Course:KIN366/ConceptLibrary/Asthma

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Asthma
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
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Asthma is a respiratory disorder, which involves chronic inflammation of the airways (Miller, 2001). Asthma can be characterized by increased sensitivity and hyper-responsiveness of the airways, bronchoconstriction, increased mucus production, causing decreased airflow, which leads to symptoms such as shortness of breath, wheezing, tightness of the chest, and coughing (Miller, 2001). There is no known cure for asthma; however, in most cases, being aware of potential triggers and the use of appropriate medication can control symptoms (Bender, 2002). Many medical interventions are available that may reduce and prevent the occurrence of asthma attacks (Bender, 2002).

The causes of asthma are nutritional, genetic, and environmental (Asthma Society of Canada [ASC], 2014). Often related to allergies, the triggers of asthma vary greatly between individuals (ASC, 2014). There are currently over 300 million people worldwide who suffer from asthma, with the majority of whom are children (Olin &Wechsler, 2014). It is important that individuals, who are diagnosed with asthma, as well as their caregivers, are well informed and educated on how to recognize and resolve symptoms (Illinois Department of Public Health [IDPH], 2010).

Asthma can range from mild and easily controllable, to severe and life threatening (IDPH, 2010). In most cases, asthma is diagnosed in early childhood. For individuals with mild symptoms, the disorder often decreases in severity throughout adolescence (Iraq, 2010). However, in more severe cases, asthma may exist throughout the lifespan (Iraq, 2010).

Asthma symptoms can be controlled by the use of inhaled corticosteroids on a daily basis (Olin &Wechsler, 2014). Long acting β agonists are also effective when used in combination with corticosteroids (Olin & Wechsler, 2014). Leukotriene antagonists can also be used to reduce symptoms, and can be especially effective in individuals with known allergens and exercise-related symptoms (Olin & Wechsler, 2014). The use of short acting β agonists can neutralize bronchoconstriction (Olin & Wechsler, 2014).

Causes

Although the causes of asthma are complex and not fully understood, researchers strongly believe that factors such as, components of nutrition, genetics, and environment factors, can attribute to the prevalence of asthma (Miller, 2001).

Nutritional Factors

Researchers believe that the occurrence of oxygen radicals may be an underlying cause of asthma (Miller, 2001). Oxygen radicals are often created and released by inflammatory cells (Miller, 2001). Individuals with asthma have been shown to have an increased number of oxygen radicals when compared with individuals who do not suffer from asthma (Miller, 2001). Additionally, asthma patients were found to have decreased levels of vitamin E and vitamin C in the fluid surrounding the lungs (Miller, 2001). Although there is a lack of strong evidence to support zinc and vitamin B12 deficiency as an attributing factor for asthma symptoms, asthma patients were found to have both lower levels of zinc and vitamin B12 when compared with healthy patients (Miller, 2001). However, researchers believe that maintaining optimal levels of antioxidants may help reduce symptoms of asthma significantly (Miller, 2001).

Genetic Factors

Researchers believe there is a 60% inheritance rate for asthma (Olin & Wechsler, 2014). Researchers have found several genes, which are believed to be a predisposition for asthma, these include, ADAM33, PHF11, DPP10, GRPA and SPINKS (WHO, 2004). Genetics may also influence the level of severity of asthma, as well as how an individual will respond to treatment (Chipps, 2004). The presence of genes that are linked to asthma, does not guarantee that an individual will develop symptoms (WHO, 2004). However, an individual who does possess these particular genes, are more likely to be susceptible to triggers within the environment (WHO, 2004).

Environmental Factors

The onset of asthma symptoms can be caused by numerous factors within the environment, which are referred to as triggers (IDPH, 2010). Environmental triggers affect the chances of an individual developing asthma as early as in-utero. (Baena-Cagnani et al., 2009) Individuals with allergies and allergic rhinitis are at a greater risk of developing asthma (Miller, 2001). The most prevalent inflammatory triggers are dust mites, animals, cockroaches, molds, pollens, viral infections and some air pollutants (Miller, 2001). Other environmental triggers, known as irritants, include vapors, air pollution, cold air, medications, cleaning products, upper respiratory tract infections, weather, as well as physical activity (IDPH, 2010).

