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Respiratory and Cardiovascular Related Disease

Introduction to Asthma in Australia

Asthma is a chronic respiratory condition which mainly impacts airways of lungs (Pandey, 2020). These airways are directly responsible for airway conduction, which helps in smooth facilitation of normal respiratory pattern in individuals. These air passages can be in the form of bronchial tubes, which allow the influx and efflux f air through them. Thus, enabling a normal ventilatory pattern.

Prevalence in Australia

As per statistical reports collected based on self-reported data, around 2.7 million Australians have been found to be suffering from asthma. This data was collected under the National Health survey (NHS), conducted by Australian Bureau of Statistics during the period of 2017-2018. In terms of gender and age group, asthma is observed to be more commonly occurring in boys aged between 0-14 years as compared to their female’s counterparts (Australian Institute of Health and Welfare, 2020). However, as the age progresses to the age group of 45 years and above, the condition of asthma is more commonly observed in females as compared to the male population. These changes can also be attributed to the respective changes in the anatomical structure changes observed in the population group. The changes are commonly observed in respect with changes in the airways size and the hormonal variations that comes with the advancing age in development phase. It can also be considered due to differences in the environmental exposure observed in the adolescent development. The indigenous population group is also found to be affected by this condition, adding to the healthcare burden of these population group. As per the survey conducted in 2018-2019, more incidence of asthma has been observed in females as compared to males. The overall prevalence of the condition of asthma, was also observed to be two times higher in indigenous population as compared to the non-indigenous Australian population (Australian Institute of Health and Welfare, 2020). This difference of prevalence amongst indigenous and non-indigenous group, has been found to vary over the past few years. Still the condition of asthma can be observed as an added burden to the indigenous population well-being.

Pathophysiology

Condition of chronic asthma mainly occurs due to combination of two responses. These are inflammation and hyperresponsiveness of the air passages (Neerincx, 2017). The exact causative factor contributing to the manifestation of asthma is still unknown, however, it is usually observed with a response to atopy. This is a tendency of the body system to reaction towards the external mediators, regulated by IgE factor (Bergantini, 2020). With an increased bronchial inflammation and airway constriction, there can be an increased resistance observed in the air passages. This can be observed as symptoms of cough, wheezing, and marked shortness of breath. The main source of inflammation can be considered as external responses, which affect the trachea and the smaller bronchioles. This causes the overdilation of the airway capillaries and thus leading to microvascular leakage. The process of inflammation is also marked by increased mucus production by the mucus-producing cells in the air passages (Cavalcanti, 2020). Due to an imbalance in the mucus production and elimination, there is a reduced mucus clearance in the lung tissues. The condition persists longer in patients as the enzymes which are responsible to bring about a decrease in inflammatory response, are generally having a lower impact. This enables the symptoms and affects to last longer than the anticipated timeframe. Due to persistent inflammation, there is an increased epithelium peeling, which can be observed as hyperresponsiveness of the air passages (Caminati, 2019). The condition of asthma when progresses and left untreated, can lead to chronic damage to the epithelium and ending in the manifestation of stage of remodeling (Cañas, 2018). This also causes as considerable decrease in the lung capacity. The inflammation and hyperresponsiveness is also marked by increased bronchospasms. This is brought by a rapid and sharp contraction of smooth muscles, known as episodic event of acute exacerbation of chronic asthma (Denlinger, 2020). The process of progressive remodeling and multiple bronchospasms can bring about degenerative changes in the lung spaces which are of permanent nature.

Signs and Symptoms

However, the signs and symptoms of asthma might vary from one person to another, some general signs are observed as a typical clinical presentation of patient suffering from the same. Due to reduced airflow or airflow limitation in the air passages, the person might feel severe shortness of breath (Nair, 2017). It can also be accompanied by severe chest tightness or pain across the sternum area. One of the classical signs observed in asthma is wheezing observed in the lower lung passages. This is mainly observed during exhalation and is observed as a whistling sound heard during auscultation. Wheezing can also be observed to be accompanied with severe cough and thus, worsening the breathing pattern further (Imai, 2018). Some other symptoms of asthma can be observed to occur in individual due to exposure to certain situations. Exercise-induced asthma is generally observed due to increased exposure to air which is cold and dry. It can also be trigger by occupational stimulus such as chemical fumes, dust exposure and many other allergens. The symptoms of asthma can also be aggravated due to exposure to certain allergens such as pollen, mould waste and many other particles related allergens as well.

