Asthma: Definition, Types, Causes - Research Paper Example

Asthma Nowadays, with the intensification of air and environment pollution, scholars (Evans et al, 1997) have d that various lung diseases are spreading widely among citizens, often regardless of their lifestyles and genetic predisposition. Asthma is a chronic disease of the lungs and airways, which affects about 17 million Americans. In most difficult cases asthma becomes a strong concern for the whole health care area, as it might have fatal outcomes (respiratory failure, suffocation). The disease annually kills more than 5,000 people in the United States, and about 450, 000 Americans need hospital treatment for acute symptoms. In spite if its prevalence, medical professionals develop dissimilar definitions of asthma. Health care authorities have quire broad definition that takes into account different factors. For instance, the National Heart, Lung and Blood Institute defines the ailment as: "a chronic inflammatory disorder of the airways (which causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning) usually associated with widespread but variable airflow obstruction that is often reversible, either spontaneously or with treatment" (Evans et al, 1997, p.157). Organizations directed basically toward the satisfaction of informational needs and research, developed another definition which is more understandable for patients. The American Lung Association thus writes that asthma is: "a chronic disease of the lungs in which the airways overreact to certain factors by becoming inflamed or obstructed, making it difficult to breathe comfortably." (ibid, p.158). Several organization view asthma as rather a complex of related diseases than a single ailment. In fact, asthma is a state of lungs in which bronchial airways react to different stimuli with inflammation. The mentioned stimuli, also known as asthma triggers, vary broadly and might include a spectrum from cold air to physical exercise and emotional outburst. Swelling of the bronchial tubes is followed by their constriction and narrowing, so that the person is barely able to inhale. Furthermore, bronchoconstriction (Ducharme et al, 2003) leads to the other unpleasant symptoms, such as wheezing, coughing, sneezing and tightness in chest. "Some people suffer asthma symptoms continuously; others experience them only if exposed to triggers. Regardless of the cause, severe asthma is a serious health concern that can lead to respiratory failure and death" (Wolfenden et al, 2003, p.232). The scholars still debate over the cause of the ailment. Research, conducted by Canadian Asthma Prevention Institute, suggests that heredity and genetic factor play foremost role in the development of the disease and the emergence of the scope of symptoms (asthmaworld.org, 2006). For instance, there is a strong connection between the disease and atopy, the high concentration of antibodies, responsible for allergic reactions, in blood. Vulnerability to environment polluters in this case increases the risk of asthma. The most widespread allergens are microscopic parts of dust mites, plants and flowers, animal dander, aerosols and enzymes (Evans et al, 1997). Earlier research shows that external factors are foremost contributors to the development of the ailment (asthmaworld.org, 2006). Exposure to aforementioned allergens as well as to occupational irritants (fumes, tobacco smokes, vapors) and medications (the most common medicine against hypertension, tachycardia and glaucoma - beta-blockers) might induce severe symptoms and fits. According to the same research report, from 5 to 20 per cent of people suffering from asthma are sensitive to aspirin, naproxen and indomethacin and to sulfites (substances used in food industry to preserve canned fish, dried apples, salads and berries). In addition, the most common allergen constitutes red and orange fruits and berries, such as cherries, oranges, lemons, strawberries and so on. Another group of influential factors includes virus infections, pregnancy, liver and pancreas diseases, climax (or hormonal crisis in women after 50 years old) and even the lifestyle - stressful everyday life and psychological disorders might lead to somatic illnesses (Wolfenden et al, 2003). The main symptoms of asthma are: inflammation, constriction and narrowing of bronchial tubes and related shortness of breath, pain (or discomfort) in chest and coughing, sometimes -headaches, tearfulness. "Except in severe cases, symptoms are occasional. The duration and severity of asthma symptoms vary greatly from time to time and from patient to patient. The symptoms may be intermittent, and they can last just a few minutes or days. In severe cases, symptoms may be constant and persistent" (Wolfenden, 2003, p.232). Medical professionals distinguish two forms of asthma - intrinsic and extrinsic (ibid). The first form usually develops during adulthood and has no obvious external cause (allergic reactions to external irritants), but follows a respiratory ailment or infection such as pneumonia or sinusitis. Intrinsic asthma emerges during weather changes, in stressful conditions (busy job schedule etc) or after physical exercise. Extrinsic asthma is associated with the increase of serum (allergic antibody) rates in blood