Asthma Management Research Summary

The assignment entails analyzing a collection of research papers focusing on various aspects of asthma management. The papers delve into topics such as secretory phospholipase A2's role in airway inflammation, medical therapies for chronic rhinosinusitis, the management of asthma in patients with existing asthma, and the influence of health literacy on self-management practices. Furthermore, the research explores cost-effectiveness strategies for managing chronic asthma and examines the utilization of technology to support asthma and COPD self-management.

Running Head: CHRONIC ASTHMA
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Title: Chronic Asthma
Assignment Name: Self-Management of Chronic Asthma
Student Name
Course Name and Number
Professor

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Contents
Introduction......................................................................................................................................3
Pathophysiology and Self-Management of Chronic Asthma..........................................................3
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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Introduction
Asthma is generally a chronic respiratory tract disease which involves an interaction of
obstruction in airflow, hyperresponsiveness of bronchi and inflammation. The severity of above
interaction varies from patient to patient. Technically, the bronchial tubes of the lungs get
inflamed and they become swollen, which in turns results in tightening of the bronchial muscles.
Therefore, airflow through these bronchial tubes becomes difficult and shows symptoms like
coughing, difficulty in breathing, wheezing and tightness of the chest.
Many changes occur due to obstructive airflow through bronchial tubes. These changes are as
follows:
In asthma, the main physiological event occurs is narrowing of airway leading to obstruction in
airflow(Asthma: pathophysiology, causes and diagnosis, 2014). In acute asthma, the narrowing
of smooth muscles occurs rapidly due to some external stimuli such as allergens or some
irritants.
Pathophysiology and Self-Management of Chronic Asthma
Bronchoconstriction due to allergens is mediated by the release of Ig-E dependent mediators
which are released by mast cells. These mediators include histamine, prostaglandins, tryptase
and leukotrienes which are responsible for contraction of bronchial smooth muscles. Further, in
addition to above mediators other stimuli such as cold air, exercise and irritants may be
responsible for airflow obstruction. The mechanisms governing the response of airway to the
above factors are not well defined, but it appears that the main mechanism is related to

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inflammation of the airway(Bachert & Zhang, 2012). The other factor which may also
responsible for precipitating asthma complications is stress.
Although the mechanisms for this is not clearly established yet. But it may be due to increased
production and release of pro-inflammatory cytokines.
When asthma becomes severe by time due to inflammation, other complications also begins such
as hypersecretion of mucus, edema, and formation of mucus plugs in the airway.
One of the reasons for hyperresponsiveness of airway may asthma. The mechanisms which are
responsible for above pathology are dysfunctional neuro-regulation, inflammation, and structural
changes.
In some patients suffering from asthma, airflow obstruction may be reversible to some
extent(Cardinale, Giordano, Chinellato & Tesse, 2013). The permanent structural modifications
can occur. These changes are due to progressive lung dysfunction which is not prohibited by or
can be reversed by current therapy. Airway remodeling includes an activation of several
structural cells, with permanent changes that enhance the airflow obstruction and airway
hyperresponsiveness. This leads to patient decreased response to therapy. The structural changes
discussed above can be the sub-basement membrane thickening, airway hypertrophy of smooth
muscles and hyperplasia, subepithelial fibrosis, proliferation of blood vessels and dilation, and
mucus hypersecretion(Henderson, 2008).
The following are the important points which should be always taken into consideration by
nurses during health management of asthma patients:
Nurses should put emphasis on long-term therapy which is ongoing.Nurses should take care of
patients with moderate as well as severe asthma require inhaled anti-inflammatory therapy on
daily basis to decrease asthma episodes.Discuss with the patient and concerned physician to

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prepare a management plan for asthma as per the needs of the patient.During every visit, review
management plan of each patient and their medication.
At every visit, nurses should ask patients about the medicines they are taking and make sure that
they are not taking beta blockers(Mogasale & Vos, 2013). For patients susceptible to aspirin, tell
them not to take any kind of NSAID’s. The NSAID’s can lead to severe asthma episode.Teach
the patient about the correct use of metered-dose inhalers and nebulizers. Ask the patient to
demonstrate the same. If needed, again teach the patient about the procedure.Nurses play an
important role in healthcare by helping patients to make decisions and learn about specific
actions to be taken to control asthma. Nurses should deliberately plan and involved in educating
their patient so as to increase the probability that patients will stick to the recommended
actions(Lehrer, Mullol, Agredo & Alobid, 2014).
Health promotion is a process of increasing the control of people over there health. It includes a
wide range of environmental and social interventions. Health promotion is linked by values e.g
Ottawa charter awareness and empowerment. The Ottawa charter, it is the name given after
international conference on health promotion held on November 1986 in Ottawa, Canada. The
principles which were included under Ottawa charter for health promotion are personal skill
development, strengthening the community, the creation of supportive environment and
reorganize health service. These principles of health promotion were discussed at an 8th global
conference held in Helsinki in 2013(Albuterol multidose dry powder inhaler efficacy and safety
versus placebo in children with asthma, 2016). Campbell and Gibson state that for the promotion
of health and enhancement of individual’s skills in order to resolve their issues, meet their needs
and locate their resources for better control over their survival, the most important thing which is
required is ‘Empowerment’.

