Week 6: Epidemiological Analysis: Chronic Health Problem

Student’s Name

Institutional Affiliations

Week 6: Epidemiological Analysis: Chronic Health Problem

Asthma is one of the chronic respiratory conditions that are affecting populations today. The disease has become a public health concern owing to the poor quality of life, mortality, and morbidity that it is causing to people of different age groups. Asthma pathogenesis is associated with chronic inflammation of the airways with the common clinical presentations being tightness of the chest, dyspnea, wheezing, and persistent cough, especially at night. The intensities of these symptoms may vary depending on the degree of airway obstruction (Centers for Disease Control and Prevention, 2022a). According to Jeyagurunathan et al. (2021), asthma affects approximately 330 million people globally. Asthma is of significance because it is linked with a huge disease burden. Additionally, uncontrolled cases of asthma are linked with increased healthcare utilization. The purpose of this paper is to explore the background and significance of asthma. It will also cover the current surveillance and reporting methods for asthma and provide its descriptive epidemiological analysis, including its diagnosis and screening guidelines and action plan for management.

Background and Significance of Asthma

Asthma affects people of different age groups. However, children usually experience more severe asthma exacerbations when compared to adults (Song et al., 2022).  Asthma is defined as a chronic respiratory condition that is characterized by the inflammation of the airway. Asthma patients often present with signs and symptoms that form a crucial component of their medical history. As Papi et al. (2020) explain, individuals affected with asthma usually experience persistent or episodic respiratory symptoms including wheezing, tightness of the chest, coughing, and wheezing. The airflow limitation experienced by asthma patients is attributed to increased mucus production, thickening of the airways, and constriction of the bronchi (Papi et al., 2020). The major causes of morbidity and poor quality of life in asthma patients are the frequent exacerbations which are also a source of economic burden attributed to the disease. Asthma is significant in that it causes disability, increases healthcare utilization, increases healthcare costs, and leads to poor quality of life. Uncontrolled asthma causes mortality in both adults and children (Jeyagurunathan et al., 2021). Exposure to irritants increases a person’s risk of developing asthma. Examples of irritants that often trigger allergic reactions leading to asthma include dust, spores, and pollen.

Recent surveys revealed that asthma incidence and prevalence have been increasing globally in the recent past. According to Papi et al. (2020), the global prevalence of asthma in 2019 was approximately 235 million people. This number increased significantly two years later. In 2021, the prevalence of asthma globally was about 339 million people (Jaragurunathan et al., 2021). The World Health Organization, in comparing the incidences and prevalence of asthma across countries, revealed that more developed countries have lower incidences and prevalence of asthma than less developed countries. For example, asthma prevalence in Australia is as high as 21% while it is significantly lower in other countries such as China which had an asthma prevalence of 0.2% as of 2021 (Jeyagurunathan et al., 2021). Understanding the variations in asthma incidences and prevalence helps public health professionals to identify countries where populations are at increased risk of developing the condition.

The prevalence of asthma in the United States is higher than that of New York State. In the United States, the prevalence of asthma is approximately 25 million people. This translates to about 1 person in every 13 people. More blacks than other races in the United States are diagnosed with asthma each year in the United States (Asthma and Allergy Foundation of America, 2021). According to the American Lung Association (2022), current Asthma prevalence in New York state among adults stands at 10.1% while in children its stands at 6.2%. When categorized in terms of age and gender, current asthma prevalence in people aged below 18 years is 8.3% in males and 6.7% in females. The prevalence among people aged 18 years and above is 5.5% in males and 9.8% in females (American Lung Association, 2022). The table below summarizes the prevalence in the United States when categorized in terms of gender.

Table 1: Asthma Prevalence in the United States Categorized in Terms of Gender

 Surveillance and Reporting

Asthma has not been classified among diseases that require mandatory reporting. However, it is recommended that cases of asthma identified among pediatrics should be reported to enhance disease management. Healthcare providers are also advised to report severe asthma cases among adults to the right professionals for specialized care (Quek et al., 2022). The United States and the State of New York emphasize the importance of surveillance and reporting to ensure adequate disease control. The surveillance data guides decision-making regarding how asthma can be controlled and managed.

The United States asthma surveillance data details disease prevalence, limitations due to the disease, control strategies, management interventions, self-care management, patient education, and visits to the emergency departments of hospitals. The data also contains information related to hospitalization and deaths caused by the disease (Centers for Disease Control and Prevention, 2022b). The surveillance data for the United States is obtained from the Vital Statistics System and the National Center for Health Statistics Surveys. Data for both adults and children in collected for surveillance. According to the 2020 National Health Interview Survey, the total number of children under 18 years who had asthma attacks during the year was 42.7%. Adults aged 18 years and above who experienced asthma attacks in 2020 were 40.7% (Centers for Disease Control and Prevention, 2022b). Interventions seeking to reduce incidences of asthma attacks should aim to lower the incidences reported under the surveillance data.

