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