Clinical Guidelines for Asthma

Definition of Asthma

Asthma can be defined as the chronic respiratory disease, characterised by bronchial constriction, airway obstruction, and wheezing and coughing. The symptoms displayed during an asthma attack are likely to vary amongst different patients, along with the patients’ severity of the condition (Global Initiative for Asthma, 2016). There are different types of asthma that present different set of symptoms that are known as phenotypes. The four identified phenotypes of asthma include:

  1. Allergic asthma: the easiest type of asthma to identify that usually occurs on early childhood. It is associated with a family history of asthma or related diseases, such as eczema, chronic rhinitis, and allergies. Patients with this asthma tend to respond well to inhaled corticosteroids (ICS) for treatment;
  2. Non-allergic: this type of asthma presents in adults;
  3. Late onset asthma: some people, mostly women, experience symptoms in their adulthood. This tends to be a non-allergic asthma;
  4. Fixed asthma limitations: caused by long term asthma, which, thus, results in the re-modelling of the airway walls.
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Diagnosis of Asthma

The most important aspect for the diagnosis of asthma is to identify patterns, associated with respiratory symptoms, such as wheezing, dyspnea, tight chest, and limitations in expiration. These are important to document, since these patterns can be associated with acute of chronic conditions, with the exception of asthma. However, there are different methods and tests used for the diagnosis of such disease. Clinical practice guidelines often use the following items.

Family history. A family history of asthma increases the probability that any respiratory symptoms suffered by the patient are likely due to asthma symptoms displayed in childhood, such as eczema and allergic reactions.

Physical examinations. These examinations are vital in picking up symptoms that can be useful in the diagnosis of asthma. Typically, in a physical examination for the diagnosis of such disease the following would be tested:

  1. Expiration: This is the most common abnormality, presented in asthma sufferers;
  2. Lung Function: this gives an indication of the extent expiratory airflow limitation.

The Management of Asthma

According to Global Initiative for Asthma (2016), the long- term goals for asthma management and treatment are:

  1. To achieve optimal control of symptoms and maintain normal activity levels;
  2. To minimize future risk of asthmatic symptom flare-ups, fixed airflow limitation as well as side-effects.

In addition, it is important to mention that the patients’ wishes for the treatment of their condition should also be taken into consideration, regardless of how unconventional they may. The management of asthma can be achieved by various methods, if one takes into account different healthcare systems, medical availability, and personal preferences. Therefore, the key elements needed for the long-term control of asthma are as follows:

  • A trusting relationship between patients with asthma and their healthcare givers;
  • Medical literacy, which does not only concern a patients’ ability to read, but to process and comprehend their condition, as well as for them to be capable of understanding what needs to be done for the effective management of their illness.
  • The management of asthma requires a substantial amount of resources, medication as well as access to health care facilities on a regular basis.

When it comes to the process of asthma management, the disease treatment should be evaluated on a continuous basis to ensure that the treatment relates to the severity of the condition. If the symptoms in the patient increase, then treatment should be increased as well, and if the symptoms decrease, so should the patient’s asthma medication. In such instances, medical options for the long-term management of asthma are:

  • Controller medications, which is used for regular maintenance treatment, i.e. the reduction of airway inflammation, future risks, and flare ups;
  • Reliever/rescue medication that offers short-term relief and prevention in situations, such as exercise induced bronchoconstriction. The success of the long-term management of asthma would to eventually phase out the use and dependency on reliever medication;
  • Add-on medication of severe asthma, which means only patients with persistent symptoms of the disease, despite their high doses of controller medication, qualify for this treatment.

The NHLBI (National Heart, Lung and Blood Institute) declares that there is enough scientific evidence to believe that people who have access to proper healthcare can enjoy the following benefits:

  • No or very little asthma symptoms;
  • No/minimal awakenings during the night due to asthma symptoms;
  • No need for absenteeism from school or work due to such disease;
  • Full participation in physical activities;
  • No need for hospital stays;
  • Few or no side effects from asthma treatment medication (National Institutes of Health, 2011).

Disparities in Asthma Treatment in the US and Other Countries

There are wide disparities when it comes to the treatment of asthma in the USA and lower income/developing countries. In the initial epidemiological reports released on the disease, it was shown that the population of high income earning classes were the most prevalently affected by asthma symptoms, but the severity asthma was most prevalent in the lower earning class. The cost of a person suffering from asthma can vary from country to country, but in 2016, the average cost was estimated at approximately $ 1900 in Europe and $ 3100 in the USA (Nunes, Perira, & Morais-Almeida, 2017).

It is obvious to pick up that asthma is an expensive condition, mainly because it is usually suffered throughout one’s life. In addition, it is a massive healthcare problem, since it can result in many unexpected hospital admissions, decreased productivity because of people missing days of work/school due to asthmatic symptoms, as well as premature death. Many 3rd World Counties do not have the capital to absorb the costs of asthma, as well as the infrastructure to manage the condition adequately.

In lower income countries, asthma guidelines are difficult to enforce, and research needs to be conducted on whether treatment methods carried out in developed countries are effective in the 3rd World Countries. Therefore, there are many cultural, geographical, and social factors that need to be taken into consideration with the implementation of new treatment in different countries. Preventative care, early detection, and early treatment could help alleviate the economic burden, presented by asthma disparities. Eventually, there are many barriers to achieving better healthcare, and they include poverty, poor education, poor sanitation, lack of infrastructure, poor nutrition, and poor access to information.

 

References

Nunes, C., Perira, A. M., & Morais-Almeida, M. (6 January 2017). Asthma costs and social impact. Retrieved on Feb. 18, 2017, from https://asthmarp.biomedcentral.com/articles/10.1186/s40733-016-0029-3

National Institutes of Health. (February 2011). Asthma guidelines. Retrieved on Feb. 18, 2017, from https://www.nhlbi.nih.gov/health-pro/resources/lung/naci/asthma-info/asthma-guidelines.htm

Global Initiative for Asthma. (2016). Global strategy for asthma management and prevention. Retrieved on Feb. 18, 2017, from http://ginasthma.org/wp-content/uploads/2016/04/GINA-2016-main-report_tracked.pdf