The New York State Surveillance Data tracks asthma-related data. The methods applied to collect and organize the surveillance data are through the use of dashboards. About 40 different indicators are used. For example, New York surveillance data indicates that emergency visits among children below 18 years are usually higher than among adults aged 18 years and above with asthma (New York State, 2022). Although asthma is not mandated for reporting in the United States, it is advisable that suspected cases are reported to relevant healthcare agencies, especially in children.

Epidemiological Analysis

Nurse practitioners should understand epidemiological concepts as they apply to asthma. The 5W’s of epidemiological analysis include What (the health event or condition), Who (person), Where (place), When (time), Why/How (modes of transmission) (Centers for Disease Control and Prevention, n.d.). The descriptive epidemiology of asthma using the 5W’s is as follows;

What: Asthma is a chronic disease that primarily affects the respiratory system. It causes morbidity, mortality, and poor quality of life for children, adults, and the elderly (Dharmage et al., 2019).

Who: Although asthma affects children, adolescents, adults, and the elderly, its prevalence and incidences are higher in children than in other age groups. Additionally, higher morbidity and mortality rates are recorded in pediatrics than in people in other age groups. In children, asthma is more commonly diagnosed in boys than in girls. In adults, the condition is more commonly diagnosed in women than in men (Dharmage et al., 2019).

Where: Asthma incidences and prevalence are recorded globally. The prevalence and incidence of asthma are higher in low and middle-income countries when compared with developed nations (Dharmage et al., 2019).

When: A person develops asthma when he or she is exposed to environmental irritants that trigger allergic reactions. Examples of irritants include spores and pollen. A family history of asthma also increases a person’s risk of developing the disease (Dharmage et al., 2019).

Why/How: Environmental exposure plays a key role in asthma development in both adults and children. A person’s genetic makeup related to a family history of the disease is also associated with asthma development. High-risk groups can be identified through gene-environment analysis and genetic comparisons. Social determinants of health have been linked with asthma and asthma attacks or exacerbations. For example, a built-in environment where there are elements that emit irritants into the environment increases asthma risk. Additionally, limited knowledge about asthma management, poverty, lack of insurance, and limited healthcare access can lead to poor disease management in people affected with asthma (Dharmage et al., 2019).

Screening and Guidelines

Screening and diagnosis of asthma must follow evidence-based clinical practice guidelines. An evidence-based screening and diagnostic tool used to assess and test asthma among populations is the Asthma Control Test (ACT). This tool is the gold standard that is used globally to screen, assess, and control asthma symptoms (Gemicioğlu et al., 2020). It has five items designed to measure dyspnea and night-based symptoms. The tool also evaluates medication use, physiological functioning on a daily basis, and a person’s perceptions regarding asthma control. A score of 19 or less on the ACT tool confirms uncontrolled cancer whereas a score that is greater than 20 indicates controlled asthma (Gemicioğlu et al., 2020).

ACT remains the gold standard for detecting asthma due to its high sensitivity, specificity, and predictive value. The sensitivity of the ACT refers to the probability of the tool to detect true positive asthma cases (Wang et al., 2021). Its specificity defines its probability to detect true negative asthma cases. The positive predictive value of ACT is the probability that a positive asthma case selected at random actually has the disease (Wang et al., 2021). According to Gemicioğlu et al. (2020), the specificity and sensitivity of ACT to detect uncontrolled asthma or give a score of 19 or less are 71% and 71% respectively. A study by Patil et al. (2018) revealed that ACT has a sensitivity, specificity, and positive predictive value of 82.3%, 69.4%, and 56% respectively. The patient may incur additional costs when ACT is administered.

Plan

The nurse practitioner works with asthma patient and their family members or caregivers to ensure that patients attain an improved quality of life. A number of interventions have been confirmed through research to be effective in improving asthma symptoms in the affected patients (Papi et al., 2020). The American Family Physician Asthma Management Guidelines recommend pharmacological management interventions for the management of asthma. According to the guidelines, asthma can be managed using inhaled corticosteroids (ICS), short-acting beta₂ agonists (SABA), or/and long-acting antimuscarinic agents (LAMAs) with ICS for long-term management of asthma (American Family Physician, 2021). When using these three pharmacological management interventions to treat asthma patients, the nurse should determine drug dosages based on the disease severity and age of the patient. The specific outcomes that are measured during medication use are the specific asthma symptoms which should improve when the administered drugs are effective.

The management of asthma should focus on promoting primary, secondary, and tertiary prevention. The best primary prevention strategy for asthma is to limit exposure to irritants. The nurse should conduct screening services as a secondary intervention to detect asthma early (Pastorino et al., 2021). The pharmacological interventions named above are effective tertiary interventions for lowering the progression of the disease after a diagnosis has been confirmed (Pastorino et al., 2021). Additionally, the nurse should act as patients’ advocate by supporting the development and implementation of policies that focus on improving the health, well-being, and quality of life of asthma patients (McCabe & Connolly, 2019).

