Type of paper: Research Paper

Topic: Asthma, Medicine, Health, Disease, Inflammation, Illness, Family, Genetics

Pages: 6

Words: 1650

Published: 2020/12/26

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Introduction

Asthma is a chronic lung disease caused by the inflammation and narrowing of the airways. It is one among the common illness affecting about 25 million individuals in the United States alone. The symptoms can vary from periodic periods of wheezing, tightness in the chest, difficulty in breathing as well as persistent coughing. While this disease affects the general population, its onset is often observed during childhood. This paper aims to address the manifestation of asthma in children, its history and pathophysiology as well as the management and treatment of its symptoms.
I. Natural History
Health issues with asthma usually start during infancy with a respiratory syncytial virus or RSV (Weinberger, 2003). About twenty percent of children who were infected with the RSV suffered from lower respiratory illness and 25 to 50 percent of them will have periodic acute asthma caused by viral respiratory infections (VRI). Respiratory syncytial virus infection is linked to symptoms such as wheezing, lower respiratory infections and asthma diagnosis with children ages four and below (Singleton et al., 2003). This age group is observed to have the highest cases of hospitalization due to symptoms of viral respiratory infection and asthma. A more than three decades clinical study on the natural history of asthma showed that almost twenty percent of children at seven years of age were diagnosed with asthma, however, only a few were found to have an occasional illness with VRI (Weinberger, 2003). There is gradual improvement in most pediatric cases of asthma as the child ages; however, some would carry the illness into adulthood often showing symptoms prompted by viral respiratory infection or exercise.
II. Factors Affecting the Prevalence of Asthma
Asthma is among the most common illness chronically affecting the health of children especially in developed countries. The clinical symptoms are being triggered by the increased sensitivity of the tracheobronchial tree to diverse irritating causes, the added intrusion of inflammatory cells particularly eosinophils into the airway, epithelial injury, airway smooth-muscle hyperthrophy, constriction and other inflammatory causes obstructing the airways (Bijanzadeh et al., 2011). In a recent study published in the Indian Journal of Medical Research, the development of asthma is reviewed in different categories:

A. Epidemiology

A research conducted in different nations showed that there is a 3.5 to 20 percent range of asthma prevalence in any given country (Bijinzadeh, 2011). Table 1 showed the prevalence of asthma in selected countries, with majority of the developed countries such as the United States, United Kingdom, Australia and some parts of Europe having the highest recorded cases. With an almost fifty percent worldwide increase in the prevalence of asthma, the World Health Organization predicted that by year 2020, this disease along with COPD will become the leading cause of mortality (Binjinzadeh, 2011).

Race and Socio-economic Status

The number of asthma cases is greater in urban compared to rural areas, with a twice frequency of it occurring in boys than in girls. There is a significant difference on the occurrence of asthma between races and socioeconomic status (Ettaro, 1997). In a study conducted in Sweden, it was concluded that there is an increase risks of developing the illness among children of lower income and education families (Gong et al., 2014). The result of the study revealed that

Prevalence of asthma in different countries

children from lower income and education families received proper medication due to the equity-promoting medical benefits of Sweden. However, there was an indicated association between
educational level of parents and proper dispensing of medication: lesser asthma medicines were taken by children of parents with lower educational background (Gong et al., 2014).
Race on the other hand has long been associated with the occurrence of asthma among young children. While previous studies revealed that there is prevalence of the illness among Hispanics and Black-Americans, recent research showed that the incidence of the disease did not differ among races with equal income. The substantial risk of developing the illness is common only among races under poor living conditions, resulting to the racial factor being overshadowed by economic factors (Smith et al., 2005).

Genetics and Environmental Factors

The strong linkage of asthma to genetic factors can be observed from the study of family history, twin studies and familial aggregation of the disease (Bijanzadeh et al., 2011). Atopic asthma is said to be caused by genetic and environmental elements, with the simultaneous presence of both increasing the risks of an asthmatic attack. Asthma is thought to be affected by the interaction of genetic elements; while some genes act to protect, others trigger the disease pathogenesis with some genes being stimulated by environmental causes (Bijanzadeh et al., 2011).
Several twin studies have been conducted proving the significance of heredity and environment in the prevalence of asthma. The Australian Health and Medical Research Council Twin Registry through an examination of genetic transmission proved that there were genetic factors that are common to asthma and hay fever (Duffy et al., 1990). The correlation is reportedly greater in monozygotic twins than in dizygotic twins in the 3808 pairs of twins sampled by this research (Duffy et al., 1990). However, despite the identification of genetic factors and their influence to the development of the illness, it is the environmental elements that determine whether an atopic person develops asthma (Barnes, 2003).
III. Pathophysiology of Asthma
The asthmatic bouts are caused by the chronic inflammation of the airways. An examination of asthma patients through fibreoptic and bronchoscopy reveal that their airways are reddened and are already swollen, a sign of acute inflammation (Barness, 2003). Inflammation is defense mechanism of the body against invading microorganisms and other toxins. The body reacts to the toxins and microorganism through an infiltration with eosinophils, but while this served is a defense mechanism, the inflammatory response can be harmful (Barness, 2003). Inflammatory reactions can destroy invading microorganisms, but in cases of allergic disease the inflammation can become a chronic swelling that can have harmful effects on the airways and skin (Barness, 2013)

Inflammatory Cells

Asthmatic inflammation cannot be accounted by only one inflammatory cell as the pathophysiology of this illness is complex involving different cells. Mast Cells initiate the acute bronchoconstrictor response to allergen and other asthma stimuli. These cells also release elements responsible for maintaining allergic inflammatory reaction and tumor necrosis factor (Barness, 2013). Macrophages are another inflammatory cell which can trigger a swelling reaction through the release of cytokines that can further orchestrate swelling (Barnes, 2013). Equally damaging is the dendritic cell that has the capacity to prompt a T-lymphocyte mediated reaction and can significantly cause an asthma attack. There are other structured cells that can become a source of inflammation mediators, such as epithelial cells that can trigger an inflammation response from the airways (Barness, 2013).

