Medication Utilization and Emergency Room Visits for Patients With Persistent Asthma Term Paper

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Asthma and ER utilization

Asthma

Asthma is a particularly debilitating condition. Asthma is characterized by a tightening in the chest with difficulty in breathing and wheezing. This difficulty in breathing can result, at best, in a decrease in quality of life and the inability of carry out normal function. At worst, the symptoms of asthma can lead to death. Incidences of asthma have increased significantly in the last twenty years. This is perhaps due to increase in urbanization, industrialization and the accompanying pollution. This pollution can also be due to the increase in dust and waste from automobiles. While the effects and symptoms of asthma are well-known and studied, the causes of asthma are not known. They are, at best, unclear. This is because indicators vary from person to person. It is important to understand the basic mechanism of an asthma attack. A discussion of the triggers of asthma will come later. During normal breathing, air enters through the nose and its hair filters. The air is piped through the trachea and then into the tracheal branches called bronchii. The bronchii, as they enter the lungs further subdivide into bronchioles. When an asthma triggering even occurs, the tissues inside the bronchioles get inflamed. At the same time, the muscles on the outside of these tubules contract. These two actions cause air pathways to constrict severely reducing the flow of air into the lungs. The body's defense mechanism is to protect the tissue by creating thick mucus in the airways. This further restricts the flow of air. Breathing becomes a problem. If the breathing is restricted for a long enough time, the oxygen supply to the blood is restricted and this can lead to heart failure and death. (Drugdigest.org, 2003)

The reason why asthma is difficult to manage is because triggers are different for different people. In some cases, hereditary factors play an important role. No specific gene has been identified for all causes of asthma. While consider heredity however, certain genes are identified in the passing down of susceptibility to allergens. There is no consistency in the allergens. Pollen allergies are far too common, but so are dust mite allergies; and for others, fruits or shellfish might cause allergic reactions. The susceptibility to allergens is called atopy. Atopic patients are said to produce certain undesirable proteins called immunoglobulin E (IgE) antibodies. Antibodies are produced by the immune system when the body is invaded by a pathogen. There is a possible relation between an inherited variant in the IL (interleukin) 4 promoter gene which gives hypersentivity to allergens that are harmless to others. (Burchard et al., 1999)

Tobacco smoke is a major risk factor for asthma in children, especially secondary smoke. Smoke is also a critical trigger for adults. For many exercise induced asthma is a major concern. Just a few minutes of sustained exercising can bring on an attack. Emotional factors also play an important role in acute attacks. Crying, laughing and even hyperventilating can bring about an attack. Cold air, wind, rain, changes in weather, and irritants like sprays, certain spices and preservatives, fumes and smog also increase the chances of an asthma attack. Occasionally, some medications such as aspirins and beta blockers can also trigger an asthmatic episode. Hospital and emergency room statistics indicate that seasonal and climatic variations play an important role in asthma attacks. Cold temperatures and low humidity are primary causes. Bacterial and viral infections can also trigger episodes of asthma. Rhinovirus, corona virus, influenza and parainfluenza, syncytial virus, mycoplasma and Chlamydia infections are also known to cause asthma attacks. (Johnston et al., 1995) In addition, some allergens include pet hair and dander, and insect droppings.

The kinds of people that are susceptible to asthmatic attacks are those that are typically atopic; or, those that are susceptible to triggers or those that have weaker lungs and a predisposition to respiratory diseases. Asthmatic mothers often have stillborn or deformed babies if their asthma is not well controlled. This is because the oxygen supply to the fetus is often restricted.

Effects and Impacts

Children are particularly affected by asthma. The numbers have increased in the last two decades and in some instances have more than doubled. According to the American Lung Association, chronic asthma is the primary chronic illness in children. The ALA estimates that 6.3 million children under the age of eighteen years have asthma. While for most, the symptoms are mild to moderate, there are enough instances of hospitalization such that it is the third largest cause of hospitalization in children with close to three quarters of a million ER visits per year. The American Lung Association also reports that the costs of treating asthma runs into the billions with the added costs of several million cumulative school days lost in a year.

Above eighty percent of children with asthma develop symptoms in the first five years of life.

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Three different types of very young children with asthma have been identified. The first type suffers from transient wheezing. These children have asthma like problems due to viral infections at very young age. These symptoms eventually die out as children grow older. The second types are less fortunate. The ill-effects of early infections do not go away and plague them for many more years. The third types of children are atopic and tend to develop symptoms after the second and their years of their lives. In the last case, this atopy can continue into adulthood. (Martinez & Helms, 1998)

Later, it will be discussed that there is a potential drawback of overuse of certain medication in a child's normal growth. But asthma as a condition has a retarding influence on the growth of the child. The intellectual and emotional development is also typically retarded because the days lost from illness often hinder extracurricular and social activities. Fortunately, the current treatment modes when properly prescribed and used can allow a child to carry on normal day-to-day activities.

Adult asthma is also an important concern. Most adults who have asthma have experienced symptoms in one form or another during childhood. There are also many reasons why adult onset asthma is also a cause for concern. If an adult takes up smoking not realizing that it is one of the triggering mechanisms, then previously hidden symptoms might come to the fore. Occupational asthma is another reason for onset in adulthood. Workers in work environments and settings with which they are not familiar may develop occupational asthma because of exposure to chemicals, materials and dust levels with which they are not accustomed. Sometimes occupational asthma takes several years to develop. Triggering materials may range from chemicals such as plastics and polymers, chemicals that aerosolize, metal dust, organic dusts such as flour, grains, coffee, cotton, flax and hemp. A worker susceptible to these might experience occupational asthma. In addition to other symptoms, adult asthma can also be characterized by intolerance to smells of chemicals and chronic nighttime coughing. (Marabini, Siracusa, Stopponi, Tacconi, & Abbritti, 2003)

Older people also develop asthma with age. One of the reason is chronic exposure to a triggering agent over a long period of time can eventually result in asthma, especially when the body's defenses are weak. It is important to recognize that asthma can affect a person for the first time at any age. Weakened lungs can cause bouts of wheezing, especially with the weather. With older people, it is important to distinguish dyspnea from fatigue, bronchitis and emphysema from an actual asthmatic attack. Despite these confusing factors that come with age in making an accurate diagnoses, asthma does affect the older generation. Of the greater than twenty million people diagnosed with asthma in America, ten percent are over sixty-five years of age. The elderly also are prone to taking medications for more than one other condition. Sometimes, a medication for one condition might be a previously unknown asthma trigger. (Lungusa.org, 2003)

We have identified that no particular race, sex or age demographic is spared from asthma. With effective short- and long-term treatment options, asthma can be treated. There are asthma management plans that allow individuals to effectively treat their condition and live normal lives. Impact is an important consideration. Impact is based on several demographics: socio economic factors, geographical location, and productivity. We already know that asthma sufferers put a strain on the health care economy sometimes burdening the system. Nearly five thousand people die every year from asthma and more than fourteen billion dollars are spent in medical and indirect expenses. Several million people are diagnosed with asthma in one year. And a significant percentage of that number has at least one asthma attack in a year. (ALA, 2002)

Asthma in children increased more than seventy-four percent between 1980 and 1996. Childhood asthma persists beyond childhood in eighty-five percent women and seventy-two percent men. Women are more susceptible to asthma than men by almost thirty percent are. Urban sprawl exposure to pollution and other typical pollution due to cramped housing means that poorer urbanites,….....

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