Asthma Control in General Practice

The ubiquity of asthma in society today is rising at alarming rates. Its prevalence has been increasing in the last two decades, and childhood asthma has become a serious public health problem because of its morbidity and related healthcare costs (Ferraro, Carraro, Bozzetto, Zanconato, & Baraldi, 2018). Overall 334 million people are affected by this condition across the globe. Asthma was ranked in the top twenty most disabling conditions in 2015, and when it comes down to statistics, there are more males affected than females from this disorder. Males are more likely to live with asthmatic conditions due to the size and capacity of the lungs, but as puberty emanates the roles are overturned and more females are likely to acquire or live with asthma. Genetics, hormones, life choices, and the environment all play a role in the accumulation of asthma. One may be born with it as genetics can be a determining factor, but other elements such as smoking, living a sedentary life, or living with obesity may cause a diagnosis later in life. Obesity is a red flag for a variety of reasons, but it can actually cause one to accumulate asthma later in life and cause major breathing complications, which is why monitoring health and staying active is so important. The later the diagnosis the higher the severity, which can lead to secondary conditions. A lot of adults are not just overweight in America, but they are obese. (Papi, Brightling, Perdersen, & Reddel, 2018).

When looking to diagnose an individual with asthma there are a few key signs and symptoms to look for that include, but are not limited to: restricted airflow, swelling of the airway walls, thickening of the muscles in the lungs, chest pressure, wheezing, rapid breathing, and shortness of breath. As airways become blocked and inflamed, the airflow to the lungs becomes limited, making it extremely hard to breathe. There are various symptoms under the umbrella of asthma, which can make identifying the condition challenging, and it is also why some individuals with asthma go undiagnosed. The spirometry breathing assessment will be administered by a specialist when testing for asthma, which will test the lungs capacity, while also measuring the speed at which air is blown at. There could be an imaginary balloon to blow up or even pretend birthday candles to be blown out during this test to make the assessment relate back some more everyday life tasks. There are other breathing diagnostic tests that may be run as well by a professional to gather more information of the lungs. (Papi, Brightling, Perdersen, & Reddel, 2018).

Often times asthma will be genetically passed down, but there are several other determining factors that can cause this respiratory condition. Allergies are a major trigger for asthma, and eczema is typically linked to asthma as well. Eczema is the inflammation and itching of the skin that can go hand in hand with the diagnosis of asthma since the two are both atopic diseases. If one has developed a respiratory infection, especially during the developmental years, the lung capacity and tissue can be damaged, which may also later on lead to decreased lung function and instigate asthma. The environment in which one lives in can also result in inflamed airways. Another possible component that can lead to asthma includes the exposure to a variety of dusts, pollens, chemicals, dander's, ragweed's, and other substances related to allergens. A number of pathogenic factors have been identified for this complex syndrome (asthma), including genetic predisposition and several environmental factors (Ferraro, Carraro, Bozzetto, Zanconato, & Baraldi, 2018).

Exercise induced bronchoconstriction is one of the several types of asthma. It is activated when one is exposed to physical activity that requires oxygen. Some of the activities that may trigger an exercise induced asthma attack include sports that require a lot of running or fast movements with no break time, such as soccer. Swimming often triggers asthma too due to the exposure of the chemicals in the water, such as chlorine, and the extremely congestive air in indoor pool facilities. Sports and activities that have time outs, break times, or that are interval based allow great opportunity for participants to catch one's breath and regain strength. Exercise induced asthma can be experienced at any age throughout the life span and sometimes it is the only form of asthma present, meaning asthma attacks and asthma like symptoms are only present during or after a workout lasting approximately thirty minutes to one hour. To avoid exercise induced asthma it is helpful to stretch and warm up for ten to fifteen minutes before and after the anticipated movement, so the body is not abruptly starting or stopping strenuous activity. (American Lung Association, 2018).

Cough variant asthma is another form of asthma. It can be from post-nasal drip, bronchitis, or upper respiratory constrictions and is most commonly found in adults. This form of asthma causes a dry cough that last about eight weeks, but it is unlike the other forms because other regular asthma symptoms are not present. It can still be life threatening and must be treated diligently. If any form of an asthma attack is happening inhalers and nebulizers are immediate responses used to treat the attack symptoms. They are used to open up airways. Nebulizers, also known as breathing treatments, are used when an inhaler is not working or if more intense treatment is needed. Both inhalers and nebulizers are fast acting and can save the life of someone having an asthma attack. Asthma cannot be cured, making it a chronic condition, but symptoms can be managed. Treating asthma symptoms requires individualizing procedures so that they can be catered to the client's symptoms. (Papi, Brightling, Perdersen, & Reddel, 2018).