Risk Factors

Asthma can be observed to develop in a patient who has a genetic history of the condition in the family. It has been observed that parents having a history of asthma are more likely give their children the same disease (Grayson, 2018). Viral infections are another major factor, responsible for the development of asthma in patients. Mother suffering from asthma during pregnancy, is more likely to transfer the disease to the child. Some of the individuals might also have underlying allergies which are responsible for the manifestation of this condition. Some common allergies can be in the form of allergic rhinitis, atopic eczema, and several other conditions. Frequent or constant exposure to allergens such as chemical fumes, vapors, industrial dusts and so on, can also add to the risk of developing asthma in patients. The same impact on health can be considered due to increased exposure to air pollution. The incidence of asthma development is observed more in smokers. Smoking causes irritation in the lung spaces and inflammation to the same. This causes the air passages to constrict and thus, adding to the risk of exposure to manifestation of asthma. Secondhand smoke also adds to the risk of development of asthma in individuals exposed to the same (Lodge, 2018). Obesity is another major risk factor, which is observed to develop higher incidences of asthma manifestation in children and adults. Obesity can be observed with a low-grade inflammation in the body (Gomez, 2017). This can also cause inflammation in the smaller air spaces, thus, adding to the risk of development of asthma in children at a very young age.

Principles of Nursing Interventions

The main consideration to be focused upon in the process of nursing care and management in patients suffering from asthma, is to actively assess for the airway response and provide the treatment to manage the same. Nurses are faced with a challenge to manage patients suffering from asthma on an emergent basis. The team should also be prepared for taking the corresponding action in case the patient doesn’t responds well to the therapy provided to lower the impact of adverse symptoms. The main aim to ensure constant monitoring of the patient, to prevent the development of status asthmaticus in patients, with in the stipulated time frame.

The principles of nursing interventions can be based on the following consideration to be covered in the process:

  • Assessment of history
  • Assessment of respiratory status
  • Assessment of medication
  • Assessment of treatment intervention
  • Assessment of fluid therapy management

Assessment of history of the patient helps in collecting the details, related to personal as well as occupational history. Genetics is one of the most common reason, leading to the development of asthma in individuals. Collecting family history can provide with a better insight in the patient’s details. It is also vital for collecting history for any possible allergic reaction to medication before it is administered to the patient. comprehensive assessment of the patient also helps in defining the treatment interventions required, which will be helpful in attaining positive healthcare outcomes post implementation. Detailed assessment can also be helpful in noting the adverse clinical signs and symptoms which can have a detrimental effect on the patient’s overall well-being. Thus, treatment can be rendered in accordance with the same.

As asthma is marked by severe bronchospasm and hyperresponsiveness of the air passages, it is likely to bring alterations in the respiratory status of the patient. This can also be monitored by noting the pattern of severity of clinical signs and symptoms, such as worsening of shortness of breath, increased use to accessory muscles for breathing, dyspnoea on exertion and so on. It can also be carried out by the means of noting the respiratory rate and pattern of the patient. Other way of assessing the same can be with the help of noting for the vitals such as oxygen saturation, heart rate, respiratory rate and so on. The abnormality in these vitals can be helpful in highlighting the negative asthmatic responses in the patient. The use of peak flow meter can also be carried out to note for the reduced or altered lung volumes. This is also observed in patients suffering from asthma.

Medication assessment can also be an integral part of the overall assessment taken for the patient. Some of the patients suffering from asthma, might be taking some other medications for multiple conditions. This point can be crucial to avoid for any adverse drug reaction in patients. Patient taking multiple medications are more prone to the risk of adverse drug reaction that others. This is mainly observed in cases in where patients are to given antibiotics for the treatment of respiratory infections developed secondary to asthma manifestation in patients (Ahmadizar, 2017). Medication assessment also helps in monitoring the patient signs and symptoms, post administration of medication, so that any adverse event can be averted.

Assessment of treatment intervention can be helpful in defining the best possible remedy for the patient as per their current signs and symptoms. Treatment intervention can be helpful directly in attaining the set nursing goals for the patient. The main aim is to recued secretion and maintain airway patency. These methods are also delivered to improve the overall behaviour of the patient to maintain a clear passage in the lungs. This method can also provide a useful insight on the potential complications and as to how appropriate preventive or corrective actions can be taken pertaining to the same. Apart from assessing for ineffective airway clearance and impaired gaseous exchange, medication assessment of the patients suffering from asthma can also be considered with respect to reduction of anxiety in patients. Asthmatic patients can also be observed to have an added anxiety apart from aggravated clinical signs and symptoms.

Fluid assessment also makes up for a crucial factor to be evaluated during asthma. This is more important to be assessed during acute asthmatic exacerbation. There is a difference in inspiratory intrapleural pressure observed in patients suffering from asthma. This can also be caused due to increased airway resistance. Therefore, treatment of asthma can be beneficial with the help of fluid therapy management. There is also a marked dehydration observed in patients suffering from asthma (Kantor, 2018). Therefore, intervention of fluid management can be helpful in fetching improved healthcare outcomes from the patients suffering from asthma.