Signs and Symptoms

Asthma results in shortness of breath, coughing, wheezing, and a feeling of tightness of the chest (Miller, 2001). Symptoms can vary greatly between individuals, however, if symptoms are left untreated, they can often become debilitating to one’s quality of life (Miller, 2001). Asthma patients, who have an increased amount of symptoms at night, will often have disturbed sleep patterns (Miller, 2001). Symptoms can be mild, which can be easily treated with self-administered medication, or they can be severe, and may be life threatening and require emergency treatment (Miller, 2001). In most cases, asthma symptoms worsen with the presence of a respiratory infection, such as the common cold (IDPH, 2010). Symptoms will also worsen in the presence of a known trigger, as well as during physical activity, with symptoms varying greatly throughout the day and on a weekly basis (Iraq, 2012).

Diagnosis

The diagnosis of asthma can be complex and must be done by a qualified physician (ASC, 2014). It not only involves the direct diagnosis of asthma itself, but also the ruling out additional respiratory diseases with similar symptoms (ASC, 2014). The diagnosis of asthma is based on the symptoms an individual will experience, when these symptoms occur, family history is examined closely as well as the exclusion of diseases which may produce similar symptoms (Iraq, 2012). A physician will administer several physical tests and have conversations with the patient, in order to determine the diagnosis (Iraq, 2012).

The most common physical test administered by physicians in order to measure lung function, is to measure the rate of air expulsion, using a peak flow monitor or spirometer (ASC, 2014). The patient will be asked to breathe in deeply and then exhale forcefully for as long as they are able to (Canadian Lung Association [CLA], 2012). While testing for asthma, doctors also closely examine if asthma is present in the patient’s family history (Iraq, 2012). Since there is a 60% link to genetics, having a parent or close relative with asthma greatly, increases the chances of an individual symptoms being caused by asthma (Olin & Wechsler, 2014). While symptoms, tests and family history may point towards asthma, physicians must still have to rule out the chance that the patient doesn’t suffer from a different condition (ASC, 2014). In most cases, asthma can be diagnosed in early childhood with many symptoms visible before the age of 5 (Iraq, 2012). For many individuals, the symptoms are transient, and often people are uncertain on whether they suffer from asthma (ASC, 2014).

Epidemiology

Asthma affects the lives of roughly 300 million individuals worldwide (Olin & Wechsler, 2014). With more options for the treatment of asthma, the number of deaths caused annually has decreased. Currently, asthma is responsible for the deaths of 250 000 individuals each year (Olin & Wechsler, 2014). The prevalence of asthma within the population has a significant impact on healthcare expenditures, with a significant amount being spent worldwide (Olin & Wechsler, 2014). Approximately 11.6% of children throughout the world, aged 6-7 years old have developed symptoms (Olin & Wechsler, 2014). There are particularly higher rates of asthma within urban areas when compared to rural areas within a population (Olin & Wechsler, 2014). Asthma is also more likely among individuals with low incomes; with approximately 13.5% of children of low-income families within the U.S., are diagnosed with asthma (Olin & Wechsler, 2014). Within the U.S., the number of individuals diagnosed with asthma has increase from 7.3% to 8.2% between 2001 and 2009, which may be attributed to environmental factors, as well as lifestyle factors, with physical inactivity becoming more prevalent among the population (Olin & Wechsler, 2014).

Treatment and Prevention

An important part of asthma treatment is to prevent the onset of symptoms. (IDPH, 2010) The most effective way to prevent symptoms is through diet, regular exercise and general avoidance of personal triggers whenever possible (IDPH, 2010). Often individuals who suffer from asthma will avoid physical activity, believing that it is a trigger, when it fact it is a critical prevention method (IDPH, 2010). By participating in physical activity, individuals increase the muscle strength of their upper body, increasing the flow of mucus from the bottom of the lungs; therefore allowing the lungs to function better (IDPH, 2010). For children diagnosed with asthma, it is important that they participate in physical education classes in school and become involved in sports (IDPH, 2010). Practitioners should work with parents to be aware of the risks and limitations of the child, as well as understand the importance of the child’s medications (IDPH, 2010).

