Asthma: Etiology, Diagnosis, and Treatment

This article explores the etiology, diagnosis, and treatment of asthma, a major global health challenge. It discusses the prevalence, symptoms, and impact on children's lives, as well as the various treatment options available. The article also highlights the importance of health policies in managing and preventing asthma.

Running head: ASTHMA
ASTHMA
Name of the student;
Name of the university:
Author’s note :

1
ASTHMA
Introduction:
With the widespread prevalence of allergic disease in the lower and middle income
counties, asthma has become one of the major global challenges, which threatens the economy
and health of a nation. The prevalence are high for children and young adults which in turn
created a burden on the health and wellbeing measures. Kuruvilla and Khan (2018) highlighted
that asthma is a condition where the airways become narrow and swell to produce extra mucus
which further gives rise to health conditions such as a difficulty in breathing, triggering coughing
and whizzing. For diagnosis of asthma, usually, the physicians ask for the medical history of
patients, and examine the nose and throat upper airway. The most common treatment of the
asthma is salbutamol which is administered, especially in children. This paper will illustrate the
etiology, diagnosis, and treatment, health policy and health behavior with the assistance of the
peer-reviewed journals in the following paragraphs.
Discussion:
The reason behind the epidemiological study:
Pawankar (2014), highlighted that the prevalence of allergic disease like asthma is rising
exponentially worldwide, especially in lower and medium economic countries. Asthma has been
chosen as a global public health concern because it was highlighted that more than 300 million
individuals are suffering from allergic disease such as asthma. Phipatanakul et al. (2017)
reported that 23 million people, including 7 million children suffered from asthma, which
resulted in 14 million of missing days of school every year. Kuruvilla and Khan (2018)
highlighted that the allergic disease mostly affected in the lower income countries because of
indoor and outdoor air pollution as well as lack of clinical attention in the initial stage. Therefore,

2
ASTHMA
immediate attention is required to reduce the prevalence of asthma, and its subsequent
management.
Etiology of asthma:
The etiology of asthma is difficult to identify since the similar symptoms were
highlighted for many of the chronic diseases which affected a considerate number of individuals.
Phipatanakul et al. (2017) suggested that usually, asthma develops because of allergic reactions
that are induced by allergen when allergen attached to the IgE receptor on the mast cells or
basophils circulating in the blood. Consequently, the basophils and eosinophils start releasing
vasodilators like histamines and patients started experiencing shortness of breath, trouble in
sleeping, chest tightness and whizzing sound. Perovich et al. (2018), highlighted that the general
process of diagnosis of asthma is lungs function tests, where physicians detect how patients
exhale air from lungs, through spirometer and peak airflow, and sometimes x-ray is also used to
detect the asthma. On the other hand, Zoratti et al. (2018) argued that acid reflux tests and sinus
x-ray tests were effective to detect whether a patient has asthma or not.

3
ASTHMA
Figure : Comparison between normal airway and asthmatic airway
Source : (Kuruvilla and Khan 2018)
Studies conducted in the epidemiological area:
A cross-sectional study by Garcia-Garcia et al. (2014) highlighted that the viral infection
especially, acute bronchitis plays a crucial role in the development of asthma in childhood. The
authors conducted an observational study in between September 2008 to December 2011 on 244
children who were previously admitted in the hospital due to bronchitis and structured questions
were used for asthma symptoms and, the specimen of the nasopharyngeal respiration were
collected for virology studies. The result suggested that the high prevalence of asthma observed

4
ASTHMA
in the patients who have previously hospitalized for bronchitis rather single infection. Moreover,
allergic rhinitis and older age at admission are also highlighted as strong independent risk factors
for developing asthma in children, who were previously hospitalized because of asthma. On the
other hand, Gupta et al. (2016) argued that the increased risk of the allergy is associated with
childhood food allergy and the environment or surroundings in which the children are living.
The authors conducted a cross-sectional family-based study amid children with the food allergy
and their siblings to evaluate the asthma prevalence. The study suggested an association between
skin infection like eczema with food allergy increases the incidents related to asthma. Orellana et
al. (2017), argued that children living in polluted outdoor air may become prone to the
development of asthma. The authors conducted a systematic review and multilevel meta-
analysis, which was a sensitivity base analysis to examine the effect of outdoor air pollution in
the children in between 0 to 18 years. The result highlighted that air pollution or poor outdoor
air may induce the risk of developing asthma in children that in turn increases the incidence of
asthma. It is highlighted as one of the health behavior of children that increase the risk of asthma.
Inci et al. (2017) conducted a prospective study with 179 asthmatic children aged 7 - 15 years
and obtained result suggested that exercise-related respiratory syndrome give rise to the
symptoms of asthma. This result further indicated that children who are engaged in the heavy
exercise and have respiratory dysfunctions are more prone to develop asthma in very young age
which in turn limited their physical activity for a lifetime. Perovich et al. (2018), suggested that
gene-environment tinteractions play a crucial role in developing asthma. However, very little
research work was conducted in this area. Data collected from surveys conducted in the year
2010 to 2012 on the health care facilities showed that the 29.5 per cent people were showed
suggestive syptoms of asthma during their lifetime and amongst them 15.6 per cent people were

