Global Strategy for Asthma Management
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In spite of a constant increase in quantity of specially trained medical professionals such as pulmonologists and allergists, new diagnostic and antiasthmatic means, progress in health care, and diverse alternative therapies, a stable growth of death rates caused by asthma has been registered for the previous several years in the developed countries. Numerous publications testify the growing rates of asthma prevalence among all demographics. Recent research has estimated that nearly 300 million people suffer from asthma throughout the world. The illness is registered in more than 5 % of cases among adult population and twice more often among children (Bateman et al. 143).
The word "asthma" originated from the Greek language, and its literal translation means “asphyxia”, “a short wind”. The more exact name of this illness is “bronchial asthma”. Bronchial asthma is a chronic obstructive pulmonary disease (COPD), which has become a serious global issue of health care systems due to its long duration and slow progression. It requires variable treatment and an ongoing supervision conducted by medical professionals. Asthma does not know age limits; it can develop in childhood or adult life. There is also a hereditary predisposition to this illness, several family members are often ill at the same time.
The disease is caused by the chronic inflammation of respiratory ways due to airway hyper responsiveness; it is accompanied by a sharp change of reactivity and sensitivity of bronchial tubes, and is also shown by the asthmatic status and asphyxia attacks at night or early in the morning. Asthma can be triggered by an allergic reaction of an individual to aspirin and some other medicines, pollen, industrial chemicals, smoke, dust mites, and bacterial allergens such as viruses, bacteria and fungi. Asthma attacks can be provoked by stress or a high level of anxiety, intense physical exercises, and inhaling cold air. Hence, bronchial asthma is generally classified in conformity with the severity of symptoms, causes, and the level of control and methods of treatment.
Two stages of the given chronic disease are distinguished. The initial stage of the bronchial asthma development can be revealed by a way, consisting in the definition of the changed reactivity and sensitivity of bronchial tubes in relation to the physical activity and to a cold air. Partial changes of sensitivity and reactivity of bronchial tubes are caused by disorders in endocrine, immune, and nervous systems which in their turn have no clinical displays and are revealed via laboratory screening, more frequently by the implementation of the loading tests.
The second phase of the disease course is the formation of bronchial asthma. It is not revealed among all the patients; it is followed by a strongly expressed asthma among 20 – 40% of patients. The physical condition before the onset of asthma is not a nosological form but a certain complex of defining characteristics which testify a threat of bronchial asthma.
Symptoms of bronchial asthma vary greatly, they may also be absent within symptom-free periods. The basic signs and symptoms of the mentioned disease are acute asthma attacks or complicated breath; moreover, it is more difficult to make an exhalation than a breath. Thus, frequently, there is a whistling breath which is well heard at distance. The exhalation becomes longer significantly, sometimes 2–4 times exceeding duration of breath. A patient sits in a typical asthmatics’ pose slightly having bent forward, leaning hands on a bed edge; his/her shoulders are raised. Cough is often observed in the beginning and in the end of the attack. The person is uneasy, frightened and catches air with a mouth. The beginning and the end of the attack can be either sudden or gradual. If the attack develops slowly, its harbingers can become the following symptoms and manifestations: a headache, frequent sneezing, watery discharges from a nose, an itch of eyeballs, anxiety, and unmotivated low mood. Easy forms of bronchial asthma are basically taking an atypical course – frequent nonproductive cough, “a whistle” in a thorax disturbs. In addition, asthma is diagnosed on the basis of laboratory tests and analyses.
Bronchial asthma treatment begins with the basic therapy which involves non-hormonal medicines such as intal (sodium cromoglicate), tilade (nedocromil), zafirlukast, or ketotifen (Adcock et al.). If asthmatic attack has already developed, these medicines do not have effect. They are aimed at its prevention. Hormonal preparations such as glucocorticoids of an adrenal cortex have a fast anti-inflammatory effect and help as preventive maintenance of acute bronchial asthma attacks. Inhalation forms are used for the continuous treatment of bronchial asthma. Medicines in the form of pills are prescribed only at exacerbation of bronchial asthma.