and appears when the person is having direct contact with the irritant (inhaling aerosols or perfumes). Evans et al also distinguish cardiac asthma that follows heart attacks or other heart failures and has the same symptoms, as a rule, triggered by physical exercise and anxiety. There is a number of methods of asthma diagnosing - examination of siblings' and relatives' medical histories, the patient's history over the last two years, spirometry, challenge test, peak expiratory flow and many other. Physical examination helps detect signs of asthma, as it includes the examination of upper respiratory tract, chest and skin with nasal spectrum and stethoscope. This diagnosing technique is widely used by general practitioners: if there is an asthma threat, they examine thoroughly the adequacy of lung functioning, allergic spots on skin and inside nose. Nevertheless, with regard to technological progress in medical sphere, there are more precise techniques to use for asthma diagnosing. Spirometry, for instance, is the most common modus operandi in lung examination. This test is noninvasive and takes about 15 minutes, during which the special apparatus, spirometer, measures the breathing frequency and depth. The most important variables, measured by this test are following: "1) Vital capacity, which is the maximum amount of air that the patient can inhale and exhale; 2) Peak expiratory flow rate, also known as the peak flow rate, which is the maximum flow rate the person can generate during a forced exhalation; 3) Forced expiratory volume, which is the maximum amount of air the patient can exhale in one second" (Wolfenden et al, 2003, p.233). If certain variable is below normal rate for the patient's age, it might be a symptom of overall airways obstruction. The doctor then asks the client to inhale a bronchodilator drug, which is the most popular asthma maintenance, and to retake the examination. If the patient's measurements increase considerably, they possibly have asthma. Nevertheless, spirometry is not infallible, so many specialists recommend taking several steps of diagnosing, and offer challenge test as an alternative. Challenge test is realized through putting patient under the influence of external irritants in order to detect asthma symptoms. For instance, the client might be asked to inhale chemicals, drugs, cold air or common allergens or to do physical activity. "After inhaling the symptom-producing substance or engaging in physical activity, the patient retakes the spirometry test. If spirometry measurements are still normal, it's likely that they don't have asthma. But if measurements have fallen significantly, it may be an indication that the patient has asthma" (ibid). Peak expiratory flow can be used instead of two above-mentioned techniques. The small hand-held device measures the patient's exhalation rates, i.e. the test is also designed to detect airway obstruction. In many cases asthma is followed by different lung diseases, so the doctor might advise that the patient took additional tests, such as complete blood count (measures antibody rates in blood), chest and sinus X-rays (checks whether the bronchial tube obstruction is caused by asthma or by respiratory diseases so that it will be possible to exclude bronchitis and sinusitis as a factor), computerized tomography (checks overall lung health), gastroesophageal reflux assessment (examines the contribution of gastroenterological factor), allergy test (finds exactly the irritants the patient is allergic to), nitric oxide test (higher rates of exhaled nitric oxide point to the severity of asthma). Asthma prevention includes many aspects: from lifestyle modification to thorough control over one's environment. Asthma prevention might also include taking vitamins or medicine that increases ribosome levels in blood, as these cell components are associated with lung immunity and overall protection from respiratory diseases. In addition, it is necessary to avoid placing dust collectors (heavy carpets and drapes) at home, especially in bedrooms, because individuals become particularly vulnerable to infections and allergens during the sleep. Over the last ten years, the progress of HEPA filters has become tremendous, so it would be useful to have an air filter, especially in those rooms where stuffed animals use to sleep. In order to prevent asthma the use of allergy-proof plastic cover and neutral air fresher is advised, and also one should consider replacing plastic furniture items by those of natural materials, such as wood. For seasonal problems, one should "keep windows closed in the car and home to avoid exposure to pollens and use air conditioning instead" and "stay indoors during the midday and afternoon when pollen counts are at their highest" (www.asthmaworld.org, 2006). Strong odors should be removed from home, as they irritate not merely lungs, but also neural system (influence irradiation and concentration processes and deteriorate sense perception). Self-management is one more component of asthma prevention: the risk groups consist of smokers, alcohol-addicts (ibid) and those with eating disorder (or lack of control over their food). Due to the fact that aforementioned groups are most vulnerable to asthma, it is vital to eliminate or minimize