Individuals with asthma will often avoid dairy products, as many believe this will increase the accumulation of mucus within the body (IDPH, 2010). In fact, dairy products only negatively influence an individual if; they have an existing dairy allergy (IDPH, 2010). Individuals suffering from asthma should follow a well balanced, healthy eating plan involving, fruits, vegetables, whole-grains, low-fat dairy products, meat and alternatives unless, they have any particular allergies (IDPH, 2010). Preventative methods are not usually sufficient to fully treat symptoms, therefore, in most instances; the use of medication is required (IDPH, 2010).

Depending on the severity of the asthma there are two types of medication physicians will prescribe, either controllers or relievers (ASC, 2014). In most severe cases individuals will be given both (ASC, 2014). Controllers, such as inhaled corticosteroids and long acting β agonists, are used on a daily basis to prevent the constriction of the airway muscles and to reduce the inflammation of the lungs (ASC, 2014). The goal of controllers is to avoid permanent lung damage and decrease the need for relievers (IDPH, 2010).

Relievers, such as short acting β agonists, are used in acute situations where immediate relief is required (ASC, 2014). During a sporadic attack, coughing, wheezing or severe shortness of breath, relievers are used in order to relax the muscles bands around the airways and relieve bronchoconstriction (IDPH, 2010). Relievers do not treat the underlying problem of inflamed airways; however, they can be used as a preventative method by being taken 5-15 minutes prior to physical activity (IDPH, 2010).

Researchers believe that patients who require the use of relievers three or more times per week should be prescribed a low dosage of inhaled corticosteroids in order to reduce chronic inflammation and prevent acute attacks (Jenkins, 2006). The use of inhaled corticosteroids has been shown to increase lung function and control of symptoms when compared with patients who solely rely on the use of short acting β agonists (Jenkins, 2006). The use of long acting β agonists is often used in combination with inhaled corticosteroids and can be more effective in some patients, rather than increasing the dosage of inhaled corticosteroids (Jenkins, 2006).

Practical Applications

Asthma is a chronic lung disease with a great deal of individual differences (ASC, 2014). Individuals who suffer from asthma have many variations of triggers, levels of severity, and response to treatment, which varies greatly from one to person the next (IDPH, 2010). It is important for each individual to understand their triggers and the most effective ways to control their symptoms (ASC, 2014). When the patient is a child and too young to be in control and fully understand, it is important for the parent or guardian, teachers and coaches to be properly educated (IDPH, 2010). A parent or guardian should be in complete understanding of their child’s asthma and particular triggers that may create symptoms (CLA, 2014). It is important that they talk to their child’s physician in order to understand triggers and severity of their child’s asthma. (CLA, 2014) Additionally, it is especially important to understand the medication that is needed, and when to properly administer this medication to their child (CLA, 2014). With this information, they will have the resources to develop diet and exercise plan, knowing not only the importance but also the limitations of physical activity for their child (IDPH, 2010). As a parent or guardian it is important to not only know how to control their child’s asthma but also, to properly convey the message to teachers and other practitioners when necessary (CLA, 2014).

A teacher, coach or any practitioner working with children need to know the importance of physical activity in aiding the lung function of children with asthma (IDPH, 2010). It is important for them to symptoms, triggers, and the proper treatment of asthma, in case of the event that a student should require assistance when experiencing an asthma attack during class or practice (U.S Department of Education [USDE], 2001). A practitioner should know the increased importance of a proper 10-minute warm up and 10-minute cool down, which can greatly reduce the incidence of symptoms arising during the main exercise (IDPH, 2010). Students should always have a relieving inhaler within quick reach with them at all times (IDPH, 2010). If the child is still experiencing symptoms following the use of medication, exercise should be stopped immediately (Lucas & Platts-Mills, 2005)). Practitioners need to know that children with asthma can experience symptoms in cold weather and in environments with increased pollen, such as freshly cut grass, and should avoid intense physical activity in these environments (USDE, 2001). Additionally, children should not exercise when they are experiencing a respiratory infection, such as the common cold (USDE, 2001). It is important that practitioners and caregivers work together to allow all children with asthma the opportunity for physical activity to promote proper development and help prevent their asthma symptoms (IDPH, 2010).