There are more effective means for the treatment of bronchial asthma, but they should be strictly supervised by a physician. They are non-medicamentous means such as physiotherapy (electrophoresis, inductothermy, ultrasound, amplipulse, and ultra-violet irradiation), reflex therapy, hyperbaric oxygenation, a laser or ultra-violet irradiation of blood for the treatment of bronchial asthma. In conformity with a patient’s condition the efferent methods, such as hemosorption and plasmapheresis, are utilized. They are based on the blood transmission through the special devices for increasing its quality. A permanent medical control over treatment of bronchial asthma and a patient’s health status is also obligatory (“Global Strategy”). Other methods, such as reflex therapy, special respiratory techniques, homeopathy, and psychotherapy can be widely applied for the treatment of bronchial asthma.
In order to maintain their good health status, asthmatics need physical activity. Research studies and pertinent research publications identify relevant forms of physical activity as an integral component of asthma management (Sucher & Sucher). “An asthma-friendly physical activity program can make a long-lasting impact” on patients with bronchial asthma (Asthma-Friendly School Initiative 250). However, intense physical exercises can provoke asthma attacks. Swimming is a kind of sports that requires high endurance; it is recommended to asthmatics as exercises take place in premises with damp and warm air. Swimming helps a patient with bronchial asthma strengthen his/her breathing muscles and, thus, fight asthma attacks when they happen.
Patients’ health conditions significantly aggravate without deliberate appropriate treatment; specific asthma action plans are developed for each asthmatic. However, numerous patients with bronchial asthma do not adhere to medical appointments and worsen their condition. They decrease their awareness of possible actions in case their asthma symptoms suddenly aggravate and are not aware when to seek medical aid. Bronchial asthma is often complicated by cardiovascular diseases, fluctuations in blood pressure, rhinitis, sinusitis, viral infections and gastro esophageal reflux disease (GERD). Any comorbid disease should be cured, taking into consideration potential adverse effects of medications. Hence, success in bronchial asthma treatment depends on both a patient and a doctor.
Numerous research studies have established a correlation between asthma and comorbid anxieties and depression (Katon et al.; Richardson et al.; Van Lieshout & Macqueen). Asthma attacks involuntarily direct asthmatics at pessimistic thoughts and forecasts of their further destiny. Asthma sufferers know in advance that their illness is incurable and that they have to carry an inhaler and be treated the whole life. Asthmatics usually think of how their relatives and friends perceive their illness. Moreover, they are anxious about their employers’ attitude to their health condition and possible discharge. Such thoughts and perceptions are typical for asthmatics; they are negatively reflected in mentality of patients and their attitudes to the world and surroundings.
Psychological factors can play an important part in asthma. On their own they do not produce asthma in subjects without an underlying susceptibility, but in the laboratory emotional factors and expectation can influence the bronchoconstrictor responses to various specific and non-specific stimuli and the bronchodilator responses to treatment. Stress and emotional disturbance are factors that must be taken into account in the overall management of asthmatic patients (Rees et al. 27).
The major objective of asthma management is the achievement of the best possible quality of life. Patients diagnosed with asthma and their family members should be educated about avoiding specific asthma triggers, maintaining appropriate physical activity, keeping healthy diet, monitoring symptoms and taking both quick-relief medicines and controllers (Global Strategy). They should be aware of methods to prevent, recognize and treat severe asthma attacks, use medications, involving the dosage, route, interactions and possible side effects. Thus, asthmatics require self management education specific to their health conditions. Each patient with bronchial asthma is unique; hence, specified methods of treatment should be developed in each case. An asthma action plan can be changed according to alterations in a patient’s condition.
Asthmatics and their families can participate in different support groups and organisations, such as “'Family Asthma Support Group”, “Easy Breathers”, “Asthma and Allergy Foundation of America” and “COPD-Support”. Patients afflicted with asthma are provided with online support programs which involve video consultations, patients and public education, books, contemporary publications and other educational resources.
In conclusion, bronchial asthma is one of the most widespread diseases worldwide; its rates have increased significantly over the last decades. Statistical data provided by the World health Organization directly testifies to weak efficiency of the existing system of diagnostics, preventive maintenance and treatment of bronchial asthma. However, deliberate appropriate treatment, properly designed asthma action plans, comprehensive education of asthmatics and their families, strict control of health care providers can ease the course of this incurable disease significantly and allow patients to lead normal activity.