Epidemiological Analysis: Asthma
Healthcare conditions are issues of interest to human life. Understanding these problems, their causes, epidemiology, risk factors, clinical presentations, diagnostic tests, treatment, and management is vital to any healthcare provider or patient. Data on prevalence, incidence, morbidity, ad mortality helps understand the disease burden and thus determine the extent of efforts in prevention and management.
The condition is unique because of its outburst of severe attacks that can occur at any time and are potentially life-threatening. The burden of asthma lies at 8.6% in Virginia, slightly higher than the national average (8.4%). Asthma is the most common chronic illness among children and can significantly affect the quality of life in childhood and adulthood. This essay explores asthma in Virginia and the US, its epidemiological analysis, surveillance and reporting, and strategies to manage and control the disease after graduation.
Background and Significance of Asthma
Asthma is an upper respiratory condition in which an individual’s airway becomes inflamed, swells, and the airway lumen narrows and produces mucus leading to difficulty breathing and wheezing sounds. The Virginia Department of Health (2018) identifies and explains two types of asthma: allergic and non-allergic. Non-allergic asthma results from irritants, viruses, stress, hypoventilation, cold or hot air, smoke, anxiety, or exercise.
The body’s immunity is not involved in these reactions. Allergic asthma arises when the body reacts to harmless antigens such as cold, pollen grains, and dust. The body reacts by producing antibodies, and the reaction occurs in the airway cells leading to their inflammation and the release of inflammatory agents. The narrowing of the airway causes dyspnea and wheezing as individuals try to force air through the airway to meet the oxygen demands.
The mucus irritates the airway leading to coughing, especially at night. Patients produce mucus or phlegm during the coughing episodes. The mucus also causes chest tightness. During an asthmatic attack, symptoms occur rapidly, including severe hypotension, abnormal breathing pattern, and wheezing that accompanies inspiration or both inspiration and expiration (Virginia Department of Health (VDH), 2018). These signs and symptoms result from the accumulation of mucus and the release of chemicals.
Virginia department of health shows that 8.6% of adults and 9.6% of children in Virginia have asthma. About one in ten individuals in Virginia have been diagnosed with asthma in their lifespan (VDH, 2018). In 2019, about 25 million or 8.4% of US citizens and 4.2 million or 5.8% of children had asthma, according to the CDC (2020). The disease often begins in childhood and typically ends in the early twenties but persists in some individuals.
Asthma begins at any age and affects more females than males. The rate is reversed in children where the males have a higher asthma rate than the females. The current prevalence of asthma lies at 11% in females and 5.5% in males. The disease costs the healthcare systems an excess of $80 million annually, and about 41% of these costs are attributed to pharmaceutical drugs.
The Asthma and Allergy Foundation of America (2019) reports that one in 13 US citizens has asthma. The table below shows asthma distribution by age, sex, and ethnicity in 2020, according to the CDC. These statistics vary slightly from those in scholarly studies and other bodies, such as the WHO and Asthma and Allergy Foundation of America. The variance results from their different sources of primary data.
Table 1 Asthma prevalence in the US
Asthma risk factors vary depending on the type; allergic or non-allergic asthma. They are either genetic or environment-related. Factors that trigger asthma symptoms are dust mites, pollen, cigar smoke, chemicals such as insecticides, sinusitis, medications such as NSAIDs, and food sulfites (VDH, 2018). animal dander, pollen, molds, cigarette smoke, chemical pollutants, and cold air.
These factors do not lead to the disease’s development but trigger its symptoms. Factors associated with the development of asthma are motherhood at a young age, poor maternal nutrition, poor breastfeeding, low birth weight, prematurity, smoking, and being overweight (Stern et al., 2020). Trivedi and Benton (2020) note that asthma genetic factors are complex, and their effects are visible in the varied burden in different populations.
Morbidity includes permanent damage to the airway and increased susceptibility to upper and lower airway tract infections such as pneumonia. Poorly managed asthma also leads to decreased lung function, severe airway inflammation, interference with daily activities, and hospitalizations (Pennington et al., 2019). The CDC reports that about 250,000 individuals die annually globally, and about nine individuals in the US die prematurely due to poorly controlled asthma.
The mortality incidence is 1.1 in 100,000, a considerable drop from 2.1 in 100000 in the 90s (WHO, 2019). Some individuals with severe asthma cannot lead everyday lives due to severe acute attacks that require urgent medical attention, thus affecting their work quality and retention as an employee. Mortality is extremely rare and indicates poor access to healthcare services and poor-quality care services.