It is important that all children and parents or guardians follow the recommended daily exercise of at least 60 minutes of moderate to vigorous intensity, at a minimum of 3 days per week for ages 5-17 years old (Canadian Society for Exercise Physiology [CSEP], 2015). Engaging in muscle and bone strengthening exercise at least three days per week is also beneficial for children in order to lead a healthy, active lifestyle (CSEP, 2015). However, small sessions of physical activity have been shown to create significant health benefits and reduce the symptoms of asthma, which ultimately may lead decreased reliance upon medications (Lucas & Platts-Mills, 2005). A sedentary lifestyle, with decreased physical fitness in childhood, can put an adolescent at risk for developing asthma (Lucas & Platts-Mills, 2005). If a child is not physically fit, it is important to slowly introduce physical activity at low to moderate intensity, such as walking or playing, and gradually introduce different activities of varying intensity (Lucas & Platt-Mills, 2005). Children, who have their asthma under control with the use of medication, are encouraged to participate in sports they enjoy (Asthma Initiative of Michigan [AIM], 2015). However, children and their parent or guardian should carefully consider the seasons in which their sport takes place (AIM, 2015). Spring sports for example, often entail exercising with increased amounts of pollen in the environment, therefore, parents or guardians should discuss this with the child’s physician to ensure the proper medication and dosage is provided in order for the child to be able to participate in relatively any sport (AIM, 2015). Children and parents or guardians are encouraged to keep a journal of the child’s physical activity and write down instances in which they experienced symptoms, in order to assist their physician in determining specific triggers (AIM, 2015).


References

Asthma Society of Canada (2014). What is asthma? Retrieved from http://www.asthma.ca/adults/about/whatIsAsthma.php

Asthma Institute of Michigan (2015). Sports, other activities, and asthma. Retrieved from http://getasthmahelp.org/kids-sports.aspx

Baena-Cagnani., Carlos, E., Gómez, Maximiliano, R., Rodrigo, Canonica, & Walter (2009). Impact of environmental tobacco smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis. Current Opinion in Allergy & Clinical Immunology, 9(2), 136-140. doi: 10.1097/ACI.0b013e3283294038

Bender, B.G. (2002). Overcoming barriers to nonadherence in asthma treatment. Journal of Allergy and Clinical Immunology. 109(6) S554-S559. doi:10.1067/mai.2002.124570

Canadian Lung Association (2014). For parents with children who have asthma. Retrieved from http://www.lung.org/lung-disease/asthma/living-with-asthma/parents-with-children.html

Canadian Society for Exercise Physiology (2015). Canadian physical activity guidelines and canadian sedentary behaviour guidelines. Retrieved from http://www.csep.ca/english/view.asp?x=949

Chipps, B.E. (2004). Determinants of asthma and its clinical course. Annals of Allergy, Asthma & Immunology. 93, 309-316. doi: http://dx.doi.org/10.1016/S1081-1206(10)61388-9

Illinois Department of Public Health (2010). What is asthma? Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download? doi=10.1.1.395.6917&rep=rep1&type=pdf

Iraq, I. (2012, July). Guidelines for the diagnosis and management of asthma. primary health care project. Retrieved from http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1& ved=0CCkQFjAA&url=http%3A%2F%2Flmsphciraq.org%2Fsites%2Fdefault%2Ffiles%2Fncd_asthma_guidelines_english.docx&ei=6ckOU_-BKY-IogT4iICACw&us

Jenkins, C. (2006). Starting steroids for asthma. Australian Prescriber. 29(3), 63-66. Retrieved from http://www.australianprescriber.com/magazine/29/3/63/6

Lucas, S.R., & Platts-Mills, T.A.E. (2005). Physical activity and exercise in asthma: relevance of etiology and treatment. Journal of Allergy and Clinical Immunology, 115(5), 928-934. doi:10.1016/j.jaci.2005.01.033

Miller, A.L. (2001) The etiologies, pathophysiology, and alternative/complementary treatment of asthma. Alternative Medicine Review, 6(1), 20-47. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11207455

Olin, J.T., & Wechsler, M.E. (2014). Asthma: pathogenesis and novel drugs for treatment. British Medical Journal, 349, 1-11. doi: 10.1136/bmj.g5517

U.S Department of Education (2001). Managing asthma: a guide for schools. Retrieved from http:/ /www.nhlbi.nih.gov/health/prof/lung/asthma/asth_sch.pdf

World Health Organization (2004). Genetics and asthma. Retrieved from http://www.who.int/ genomics/about/Asthma.pdf