bad habits (if one can't give up smoking, it is possible to reduce nicotine consumed) and to follow heart-supportive diet that includes eating more sea products (Kotses et al, 1995; Gallefoss and Bakke, 1999), white meet, green vegetables and less cholesterol, carbohydrates and exotic fruits. In order to make lungs more resistant, one should do swimming and breath gymnastics (a special set of exercises which also enhance lung function and is included into stress-coping strategy). As it has already been mentioned, asthma is chronic disease, so in this case it is possible to speak about maintenance rather than treatment. "Four classifications of asthma based on frequency and duration of symptoms are used to develop a treatment plan: (1) mild intermittent asthma, (2) mild persistent asthma, (3) moderate persistent asthma, and (4) severe persistent asthma. Patients often move from one classification to another, and the treatment is adjusted accordingly" (Ducharme et al, 2003, p.379). Mild intermittent asthma doesn't need long-term control medication, as its symptoms are episodic, so the only goal of maintenance is the removal of chest discomfort by using bronchodilator. In case of mild persistent asthma the patient should take long-term control medicine such as nedocromil, inhale corticosteroids and leucotriene modifier and naturally needs bronchodilator when symptoms are about to become acute. Two other classes need more complicated maintenance and include using long-term bronchodilator and oral leucotriene modifiers as well as inhalation of concentrated corticosteroids. Asthma medication can be divided into several groups according to the goals and the influence of certain medication. Pharmacological therapy is oriented to several objectives: prevention of clinical picture worsening, recurrent exacerbations, hospitalization and emergency room visits. Quick-relief medications used within pharmacological approach are aimed at removing negative symptoms for next 2-3 hours and thus contain beta2 agonists, which help get rid of airway obstruction and normalize breath frequency. Long-term control drugs include corticosteroids, leucotriene modifiers, necodormil and theophylline. These drugs are used in serious clinical cases, as they have considerable impact on the other body organs (liver, intestine) and might cause problems with hormonal balance (Kotses et al, 1995; Ducharme et al, 2003). There are two kinds of long-term control medications: anti-inflammatory medicine and prolonged bronchodilators, which can be prescribed in case of frequent occurrence of symptoms. Another approach to asthma maintenance is known as stepwise model, which takes into account individual features of each particular patient up to their temperament type and psychological peculiarities. "The initial objective is to abolish symptoms and normalize lung function, then adjust medication appropriately in response to changes" (Gallefoss and Bakke, 1999, p.2001). this approach allows creating specific methods of supporting children and seniors who suffer from the disease. This model also includes the reduction of addiction to short-term bronchodilators, i.e. systematic desensibilization. As an alternative, stepwise therapy opffers dry powder inhalers, metered-dose inhalers and nebulizers. The treatment course sometimes requires hospitalization, as drug delivery is realized by using special devices (inhalators etc), but the effect of the course is quite apparent: the patient can return to normal lifestyle and is no longer dependant on short-term or control medicine. As one might assume, asthma is quite a dangerous disease that demands significant lifestyle changes, so preventative measures are particularly important, since healthy person is usually socially productive. It is barely possible to treat this ailment completely and contemporary health care is only capable of removing unpleasant symptoms such as breath obstruction. With respect to all negative environment issues, asthma prevention is becoming a governmental concern, so everyone should be aware of the negative outcomes of nicotine- and alcohol-addiction and unhealthy nutrition. Reference list 1) Canadian Asthma Prevention Institute (2006). Researching Asthma and the Influence of Nutritional Supplements. Available at: http://www.asthmaworld.org/ 2) Ducharme, F.; Chabot, G.; Polychronakos, C.; Glorieux, F.; Mazer B.(2003) Guidelines for the diagnosis and management of asthma. Pediatrics, 111(2):376-83 3) Evans, D; Mellins, R.; Lobach, K.; Ramos-Bonoan, C.; Pinkett-Heller, M.; Wiessemann, S.; Klein, I.; Donahue, C.; Burke, D.; Levison, M., Levin, B.; Zimmerman, B.; Clark, N. (1997) Improving Care for Children with Asthma: Professional Education in Public Health Clinic. Pediatrics, 99(2): 157-164. 4) Gallefoss, F.; Bakke, P.(1999) How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication Am J Respir Crit Care Med, 160(6):2000-5. 5) Kotses, H.; Bernstein, L.; Bernstein, D. (1995) A Self-Management Program for Adult Asthma. Part I: Development and Evaluation. J Allergy Clin Immunol, 95: 529-40. 6) Wolfenden, L.; Diette, G.; Krishnan, J.; Skinner, E.; Steinwachs, D.; Wu, A.(2003). Lower physician estimate of underlying asthma severity leads to undertreatment. Arch Intern Med, 163(2):231-6 Read More