5
ASTHMA
diagnosed with asthma (Mukherjee et al. 2016). Moffatt et al. (2010) have conducted a genome
wide association study with 10,365 asthma affected persons and 16,110 unafffected person. They
have reported that there is a association between asthma and single-nucleotide polymorphisms:
rs3771166 on chromosome 2. They have also reported the fact that the onset of this disease in
the childhood is specific to the association with the ORMDL3/GSDMB locus on chromosome
17q21 (Moffatt et al. 2010).
Figure : current prevalence of asthma
Soure : (Inci et al. 2017)
Impact on children life and Treatment:
Phipatanakul et al. (2017), reported that the asthmatics children experience the limitation
in different physical activities such as, running which further affected their wellbeing. For
example, a child of 11 years with asthma who desired to be a sportsman faces the limitation of
physical activities such as running; cycling and swimming that further influenced the emotional
wellbeing of children. Perovich et al. (2018), argued that a considerate number of children are

6
ASTHMA
being bullied and being ignored due to their limitation of physical activities. They feel different
from their peers because of asthma and it influenced their perspective of the future. Moreover,
Zahran et al. (2018), analyzed CDC data of asthma from 2001 to 2016 considering children of 0
to 17 years and the obtained result suggested that approximately 14 million children miss school
every year because of asthma.
There is the mountain of research evidence that has been conducted to find out the best
treatment of asthma in children. Condella et al. (2018) analyzed 17 observation studies of 1,
016 infants who were hospitalized due to asthma or bronchitis. The result suggested that the local
practice of pre-admission albuterol is effective to reduce the asthma attack or bronchitis. On the
other hand, Kuruvilla and Khan (2018), argued that salbutamol is identified as one of the most
potent medicine to reduce asthma attack since it acts as bronchodilator which relaxes the muscles
present in the airway and improves the air flow. Esquivel et al. (2016) stated that Cromolyn
sodium, Antileukotrienes, and different immunotherapies are also a potential modifier of
asthmatic symptoms and reduce asthma attacks. Zielen et al. (2018) conducted a retrospective
study on the children of 0 to 17 years and the result suggested that Sublingual immunotherapy
provides long term reliefs from the asthma attacks and rhinitis. Therefore, these treatments are
effective in reducing asthma. Imperial College London led clinical trail have brought forward a
different solution for the management of asthma. The authors of the study have presented the fact
that the long term disease like asthma requires long term care plan. In order to achieve that the
authors have suggested that the layman led self management education has better effect for the
management of asthma. The intervention method that employed was that the self management
education will be given by either a lay educator or professional like nurses. Total duration of the
intervention was 12 months long (Clinicaltrials.gov 2019).

7
ASTHMA
Figure: Asthma management rate
Source: (Zahran et al. 2018)
Health policies:
The government took health care initiatives by implementing a strategic framework like
healthy government 2020 where they promoted better respiratory healthy through better
interventions, treatment, and education effort. Zahran et al. (2018), analyzed CDC data of
asthma from 2001 to 2016 considering children of 0 to 17 years for the evaluating different
initiatives in united states and result suggested that 50.8% of children with asthma in united
states received an asthma action plan, 11% of them are taking classes to learn the management
and prevention of asthma. Moreover, 76% of children were taught to recognize early symptoms
of an asthma attack and 80% of children in the United States were taught how to respond to an

8
ASTHMA
asthma attack. Moreover, American lungs association implemented asthma friendly initiatives to
create an asthma management plan (Garcia-Garcia et al. 2014). Polices such as Sample Asthma
Action Plan Policy, Sample field trip policy, no smoking policy was implemented in the school
to reduce the prevalence of asthma. Department of Health (2014) provides guidance on the use
of emergency salbutamol inhaler in schools to reduce this chronic disease. To educate all
personnel of school district policy for asthma education, Michigan example of asthma
management policies, asthma control test policies were implemented that further reduced asthma
in children (Cleary et al. 2017).
Conclusion:
Thus, it can be concluded that asthma has become one of the global challenges which
threats the economic and health and the victims of this disease are children log with young
adults. The study explored different accumulated evidence to find out that 23 million people,
including 7 million children is suffering from asthma which resulted in the 14 million of missing
days of school every year. Skin infections eczema with food allergy, poor air conditions, and
different viral infection along with exercise are acts as an inducer of asthma development. The
most common treatment of asthma encompasses salbutamol and other treatments such as
Cromolyn sodium, Anti-leukotrienes, and different immunotherapies are potentially modified of
asthma. Treatment for asthma has been radicallised even since the discovery of the monoclonal
antibodies. Future treatment for asthma largely focused on the targeted therapies which
encouraged the characterization of patients using biological (endotype) and clinical (phenotype)
tools.