Current Surveillance and Reporting Methods
Data on asthma is collected at various points by the National Center for Health Statistics (NCHS) surveys and the Vital Statistics System. Data is collected on child and adult prevalence. Pate et al. (2021) note that the NCHS collects data on various asthma-related issues such as activity limitation, work or school days lost, rescue and control medication, self-education management on asthma coverage, clinic, and emergency department visits, hospitalizations, and deaths.
Data at the state level includes child and adult asthma prevalence from the Behavioral Risk Factor Surveillance System (BRFSS) (GINA, 2022). Other thorough details besides prevalence can be collected through the Asthma Call-back Survey under the BRFSS. The WHO Package of Essential Noncommunicable Disease Interventions (PEN) encompasses asthma management in the plan (WHO, 2019).
The CDC also collects data on the diseases’ mortality, morbidity, and care costs and collaborates with organizations such as NCHS to produce and report on the asthma burden in the nation (Pate et al., 2021). The government has developed an asthma reporting tool that the Department of Health will use to report asthma cases and enhance proper recording and control of the disease. There are multiple tools used by healthcare providers and bodies responsible for asthma.
These tools, such as Asthma Control Test and Asthma Control Questionnaire, help healthcare providers diagnose the disease and report accordingly (Pennington et al., 2019). The Tools for Assessing referral Systems (TAARS) are tools responsible organizations use to help assess their referral systems’ effectiveness. These efforts by the government and responsible bodies enhance the surveillance and reporting of asthma.
Descriptive Epidemiology Analysis of Asthma
Asthma affects individuals of all ages, races, and classes. The condition is autoimmune, and individuals have varying severity. It majorly begins in childhood or early twenties. Asthma beginning in childhood can be managed by age 18, but some persist to a lifelong chronic illness. It’s crucial to understand that most patients develop symptoms by age five, but an individual can develop asthma at any age.
Asthma affects interracial individuals most (14.1%), followed by African Americans (11.2%), Alaska natives (9.4%), and Whites (7.7%), and the lowest was among Asians (5.2%) (CDC, 2019). The differences in prevalence can be attributed to genetic and environmental factors. The disease caused 455000 deaths globally and affected more than 262 million people (WHO, 2019).
Various social determinants of health affect the prevalence, severity, and asthma burden, contributing to health disparities. Grant et al. (2022) observe a close relationship between acute asthma, environmental factors, and social determinants of health. Socioeconomic status affects access to healthcare services. It also affects how individuals perceive attacks or take care of them.
Some individuals from low socioeconomic statuses fail to access healthcare services for minor symptoms and only seek healthcare services for severe life-threatening symptoms. Access to daily and emergency medications is challenging for individuals from low-income families, hence high mortality and morbidity rates (Grant et al., 2022). Environmental exposure is of crucial interest in asthma.
Individuals from cold areas or during the cold season report more emergency department visits than their counterparts in warmer areas or summer (Kozik & Huang, 2020). Individuals from dusty suburbs report attacks, often minor attacks. Poor access to quality healthcare services is a significant factor in asthma severity.
Asthma attacks are life-threatening and failure to access healthcare services in time leads to exacerbations, increasing morbidity and mortality rates (Seibert et al., 2019). Economic activities such as farming or working in factories affect exposure to chemicals, dust, pollen, and cold that contributes to asthma attacks. Housing and sanitation services are also a determinant of the health significance of asthma.
Poor warming structures and dust filters, poor water supply, and poor sanitation and hygiene can lead to asthma (Seibert et al., 2019). Chemical pollutants that irritate the airway, such as those found in water or poor,y ventilated houses are essential triggers of allergic and non-allergic asthmatic attacks; Individuals with asthma should opt for houses with adequate clean water and dust filters. Patients are affected differently by the determinants of health, and it is crucial to assess these factors as done in an asthma survey for optimum outcomes.
Screening and Guidelines:
Asthma is diagnosed using a physical exam, health history, and medical tests. Asthmatic attacks have profound symptoms, as discussed earlier, but chronic asthma symptoms can be confused with symptoms of other diseases such as cardiac failure and tracheomalacia. The GINA (2022) guideline recommends a complete physical examination and health history to help diagnose the disease, initiate accurate medications, and promote remission.
Diagnostic tests include spirometry, peak flow rate, allergy blood test, methacholine challenge test, and sputum eosinophils (VDH, 2018). The Global Initiative for Asthma is the medical guideline that assesses, diagnose, and manages asthma. GINA produces guidelines that help professionals accurately diagnose and manage asthma.
The GINA 2022 guidelines identify the four cardinal signs as key to the diagnosis of asthma: wheezing, shortness of breath, cough, and chest tightness. The guidelines also recommend spirometry (lung function) test as the diagnostic test of choice to confirm the diagnosis of asthma (GINA, 2022).