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In the case of an asthmatic patient, the aim of empowerment would be the betterment of the
patient’s condition as asthma is incurable, making patients responsible for their health and focus
on the opportunities that are available in their communities. The role of nursing within this
context is to promote health and provide education on inhaler therapy technique used by asthma
patient(Kowalski, 2010).
According to Marmot et.al improvement in education on asthma would increase awareness,
knowledge and help the patient to make healthier choices. There are various theoretical models
on health promotion which focus on health related decisions like Rosenstock Health belief
model. This is the best-known model for health promotion. Health belief model was modified in
1980, it explained a reason behind a failure to use health services by the people.There is an
another model named shiing perspectives model of chronic illness that indicate a pathway for
health professionals on improvement and supporting individuals suffering from chronic
illness(Londoño & Schulz, 2015). Whitehead developed a Florence Nightingale's model which
states that “ the nurse, the client, and the environmental factors are in balance”. If the
environmental factor is out of balance the patient spends unnecessary energy. So, the role of the
nurse is to maintain the balance of the patient with environmental factors which encourages
healing.
Chronic asthma manifestations and symptoms such as wheezing, cough, and dyspnea
significantly affect the daily life of family members or carers. According to a survey in children
asthma and their carers, about 33% of their carers left work in one year due to their the asthma of
child. The work lost and burden on the family members is directly associated with the severity of
asthma. Carers of patient’s with uncontrolled asthma are likely to have high chances to bear

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work loss approximately more than 5 days a week as compared to carers of patient’s having
controlled asthma(Ellis, 2012).
People suffering from chronic illness need more health services which increase their interaction
with the health system. If the system and organizations fail to provide culturally competent
healthcare, there is a higher risk of negative health results. Americans, Africans and other
minorities have less interaction with the physicians which results in lower satisfaction with their
care(Nygårdh, Malm, Wikby & Ahlström, 2011). There is lower interaction among Asian
Americans and Latinos with physicians. Lower patient- physician interaction is associated with
dissatisfaction system. Latinos, Asian Americans, and African Americans in comparison to
whites believe that they would have received better services if they belong to different ethnicity
or race. Various reports have shown that African Americans, they feel more disrespectful when
they were treated as compared to other different minority groups. Individual behavior, values,
and beliefs about well being and health services are affected by various factors such as
nationality, ethnicity, race, socioeconomic status, occupation, physical & mental status and
language (Morrison, Mair, Yardley, Kirby & Thomas, 2016). Cultural competence is broadly
defined as the ability of the organization to integrate and understand these factors for better
delivery of healthcare services. The goal of the culturally efficient health care system is to
provide better health care services irrespective of ethnicity, nationality, race, English proficiency
and cultural background.
There are various strategies to improve patient-physician interaction for better health services:
Providing training to improve skills, increasing knowledge, and cultural awareness.

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Introduce various cultural specific tools into the healthcare system(Nunes, Pereira & Morais-
Almeida, 2017).To increase operation hours.Include community and family members in making
healthcare decisions. Recruit minority staff.
For better cultural competence in the healthcare system, professional should be taught about how
to provide better services in culturally competent manner. There are various training courses,
teaching methods which vary greatly in content from four-hour seminar to months academic
course.
Key DO’s and DONT’s must provide to healthcare professionals for a particular group. It is
nearly impossible to know everything about each culture completely. Training courses must be
provided which are universal.
Some key points for a better understanding of people from different cultural background(Evans-
Agnew, 2017):
Physician or health care provider must be polite, non-confronting and predictable with patients
and their family members.They do not ask questions or make assumptions.They do not get
inattentive if the patient does not make eye contact.They must use an interpreter if a patient is
from different cultural background.Healthcare providers or physicians must learn how to greet
Non-English speakers.They must use visual aids if there is a language problem.
The main principle of the concept is to make patient informed about choices and helps them in
making their decisions. For further elaboration, Patient empowerment is the concept which
involves control over the daily conditions of the patients(Sills, Ginde, Clark & Camargo, 2010).
Patients attain necessary knowledge, self-awareness, and skills to make their quality of life
better. The concept of patient empowerment includes following key points:

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There are main three parameters which are important at the initiative stage of patient
empowerment i.e education, health literacy, provision for information for self-management and
making right decisions.The concept includes strategies for both patients and healthcare
professionals.
Implementation of strategies is categorized into three levels i.e micro level which is initiative
level, a meso level which is implementation at some regional level and macro level which
includes implementation at the national level or another higher level(Anderson & Funnell, 2010).
Conclusion
Several patients suffering form uncontrolled asthma, despite the frequent availability of effective
therapy options. Nursing practitioners have a unique role and opportunity as frontline healthcare
professionals and patient educators to recognize and analyze chronic asthma. Nursing
practitioners also have to determine the necessary actions to facilitate patients and maintain the
check on symptom control. With the implementation of the above-discussed points such as
patient empowerment, cultural safety, and health management, the role of Nursing practitioners
in asthma management will become more critical. Nursing practitioners are best suited for the
duties of primary purveyors of asthma awareness, promoters for the partnership of healthcare
system and patients for optimization of their health, and also plays an important role in ongoing
monitoring to make sure for consistent achievement of therapeutic objectives for asthma
management and control.

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References
Albuterol multidose dry powder inhaler efficacy and safety versus placebo in children with
asthma. (2016). Allergy And Asthma Proceedings.
http://dx.doi.org/10.2500/aap.2016.37.4015
Anderson, R., & Funnell, M. (2010). Patient empowerment: Myths and misconceptions. Patient
Education And Counseling, 79(3), 277-282. http://dx.doi.org/10.1016/j.pec.2009.07.025
Asthma: pathophysiology, causes and diagnosis. (2014). Clinical Pharmacist.
http://dx.doi.org/10.1211/cp.2014.20066997
Bachert, C., & Zhang, N. (2012). Chronic rhinosinusitis and asthma: novel understanding of the
role of IgE ‘above atopy’. Journal Of Internal Medicine, 272(2), 133-143.
http://dx.doi.org/10.1111/j.1365-2796.2012.02559.x
Cardinale, F., Giordano, P., Chinellato, I., & Tesse, R. (2013). Respiratory epithelial imbalances
in asthma pathophysiology. Allergy And Asthma Proceedings, 34(2), 143-149.
http://dx.doi.org/10.2500/aap.2013.34.3631
Ellis, J. (2012). The impact of lung cancer on patients and carers. Chronic Respiratory
Disease, 9(1), 39-47. http://dx.doi.org/10.1177/1479972311433577

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Evans-Agnew, R. (2017). Asthma Disparity Photovoice. Health Promotion Practice,
152483991769103. http://dx.doi.org/10.1177/1524839917691039
Henderson, W. (2008). Secretory Phospholipase A2and Airway Inflammation and
Hyperresponsiveness. Journal Of Asthma, 45(sup1), 10-12.
http://dx.doi.org/10.1080/02770900802569751
Kowalski, M. (2010). Medical Therapy in Chronic Rhinosinusitis. Current Allergy And Asthma
Reports, 10(3), 153-154. http://dx.doi.org/10.1007/s11882-010-0100-8
Lehrer, E., Mullol, J., Agredo, F., & Alobid, I. (2014). Management of Chronic Rhinosinusitis in
Asthma Patients: Is There Still a Debate?. Current Allergy And Asthma Reports, 14(6).
http://dx.doi.org/10.1007/s11882-014-0440-x
Londoño, A., & Schulz, P. (2015). Influences of health literacy, judgment skills, and
empowerment on asthma self-management practices. Patient Education And
Counseling, 98(7), 908-917. http://dx.doi.org/10.1016/j.pec.2015.03.003
Mogasale, V., & Vos, T. (2013). Cost-effectiveness of asthma clinic approach in the
management of chronic asthma in Australia. Australian And New Zealand Journal Of
Public Health, 37(3), 205-210. http://dx.doi.org/10.1111/1753-6405.12060
Morrison, D., Mair, F., Yardley, L., Kirby, S., & Thomas, M. (2016). Living with asthma and
chronic obstructive airways disease: Using technology to support self-management - An
overview. Chronic Respiratory Disease. http://dx.doi.org/10.1177/1479972316660977
Nunes, C., Pereira, A., & Morais-Almeida, M. (2017). Asthma costs and social impact. Asthma
Research And Practice, 3(1). http://dx.doi.org/10.1186/s40733-016-0029-3

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Nygårdh, A., Malm, D., Wikby, K., & Ahlström, G. (2011). The experience of empowerment in
the patient-staff encounter: the patient's perspective. Journal Of Clinical Nursing, 21(5-6),
897-904. http://dx.doi.org/10.1111/j.1365-2702.2011.03901.x
Sills, M., Ginde, A., Clark, S., & Camargo, C. (2010). Multicenter Study of Chronic Asthma
Severity Among Emergency Department Patients With Acute Asthma. Journal Of Asthma,
100913044443056-9. http://dx.doi.org/10.1080/02770903.2010.504878