9
ASTHMA

10
ASTHMA
References:
Cleary, E., Asher, M., Olawoyin, R., and Zhang, K. 2017. Assessment of indoor air quality
exposures and impacts on respiratory outcomes in River Rouge and Dearborn,
Michigan. Chemosphere, 187, 320-329.
Clinicaltrials.gov, 2019. Trial of Lay-led Individualised Self-management Education for Adults
With Asthma - Full Text View - ClinicalTrials.gov. Clinicaltrials.gov. Available at:
https://clinicaltrials.gov/ct2/show/study/NCT00129987?cond=Asthma&cntry=GB&rank=9
[Accessed 2 Mar. 2019].
Condella, A., Mansbach, J. M., Hasegawa, K., Dayan, P. S., Sullivan, A. F., Espinola, J. A., and
Camargo Jr, C. A. 2018. Multicenter study of albuterol use among infants hospitalized with
bronchiolitis. Western Journal of Emergency Medicine, 19(3), 475.
Ebell, M., Marchello, C.,and O'Connor, J. 2017. The burden and social determinants of asthma
for adults in the state of Georgia. Journal of the Georgia Public Health Association, 6(4), 426-
434.
Esquivel, A. T., Busse, W. W., Calatroni, A., Gergen, P. J., Grindle, K., Gruchalla, R. S., ...and
Lebeau, P. 2016. Omalizumab Decreases Rates of Cold Symptoms in Inner-City Children with
Allergic Asthma. Journal of Allergy and Clinical Immunology, 137(2), AB87.
Garcia-Garcia, M. L., Calvo, C., Ruiz, S., Pozo, F., Del Pozo, V., Remedios, L., and Casas, I.
2017. Role of viral coinfections in asthma development. PloS one, 12(12), e0189083.

11
ASTHMA
Gupta, R. S., Singh, A. M., Walkner, M., Caruso, D., Bryce, P. J., Wang, X., Pongracic, J. A.,and
Smith, B. M. 2016. Hygiene factors associated with childhood food allergy and asthma. Allergy
and Asthma Proceedings, 37(6), e140–e146.
Inci, D., Guggenheim, R., Altintas, D. U., Wildhaber, J. H., & Moeller, A. (2017). Reported
exercise-related respiratory symptoms and exercise-induced bronchoconstriction in asthmatic
children. Journal of clinical medicine research, 9(5), 410.
Kuruvilla, M. E., and Khan, D. A. 2018. Rhinitis and Asthma. In Rhinitis and Related Upper
Respiratory Conditions (pp. 153-161). Springer, Cham.
Moffatt, M.F., Gut, I.G., Demenais, F., Strachan, D.P., Bouzigon, E., Heath, S., Von Mutius, E.,
Farrall, M., Lathrop, M. and Cookson, W.O., 2010. A large-scale, consortium-based
genomewide association study of asthma. New England Journal of Medicine, 363(13), pp.1211-
1221.
Mukherjee, M., Stoddart, A., Gupta, R.P., Nwaru, B.I., Farr, A., Heaven, M., Fitzsimmons, D.,
Bandyopadhyay, A., Aftab, C., Simpson, C.R. and Lyons, R.A., 2016. The epidemiology,
healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of
standalone and linked national databases. BMC medicine, 14(1), p.113.
Orellano, P., Quaranta, N., Reynoso, J., Balbi, B., and Vasquez, J. 2017. Effect of outdoor air
pollution on asthma exacerbations in children and adults: systematic review and multilevel meta-
analysis. PLoS One, 12(3), e0174050.
Pawankar R. 2014. Allergic diseases and asthma: a global public health concern and a call to
action. The World Allergy Organization journal, 7(1), 12. doi:10.1186/1939-4551-7-12

12
ASTHMA
Perovich, L. J., Ohayon, J. L., Cousins, E. M., Morello-Frosch, R., Brown, P., Adamkiewicz, G.,
and Brody, J. G. 2018. Reporting to parents on children’s exposures to asthma triggers in low-
income and public housing, an interview-based case study of ethics, environmental literacy,
individual action, and public health benefits. Environmental Health, 17(1), 48.
Phipatanakul, W., Koutrakis, P., Coull, B. A., Kang, C. M., Wolfson, J. M., Ferguson, S. T., ...
and Gaffin, J. M. 2017. The school inner-city asthma intervention study: design, rationale,
methods, and lessons learned. Contemporary clinical trials, 60, 14-23.
Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., and Breysse, P. N. 2018. Vital signs:
asthma in children—United States, 2001–2016. Morbidity and Mortality Weekly Report, 67(5),
149.
Zielen, S., Devillier, P., Heinrich, J., Richter, H., & Wahn, U. (2018). Sublingual immunotherapy
provides long‐term relief in allergic rhinitis and reduces the risk of asthma: a retrospective, real‐
world database analysis. Allergy, 73(1), 165-177.
Zoratti, E. M., Krouse, R. Z., Babineau, D. C., Pongracic, J. A., O'connor, G. T., Wood, R. A., ...
and Teach, S. J. 2016. Asthma phenotypes in inner-city children. Journal of Allergy and Clinical
Immunology, 138(4), 1016-1029.