The tests are simple and can be undertaken at home. GINA collaborates and implements surveys and screening guidelines for the government. It collaborates with other organizations and strategies such as the CDC, WHO, and National Health Interview Survey to collect and report on Asthma burden and aid in implementing and evaluating strategies that target improving the diagnosis and management of asthma.
Spirometry is the choice test for diagnosing asthma. The spirometry test assesses the speed and volume of air entering the lungs. In trachea obstruction, such as asthma, the speed is high volume is low; thus, the speed is high to try to compensate for the obstruction. Typically, doctors use the test alongside other tests to detect airway obstruction; thus, other individuals with airway obstruction from other conditions could have positive results.
Unlike other conditions, asthma is a disease that attacks spasms, and the airway is not always constructed. An individual could lead an everyday life and portray symptoms only during an attack. These high values are related to the variety of spirometry tests. However, there is a weak agreement between asthma diagnosis and spirometry. The specificity lies at 90%, sensitivity at 22%, positive predictive value22%, and negative predictive value at 91% (Peled et al., 2021).
They are less expensive and non-invasive compared to tests such as full hemograms. Spirometry tests are relatively cheap, costing an average of $42, but the price varies with the specific hospital. A patient breathes into the machine to produce these measurements. However, the test is a valuable tool in diagnosing airway obstruction to help the doctor diagnose airway obstruction as the source of patient symptoms.
Plan for Integrating Evidence
Every learner intends to implement learned material to improve the health and well-being of patients. Asthma is a global health problem requiring healthcare providers’ attention and global health initiatives. The goals for managing and controlling asthma are aligned with HP2030 goals, which are to reduce hospitalizations caused by asthma (HP2030).
Nurse practitioners have a significant role in patient and care provider education on the disease (Kindi et al., 2022). Kindi et al. (2022) showed that patient-led education interventions led to improved prognoses s and decreased incidence of acute asthma attacks.
Asthma is a condition that requires daily prevention through a series of activities such as avoiding triggers and taking medications. Creating and promoting policies on patient education on the disease will be a priority (Scullion, 2018). Patients must understand the diseases, their causes, prevention, management, and complications.
Information increases an individual’s ability to take care of self. The goal of education is to reduce acute asthmatic attacks. The National Institute of Health recommends nurses perform the role of patient education in asthma management because they are the professionals closest to the patients. Asthma is the most common chronic illness among children, and educating caregivers on how to prevent and manage asthmatic attacks is essential.
I will also help asthma patients develop an asthma action plan that will entail the chain of actions to help the patient with the prevention and management of asthma in all populations. A personalized action plan is vital for every patient and helps create unique interventions that meet unique patient needs.
As a nurse practitioner, I will ensure some policies promote and monitor patient education to reduce acute attacks and help them lead normal lives, as supported by Mowbray et al. (2020). I will also educate patients as part of my role as a nurse practitioner.
Asthma attacks are acute and often received in the emergency department. Education on rescue medication used in these rescue episodes will significantly reduce emergency clinic visits. Thus, evaluating the emergency department visits secondary to asthma will help determine the effectiveness of the education in promoting better patient outcomes.
According to GINA (2020), asthma attacks can be severe and lead to loss of life or other comorbidities. Another priority is creating an organizational protocol that shows nurses how to handle emergency department visits secondary to asthma. Patients visiting the emergency department are those with little or no knowledge or access to education on asthma management or individuals with severe attacks unresponsive to rescue medications.
Pioneering a clear organizational policy on the protocol for managing different patients will be integral. Morbidity and mortality, especially in children, can be increased when patients do not receive the proper medications. It is vital to have a guideline that triages these patients and manages their problems according to the triage level (Patel et al., 2018).
Another vital role is patient follow-up and increasing the frequency of reviews. Many patients do not go for follow-up unless they perceive their healthy state is non-demanding (Takala et al., 2020). Asthmatic patients need reviews to help determine the effectiveness of current medication and promote continued education for better management. Patients develop resistance to drugs leading to exacerbations, and medication change-overs help manage the problem. However, such exacerbations can be prevented by prompt follow-up.
According to Takala et al. (2020), following patients helps showcase the importance of controlling the disease and helps patients see that their health system values them. Follow-up also increases their collaboration and thus promotes better patient outcomes.
Patient follow-up appointment adherence helps strategies such as GINA to track these patients and keep vital records on mortality, prevalence, and morbidity that help the government to plan interventions that promote the health of the citizens. These interventions will help me as a nurse practitioner to enhance success in the prevention and management of asthma.
Asthma is a chronic illness that affects individuals of all ages and gender. The burden is relatively higher in adult females and male children than in their counterparts. The prevention of the disease is tricky because of its complex etiology—however, the prevention of acute asthmatic attacks with proper use or routine and rescue medications.