Summary/Conclusion

Understanding the epidemiology of asthma helps nurses to make the right decision whenever they are handling patients with the condition. Asthma is significant in that it causes disability, increases healthcare utilization, increases healthcare costs, and leads to poor quality of life. Uncontrolled asthma causes mortality in both adults and children (Jeyagurunathan et al., 2021). Although there is no mandatory reporting for asthma in the United States, the government collected surveillance data to inform decisions related to asthma treatment and management. Using the 5W’s of epidemiological analysis helps nurses to understand asthma better in terms of what, who, where, when, and why/how. The gold standard tool for screening and diagnosing asthma is the ACT. Interventions for managing asthma should be evidence-based and should aim to promote primary, secondary, and tertiary prevention (Pastorino et al., 2021). Nurses should advocate for asthma patients by participating in the development and execution of relevant health policies.

References

American Family Physician. (2021). Asthma Management Guidelines: Focused Updates for 2020. https://www.aafp.org/pubs/afp/issues/2021/1100/p446.html

American Lung Association. (2022). Current asthma demographics. https://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/current-demographics

Asthma and Allergy Foundation of America. (2021). Asthma facts and figures. https://www.aafa.org/asthma-facts/#:~:text=How%20Common%20Is%20Asthma%3F,about%201%20in%2013%20people.&text=About%2020%20million%20U.S.%20adults%20age%2018%20and%20older%20have%20asthma.

Centers for Disease Control and Prevention. (n.d.). Lesson 1: Introduction to Epidemiology. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section1.html#:~:text=The%20difference%20is%20that%20epidemiologists,transmission%20(why%2Fhow).

Centers for Disease Control and Prevention. (2022a). Asthma. https://www.cdc.gov/asthma/default.htm#:~:text=Asthma%20is%20a%20disease%20that,nighttime%20or%20early%20morning%20coughing.

Centers for Disease Control and Prevention. (2022b). Asthma: 2020 National Health Interview Survey (NHIS) Data. https://www.cdc.gov/asthma/nhis/2020/table6-1.htm

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in Pediatrics, 7, 246. https://doi.org/10.3389/fped.2019.00246

Gemicioğlu, B., Mungan, D., Bavbek, S., Yıldız, F., Polatlı, M., Naycı, S., Erkekol, F. Ö., Türker, H., Günen, H., Çamsarı, G., Abadoğlu, Ö., Çımrın, A., Dursun, A. B., Göksel, Ö., Özdemir, S. K., Börekci, Ş., Aydın, Ö., Ocaklı, B., Gür, A., Baygul, A., … Mısırlıgil, Z. (2020). Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study. Turkish Thoracic Journal, 21(2), 93–99. https://doi.org/10.5152/TurkThoracJ.2019.180186

Jeyagurunathan, A., Abdin, E., Shafie, S., Sambasivam, R., Yunjue, Z., Chua, B. Y., Vaingankar, J. A., Verma, S., Ee, T. W., Chong, S. A., & Subramaniam, M. (2021). Asthma prevalence and its risk factors among a multi-ethnic adult population. The Yale Journal of Biology and Medicine, 94(3), 417–427.

McCabe, E. M., & Connolly, C. (2019). From intention to action: Nurses as policy advocates for asthma care in schools. NASN school nurse (Print), 34(2), 113–116. https://doi.org/10.1177/1942602X18786394

New York State. (2022). Information on asthma in New York State. https://www.health.ny.gov/statistics/ny_asthma/

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: reshaping the concept of asthma management. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 16, 75. https://doi.org/10.1186/s13223-020-00472-8

Pastorino, R., Loreti, C., Giovannini, S., Ricciardi, W., Padua, L., & Boccia, S. (2021). Challenges of prevention for a sustainable personalized medicine. Journal of Personalized Medicine, 11(4), 311. https://doi.org/10.3390/jpm11040311

Patil, B., Eti, A., Lolly, M., Khan, S., & Bansal, A. (2018). A clinical evaluation of asthma control test to assess the control of asthma and its relation to the severity of asthma. International Journal of Health and Allied Sciences, 7, 12-6. doi: 10.4103/ijhas.IJHAS_84_16.

Song, P., Adeloye, D., Salim, H., Dos Santos, J. P., Campbell, H., Sheikh, A., & Rudan, I. (2022). Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study. Journal of Global Health, 12, 04052. https://doi.org/10.7189/jogh.12.04052

Quek, J. S., Tang, W. E., Chen, E., & Smith, H. E. (2022). Understanding the journeys of patients with an asthma exacerbation requiring urgent therapy at a primary care clinic. BMC Pulmonary Medicine, 22(1), 231. https://doi.org/10.1186/s12890-022-02024-9

Wang, H., Wang, B., Zhang, X., & Feng, C. (2021). Relations among sensitivity, specificity and predictive values of medical tests based on biomarkers. General Psychiatry, 34(2), e100453. https://doi.org/10.1136/gpsych-2020-100453.