References for Asthma in Australia

Ahmadizar, F., Vijverberg, S. J., Arets, H. G., de Boer, A., Turner, S., Devereux, G., ... & Palmer, C. N. (2017). Early life antibiotic use and the risk of asthma and asthma exacerbations in children. Pediatric Allergy and Immunology28(5), 430-437. https://doi.org/10.1111/pai.12725

Australian Institute of Health and Welfare, 2020. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/contents/asthma

Bergantini, L., Cameli, P., d’Alessandro, M., Vietri, L., Perruzza, M., Pieroni, M., ... & Bargagli, E. (2020). Regulatory T cells in severe persistent asthma in the era of monoclonal antibodies target therapies. Inflammation43(2), 393-400. https://doi.org/10.1007/s10753-019-01157-0

Caminati, M., Polk, B., & Rosenwasser, L. J. (2019). What have recent advances in therapy taught us about severe asthma disease mechanisms? Expert Review of Clinical Immunology15(11), 1145-1153. https://doi.org/10.1080/1744666X.2020.1672536

Cañas, J. A., Sastre, B., Rodrigo‐Muñoz, J. M., Fernández‐Nieto, M., Barranco, P., Quirce, S., ... & Del Pozo, V. (2018). Eosinophil‐derived exosomes contribute to asthma remodelling by activating structural lung cells. Clinical & Experimental Allergy48(9), 1173-1185. https://doi.org/10.1111/cea.13122

Cavalcanti, R. F., Gadelha, F. A., de Jesus, T. G., Cavalcante-Silva, L. H., Ferreira, L. K. P., Ferreira, L. A. P., ... & Piuvezam, M. R. (2020). Warifteine and methylwarifteine inhibited the type 2 immune response on combined allergic rhinitis and asthma syndrome (CARAS) experimental model through NF-кB pathway. International Immunopharmacology85, 106-118. https://doi.org/10.1016/j.intimp.2020.106616

Denlinger, L. C., Heymann, P., Lutter, R., & Gern, J. E. (2020). Exacerbation-prone asthma. The Journal of Allergy and Clinical Immunology: In Practice8(2), 474-482. https://doi.org/10.1016/j.jaip.2019.11.009

Gomez-Llorente, M., Romero, R., Chueca, N., Martinez-Cañavate, A., & Gomez-Llorente, C. (2017). Obesity and asthma: a missing link. International Journal of Molecular Sciences18(7), 1490. https://doi.org/10.3390/ijms18071490

Grayson, M. H., Feldman, S., Prince, B. T., Patel, P. J., Matsui, E. C., & Apter, A. J. (2018). Advances in asthma in 2017: mechanisms, biologics, and genetics. Journal of Allergy and Clinical Immunology142(5), 1423-1436. https://doi.org/10.1016/j.jaci.2018.08.033

Imai, E., Enseki, M., Nukaga, M., Tabata, H., Hirai, K., Kato, M., & Mochizuki, H. (2018). A lung sound analysis in a child thought to have cough variant asthma: A case report. Allergology International67(1), 150-152. https://doi.org/10.1016/j.alit.2017.06.004

Kantor, D. B., Hirshberg, E. L., McDonald, M. C., Griffin, J., Buccigrosso, T., Stenquist, N., ... & Hirschhorn, J. N. (2018). Fluid balance is associated with clinical outcomes and extravascular lung water in children with acute asthma exacerbation. American Journal of Respiratory and critical Care Medicine197(9), 1128-1135. https://doi.org/10.1164/rccm.201709-1860OC

Lodge, C. J., Bråbäck, L., Lowe, A. J., Dharmage, S. C., Olsson, D., & Forsberg, B. (2018). Grandmaternal smoking increases asthma risk in grandchildren: a nationwide Swedish cohort. Clinical & Experimental Allergy48(2), 167-174. https://doi.org/10.1111/cea.13031

Nair, P., Martin, J. G., Cockcroft, D. C., Dolovich, M., Lemiere, C., Boulet, L. P., & O'Byrne, P. M. (2017). Airway hyperresponsiveness in asthma: measurement and clinical relevance. The Journal of Allergy and Clinical Immunology: In Practice5(3), 649-659. https://doi.org/10.1016/j.jaip.2016.11.030

Neerincx, A. H., Vijverberg, S. J., Bos, L. D., Brinkman, P., van der Schee, M. P., de Vries, R., ... & Maitland‐van der Zee, A. H. (2017). Breathomics from exhaled volatile organic compounds in pediatric asthma. Pediatric Pulmonology52(12), 1616-1627. https://doi.org/10.1002/ppul.23785

Pandey, P., Mehta, M., Shukla, S., Wadhwa, R., Singhvi, G., Chellappan, D. K., ... & Hansbro, P. M. (2020). Emerging Nanotechnology in Chronic Respiratory Diseases. Nanoformulations in Human Health, 449-468. https://doi.org/10.1007/978-3-030-41858-8_20

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