Chronic Disease Paper. Sarah ODonoghue

docx

School

Chamberlain College of Nursing *

*We aren’t endorsed by this school

Course

503

Subject

Health Science

Date

Oct 30, 2023

Type

docx

Pages

Uploaded by JusticeElephant2301

Chronic Health Problem: Asthma Sarah O’Donoghue Chamberlain University NR 503: March 2023

Asthma is a chronic disease that causes inflammation and swelling of the airways, and it is one of the costliest diseases in America. (Asthma and Allergy Foundation of America, n.d.) Asthma affects people of all ages but is one of the most prevalent chronic diseases amongst children. Asthma is characterized by symptoms such as cough, wheezing, shortness of breath, and tightness in the chest. Asthma is extremely common and can be debilitating without the correct treatment. “Symptoms and airflow limitation may resolve spontaneously or in response to medication and may sometimes be absent for weeks or months at a time” (GINA, 2019, p. 16) Exacerbations of asthma, known as asthma attacks, can require trips to the emergency department and can result in hospitalizations, or even death. There is no cure for asthma, so efforts to reduce its burden on the healthcare system are abundant. Surveillance and reporting methods as well as funding for programs and research are all necessary to improve the lives and care of asthma patients. 1 in 13 people in the United States suffer from asthma, that is almost 26 million people. (AAFA, n.d.) Asthma is more common in females in adult patients however more common in male children. Almost 21 million adults suffer from asthma in the United States and 4.8 children. (AAFA, n.d.) Racial disparities are highly present in asthma with black children two times more likely to have asthma than white children. Asthma attacks are one way this disease burdens the healthcare system, particularly the emergency departments. In 2020, 42% of children with asthma younger than 18 reported having one or more attacks in the past year. (AAFA, n.d.) In 2019, asthma accounted for 4.9 million doctor’s visits and 1.5 million emergency department visits. Death from asthma is also a possibility. 10 people in the United States die from asthma every day. Adults are six time more likely to die from asthma than children and

black people are three times more likely to die than white people. Black females have the highest fatality rate from asthma in the United States. (AAFA, n.d.) In the state of New Jersey, healthcare costs for people with asthma are $3,266 higher than those without. (NJDOH, 2022) In New Jersey, 600,000 adults have asthma while 167,000 children are suffering from the condition, children including those under the age of 18. In 2020, there were 3,418 hospitalizations in New Jersey and 6,211 New Jersey hospitalizations in 2019. It is very likely that the numbers for 2020 were affected by the COVID-19 pandemic. (NJDOH, 2022) Black people in the state of New Jersey are far more likely to present to the emergency department with complaints related to asthma. In 2020, the rate of emergency department visits for black people with asthma was 984 per 100,000 and only 135 per 100,000 for white people (NJDOH, 2022). Refer to the tables below for state versus national statistics. National data for asthma is available on prevalence, activity limitation, days of work/school missed, rescue and control medication use. Asthma self-management education, physicians’ visits, emergency department visits, hospitalizations and deaths from the National Center for Health Statistics and vital statistics system. (CDC, n.d) “Chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes” (Maloney et al., 2023, p, 1), however reporting through the electronic health record is not currently required. One way that data is obtained on a state level is the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a state-based telephone survey of noninstitutionalized Americans ages 18 and up. This survey is used to improve the health of the American people by monitoring the prevalence of major behavioral risks that are associated with premature morbidity and mortality. (CDC, n.d.) All fifty

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

states are currently participating in this nationwide survey. States can also choose to add their own questions, picking from several modules that go into greater detail in different areas. Improved surveillance and data collection on asthma is needed and technology should be utilized. “A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR” Maloney et al., 2023, p.1). Asthma can be analyzed through the 5 Ws of epidemiology, many of them being discussed at length in this paper. Asthma is very common in the United States and one of the costliest of chronic conditions. Asthma is unique in that it is a chronic condition that affects adults and children in large numbers. Asthma affects adult women more than adult men, and male children more than female children. Black people are also disproportionately affected by asthma. National and state prevalence rates of asthma are higher in black people than white people. Black people are also far more likely to visit the emergency department due to asthma and are more likely to die from asthma. Black women are the most high-risk population affected by asthma, when gender is considered, being the most likely group to die from asthma. The why of asthma includes risk factors, causes, and modes of transmission. Asthma is not an infectious disease so it cannot be transmitted from one person to the next. Risk factors are present amongst families, however many children with asthma are born into families where no asthma exists. There are many risk factors for developing asthma including “having a parent with asthma, having a severe respiratory infection as a child, having an allergic condition, or being exposed to certain chemical irritants or industrial dusts in the workplace” (American Lung Association, n.d.). Asthma has been a public health concern for some time due to the increase