Part II

Physical- The movements needed to pursue every day activities can be strenuous on an individual who is living with asthma. Walking up a flight upstairs, running to catch the local bus, bending down to lift up a child, taking care of self-care needs, or even participating in a daily household activity can trigger wheezing, shortness of breath, or asthma attacks. When it comes to participating in physical activity there are symptoms to remain aware of in relation to exercise-induced bronchoconstriction. If you are working out in the cold weather or extreme heat it is important to monitor all asthma symptoms because cold dry air can initiate attacks. For a child with asthma it is vital to get outside and play as much as possible so the development of the lungs can be continuously strengthened, and so physical activity can become normalized at a young age. Strenuous outdoor activities can initiate an asthma attack, but if there is no physical activity or play at all an attack can come along easier. Finding moderately challenge games or very straightforward exercise concepts to participate in can help with long term endurance and lung efficiency. Karate, yoga, tai chi, golf, bowling, fishing, and a variety of other tasks that require breath control, but are not too triggering of aerobic movements. These can be a happy medium when searching for sports to participate in when living with asthma.

Practicing breathing exercises regularly and monitoring what interventions cause attacks to begin can help one establish a plan of action to take when deciding what activities are appropriate to participate in and that won't trigger respiratory complications. Creating an Asthma Action Plan and addressing all three zones of the plan can help one maintain a suitable physical activity environment and healthy life overall. In Asthma Action Plans there are two parts. Part one expresses the day to day management of symptoms, while part two addresses how to cope and react to severe signs that show the asthma is progressively becoming more dangerous. All three zones of the asthma action plan are labeled with a color, what symptoms one should look out for, and the action that should be taken if the signs are presented for a prolonged period in an individual with asthma. If there are not any asthma symptoms present, if everyday prescriptions and treatments are used as directed, and if things are overall running smoothly throughout the respiratory system, then one would be marked in the green zone of the Action Plan. If the yellow zone is underway that means wheezing, shortness of breath, and disruption of sleep are occurring and it is time to use a rescue inhaler. It is also crucial to make an appointment with a health care professional to discuss the use of new treatment and new medication. The last zone is known as the red danger zone. In the red danger zone sleeping is close to impossible, breathing is exceptionally difficult, and all asthma symptoms are highly problematic and getting in the way of daily activities. This stage requires the use of a rescue inhaler and calling 911 or immediately going to the emergency room. Having an Asthma Action Plan can save lives and if a healthcare provider does not make one for a client the client should ask to create one. (Developing an Asthma Action Plan, 2018).

Emotional- It can be difficult psychologically to live with asthma. Opportunities to participate in community events, local sports teams, and pursuing personal interests may be restricted due to the severity of the condition, which can be emotionally taxing. Living with anxiety or panic attacks can cause asthma attacks as well due to frequent shortness of breath, the feeling of a tight chest, or the other stressors this diagnosis may put on the body. Emotions, such as anger, can evoke breathing complications too, so a respiratory attack can be triggered without even participating in physical movement. The severity of asthma and how much it confines daily activities can put a strain on one mentally and can be a contributor to dual psychological conditions. Finding interventions that do not require constant medical treatment can help. Strengthening the lungs through meditative breathing exercise can be beneficial to both the mind and body. Acquiring more knowledge related to the condition can allow for stronger coping skills to be created, better reaction when an attack presents itself, and a better understanding of asthma overall can help friends and family assist when needed. Remaining active in the community and practicing self-care can boost confidence as well, which is great for emotional health. Unfortunately, having a near death experience or life threatening asthma attack can create negative feelings towards the condition of asthma. These frightening experiences can restrict individuals from attempting to live life to the fullest. Once an individual has found an activity, intervention, or hobby that is enjoyable and creates feelings of confidence they can reach the optimal experience from the activity, while also finding mental stability and comfort. Benefits from focusing on mental and emotional health can result in positive social interactions, finding common interests, developing a sense of community, and it can increase alertness while improving stimulation to the brain. In relation to emotional growth, finding emotional interventions will also help reduce stress, high cholesterol, and risk of future asthma attacks.(Emotional Effects of Asthma, 2018).