The disease affects races and ethnic groups differently based on genetics, environmental factors, and social determinants of health. Various tools are used for asthma surveillance and reporting to enhance knowledge of the disease burden and help planners allocate adequate resources to control the disease. As a nurse, I will ensure I participate in asthma management through the various roles of a nurse practitioner.
I will participate in making policies that improve patient education, implementing patient education, following up on patients, and managing patients with exacerbations and acute attacks accordingly. I will also participate in developing organizational policies that will assist in managing the different types of asthma and their complications.
Global Initiative for Asthma (GINA), (2022). 2022 GINA Report, Global Strategy for Asthma Management and Prevention. 2022 GINA MAIN REPORT. https://ginasthma.org/gina-reports/
Grant, T., Croce, E., & Matsui, E. C. (2022). Asthma and the social determinants of health. Annals of Allergy, Asthma & Immunology, 128(1), 5-11. https://doi.org/10.1016/j.anai.2021.10.002
Kodadhala, V., Obi, J., Wessly, P., Mehari, A., & Gillum, R. F. (2018). Asthma-related mortality in the United States, 1999 to 2015: a multiple causes of death analysis. Annals of Allergy, Asthma & Immunology, 120(6), 614-619.
Kozik, A., & Huang, Y. J. (2020). Ecological interactions in asthma: from environment to microbiota and immune responses. Current Opinion In Pulmonary Medicine, 26(1), 27. https://doi.org/10.1097/MCP.0000000000000632
Mowbray, F. I., DeLaroche, A. M., Parker, S. J., Jones, A., & Ravichandran, Y. (2020). Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department. International Emergency Nursing, 50, 100844. https://doi.org/10.1016/j.ienj.2020.100844
Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma Surveillance—the United States, 2006–2018. MMWR Surveillance Summaries, 70(5), 1. https://doi.org/10.15585/mmwr.ss7005a1
Patel, S. J., Chamberlain, D. B., & Chamberlain, J. M. (2018). A machine learning approach to predicting the need for hospitalization for pediatric asthma exacerbation at the time of emergency department triage. Academic Emergency Medicine, 25(12), 1463-1470. https://doi.org/10.1111/acem.13655
Peled, M., Ovadya, D., Cohn, J., Seluk, L., Pullerits, T., Segel, M. J., & Onn, A. (2021). Baseline spirometry parameters as predictors of airway hyperreactivity in adults with suspected asthma. BMC Pulmonary Medicine, 21(1), 1-8. https://doi.org/10.1186/s12890-021-01506-6
Pennington, E., Yaqoob, Z. J., Al-Kindi, S. G., & Zein, J. (2019). Trends in asthma mortality in the United States: 1999 to 2015. American Journal Of Respiratory And Critical Care Medicine, 199(12), 1575-1577. https://doi.org/10.1164/rccm.201810-1844LE
Scullion, J. (2018). The nurse practitioners’ perspective on inhaler education in asthma and chronic obstructive pulmonary disease. Canadian Respiratory Journal, 2018. https://doi.org/10.1155/2018/2525319
Seibert, R. G., Winter, M. R., Cabral, H. J., Wolf, M. S., Curtis, L. M., & Paasche-Orlow, M. K. (2019). Health literacy and income mediate racial/ethnic asthma disparities. HLRP: Health Literacy Research and Practice, 3(1), e9-e18. https://doi.org/10.3928/24748307-20181113-01
Stern, J., Pier, J., & Litonjua, A. A. (2020, February). Asthma epidemiology and risk factors. In Seminars in Immunopathology (Vol. 42, No. 1, pp. 5-15). Springer Berlin Heidelberg. https://doi.org/10.1007/s00281-020-00785-1
Takala, J., Ilmarinen, P., Tuomisto, L. E., Vähätalo, I., Niemelä, O., & Kankaanranta, H. (2020). Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry. NPJ Primary Care Respiratory Medicine, 30(1), 1-8. https://doi.org/10.1038/s41533-020-0166-2
Trivedi, M., & Denton, E. (2019). Asthma in children and adults—what are the differences, and what can they tell us about asthma? Frontiers in Pediatrics, 7, 256. https://doi.org/10.3389/fped.2019.00256
Virginia Department of Health (VDH), (2018). Virginia 2018 Asthma Burden Report. https://www.vdh.virginia.gov/content/uploads/sites/94/2018/11/Asthma-Burden-Report_Final_10232018-1.pdf
World Health organization (WHO), (2020). Asthma Key Facts. https://www.who.int/news-room/fact-sheets/detail/asthma
Kindi, Z. A., McCabe, C., & McCann, M. (2022). Impact of nurse-led asthma intervention on child health outcomes: A scoping review. The Journal of School Nursing, 38(1), 84-97. https://doi.org/10.1177/10598405211003303