in prevalence every year since the 1980’s. However, beginning in 2010, the asthma prevalence rates seemed to have flattened while asthma related mortality is on a steady decline (American Lung Association, n.d.). Screening and diagnosis guidelines for asthma are ever improving and may be partially responsible for the decrease in asthma related mortality over the past 10 years. Screening for asthma mostly includes screening and assessing for characteristics symptoms (AAFP, 2020). Characteristic symptoms of asthma include wheezing, shortness of breath, and chest tightness that is worse at night or early in the morning. If the patient is experiencing these symptoms, it is important to ask what the patient is doing at symptom onset, what makes the symptoms better, and what makes them worse. Asthma can present similarly to other cardiopulmonary diseases, particularly in adults, and needs to be screened for very carefully. It is important to note that many symptoms of asthma can be brough on by allergens or toxins such as cigarette smoke or can be exercise induced. After careful consideration of patient symptoms, diagnosis should be confirmed with pulmonary function tests (AAFP, 2020). An increase or decrease in forced expiratory volume in one second of greater than 12% and 200 ml from baseline of change in peak expiratory flow of at least 20% is consistent with asthma (AAFP, 2020). Severity of asthma is diagnosed based on how easily asthma symptoms are controlled and results of the asthma control questionnaire (GINA, 2019). As a practicing Nurse Practitioner (NP), a plan of action in asthma should include primary, secondary, and tertiary prevention. Through prevention, the NP can affect change. Primary prevention in asthma includes annual wellness exams, screening questions about allergens and possible exposures, and smoking cessation for patients who have yet to develop

symptoms of asthma. By addressing possible allergies and exposures, the nurse practitioner may be able to prevent the development of asthma, particularly in children. Furthermore, when working with children, the NP should question the parents about smoking in the home. Children of parents that smoke are more likely to have children who develop asthma. Continued exposure to cigarette smoke is linked to the development and the worsening of asthma symptoms. Secondary prevention is defined as the diagnosis of the disease in people who have developed symptoms. For asthma, this includes medical screening and diagnosis such as pulmonary function tests and characterization of symptoms. Tertiary prevention includes improving the quality of life of those already living with asthma. Methods can be similar to primary prevention methods, but with a different aim. In the tertiary stage of prevention, we are no longer trying to prevent the disease from occurring but trying to improve quality of life. This can include smoking cessation, allergen tests, and removing any type of irritants or exposure. “Tobacco smoking is associated with more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids” (Tiotiu et al., 2021, p. 1). Smoking cessation has been studied extensively in asthma patients with consistent findings that “the negative impact of smoking on asthma control seems to be at least partially reversible, as patients who had quit smoking reported significantly better asthma control” (Tiotiu et al., 2021, p. 7) than those who continue to smoke. Mild exercise, as tolerated, may also improve the symptoms of those living with asthma. Furthermore, the NP needs to be aware of health disparities to direct prevention and education efforts towards at-risk groups. In the case of asthma, it may be appropriate to screen black children who have a family history of asthma, or a parent that smoke, for allergies or other environmental irritants. It may also be appropriate to

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

dedicate extra time to educating parents of at-risk children in the signs and symptoms of asthma. The NP may also take particular care in assessing for symptom severity in black female adults who currently have a diagnosis of asthma due to their high rate of mortality compared with other groups. “Research shows that asthma disparities are highly driven by socioenvironmental and economic factors, and that structural injustices over time have led to a situation of accumulated disadvantage for specific racial and ethnic subpopulations in the U.S.” (AAFA, 2020, p. 53). The social and political structures that patients exist in are overwhelmingly complex. Though the NP may not be able to change the world overnight, the NP can affect change in their space through care, compassion, and cultural competence. Asthma is a chronic disease affecting over 20 million people in the United States, adults, and children. Asthma costs millions in healthcare per year. It is debilitating to those affected, causing hospitalizations and death. As with many other diseases, black people are disproportionately affected, black females having the highest risk. Through surveillance and reporting, improvements in the care of asthma continue to be developed. Screening and diagnosis are important to begin the treatment of asthma in a timely manner and to address any exacerbating factors. Armed with a knowledge of public health and racial disparities, the NP can improve public health by delivering quality care with compassion.