Social- The social constraints to asthma are manageable with the use of leisure education, knowledge on controlling symptoms, and confidence in medication use one can positively integrate into society with certainty. Looking to control symptoms in everyday life can present obstacles that are out of one's control, such as the weather. Cold dry weather can be a trigger for asthma attacks as well as days with a high pollen count or low air quality, but finding weather apps and local new channels to touch up on at the beginning of each day can help an individual plan out the week and see when it is most appropriate to spend time outside. Communicating throughout all relationships and establishing solid boundaries about pets and other triggers that may come up in social situations can help avoid flare ups too. Establishing positive interactions and communication with doctors can lead to better professional recommendations and more personalized Asthma Action Plans, which can then allow for more flexibility in social life. Finding comfort when integrating into society may reduce social anxieties and fears as well. (Newcomb, McGrath, Covington, Lazarus, Janson, 2010). Some social constraints related to asthma can also be correlated to academic or occupational work. If an individual is having an asthma attack or sever symptoms it might be required to miss work or school. If this happens important information might be missed and the opportunity to remain social, make friends, or build connections has a smaller window.

Cognitive- Education is going to be the most proactive approach when focusing on cognitive symptoms related to asthma. Understanding the different types of asthma and what to do in an attack, addressing triggers that contribute to airway restriction or increase likelihood of airway restriction, knowing mediation use and management, knowing the symptoms, treatment, and symptom management related to asthma are all vital. Asthma is a common, potentially severe chronic disease that in the majority of cases can be treated effectively to control the symptoms and minimize the risk of flare-ups (exacerbations) (Ferraro, Carraro, Bozzetto, Zanconato, & Baraldi, 2018). Cognition is not relatively linked to asthma, but if a client has a dual diagnosis of a mental health disorder or intellectual deficit cognitive dysfunction may be present.

Part III

Emma is a 13-year-old who has been living with severe asthma her whole life. Her current treatment consists of using an inhaler 2-3 times a day and a nebulizer once a week or as necessary. Emma enjoys watching movies and talking about how much she loves dogs. She also loves to read and spend time at the local Barnes and Noble. Emma tries to remain active by participating in karate 3 times a week. She has her worst asthma symptoms directly after karate practice and when walking to and from the bus stop, which is at the top of a hill in her neighborhood. Emma is afraid of having an asthma attack at school, during karate practice, and when she is away from her family. Her asthmatic condition creates a negative mindset for herself to the point where she is too scared to try out for any higher level cardio and endurance sports in fear of having an attack and not being able to control the symptoms. This fear is heightened when she knows she is going to be away from those who know how to help her.

Goal: Reduce an emotional blockage and negative set associated with asthmatic restrictions when participating in community sports and personal interests.

Objective: Each time client goes to Barnes and Noble try to find an article or book about asthma and asthma friendly sports to play so client can begin to feel more comfortable with symptoms and so client can teach those around him symptom management.

Goal: Increase awareness of the body's respiratory endurance.

Objective: Participant will practice holding yoga 8 different poses for one minute at a time each day for 3 months to aid in gaining awareness of the body's strength and understanding breath control.

Intervention to meet goals: Yoga and mindfulness meditation

Yoga may be used to increase lung function and reduce anxiety or stress related symptoms associated with asthma. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally (Yang et al., 2016). The flow of yoga can be slow and uplifting or fast and controlled, but regardless of the style, yoga can still be great for stress relief and is a great form of physical activity. Savasana is a yoga pose that can benefit breath control for one living with respiratory restrictions. This asana focuses on breath and total body relaxation, which can allow one to improve more control and gain familiarity with breathing exercises for 5-10 minutes each day. The more it is practiced the easier it becomes. Stress management along with breath control can be great skills to have if asthma attacks are present of symptoms are flaring up due to anxiety. Pranayama, the practice of inhalation and exhalation patterns, can also be added to an individual's yoga practice each day. Participating in a beginner level yoga class that emphasizes finding balance within the body and building strength through controlled movements can be beneficial. (Saxena, T., & Saxena, M. 2009).

Precautions:

1. Be aware of the environment especially if the intervention is outside because the weather or allergies could be triggers
2. Check to make sure all yoga equipment is safe to use
3. Avoid eating heavy meals before activity
4. Avoid wearing restrictive clothing during intervention

Contraindications:

• Be aware of what medications participants are taking
• Allow break times when needed to allow heart rates to slow down and to catch one's breath again.
• Ask participant if they have had any recent flare up's in symptoms, if so know what they are
• Check and monitor for symptoms of wheezing, shortness of breath or rapid breathing, and inflamed airways

Suggested RT considerations:

Monitor client's emotions and how interested the client is during the yoga flow. There are modifications and different variations for yoga poses, as well as options for the speed of the class, so be sure to keep engagement on the radar at whatever level the client feels comfortable. Age and other personal interest can be determining factors in choice of music, location, and what poses are chosen during the intervention. Remain flexible and honest throughout the yoga flow and remind the client that loss of balance, mistakes, and difficulty allowing vulnerability are all normal because yoga will take patience and practice.

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