Inflammatory Mediators

Inflammatory mediators affecting the airways could explain the pathological characteristics of allergic diseases. The diverse effect of mediators makes it implausible that stopping the activity of one can directly impact the symptoms of asthma. Lipid mediators, cytokines, chemokines and other growth factors are mediators that work on amplifying inflammation while some can inhibit the allergic inflammatory process (Barness, 2003). For example, cytokines such as the GM-CSF which came from macrophages and epithelial cells increases the inflammation, while another form of such cell, the interferon prevents further inflammation (Barness, 2003). It is the cytokines, however, that triggers the chronic inflammation that results to “structural changes in the airways, including subepithelial fibrosis, airway smooth muscle hyperthrophy/hyperplasia, angiogenesis and mucus hyperplasia (Barenss, 2003).

Effects of Inflammation

The inflammatory reaction affects the respiratory tract cells, leading to the pathophysiological consequences that can be linked to asthma (Barness, 2003). Though many patients proceed to have normal functioning lungs despite the illness, there are irreversible alterations in the airway epithelium, lamina propria, and submucosa that results to the thickening of the airways (Fahy et al., 2000). The consequent thickening of the airways may include an incomplete reversibility of the airways, hyperesponsiveness, edema and excessive secretion of mucus (Fahy et al., 2000). The airway inflammation causes not only the symptoms of severe asthma but also that of the mild and moderate asthma. Obstruction of the airways, however, may sometimes lead to asthma exacerbations and even death due to the obstruction of the passage of air “caused by smooth muscle contraction, airway edema, and mucus plugging”(Fahy et al., 2000).

Managing Asthma

With proper management, asthma and its symptoms can be reduced as to relieve the patient of the frequency and intensity of the illness. It involved an initial diagnosis and application of treatment to take the symptoms under control and regular, long term check- up for maintenance (U.S Deparatment, 2012). The objectives of asthma controls are aimed at preventing chronic symptoms, prevent exacerbations, reduces the need for medical emergencies as well as prevent the irreversible damaged to the lungs and airways. After the initial diagnosis, the patient, or the caregivers should be instructed how to best manage the illness and understand the difference between short and long term medications (U.S. Departmetn, 2012). Long term relief treatments may not be give instant relief but will lessen inflammation in the process. On the other hand, the quick relief medication instantly relaxes the muscles giving immediate relief. In addition to medications, the patient should also avoid environmental elements that can trigger an asthma attack.

Conclusion

Asthma is one of the common disease affecting millions of people worldwide. The illness usually starts during infancy and ay be triggered by genetics, environment and other factors. The symptoms may include excessive wheezing, coughing and breathing difficulties. While researches revealed diverse elements that contribute to the development of asthma, it is the genetics and environmental factors that are more often associated with asthma attacks. Medical and pharmacological researches have yet to discover medications that can totally cure asthma, but there are management measures that can be observed to reduce symptoms. Proper and continuing medical attention can do a significant contribution to the relieved the patient of frequent or even sporadic occurrence.

References

Barness, P. 2003. Pathophysiology of Asthma. National Heart and Lung Institute, UK. Retrieved from pneumonologia.gr
Bijanzadeh, M., Mahesh, P., Ramachandra, 2011. N., An Understanding of the Genetic Basis of Asthma. Indian Journal of Medical Research. Retrieved from www.ncbi.nlm.nih.gov
Duffy, D., Ng, M., Hopper, J., Mathews, J., Genetics of Asthma and Hay Fever in Australian Twins. Retrieved from www.ncbi.nlm.nih.gov
Ettaro, L., 1997. Asthma. University of Pittsburgh. Retrieved from www.pitt.edu
Fahy, J., Corry, D., Boushy, H., Airway Inflammation and Remodeling in Asthma. US National Library. [abstract] Medicine. Retrieved from www.ncbi.nlm.nih.gov.
Gong, T., Lundholm, C., Rejno, G., Mood, C., Langstrom, N., Almqvist, C., 2014. Parental Socio-economic Status, Childhood Asthma and Medication Use- A Population Based Study. Retrieved from journals.plos.org
Smith, L., Gatcher-Ross, J., Wertheimer, R., Kahn, R., Rethinking Race/Ethnicity, Income, and Childhood Asthma: Racial/Ethnic Disparities Concentrated Among the Poor. Retrieved from www.ncbi.nlm.nih.gov
Singleton, R., Redding, G., Lewis, T., Martinez, P., Bulkow, L., Morray, B., Peters, H., Gove, J., Jones, C., Stamey, D., TAlkington, D., Demain, J., Bernert, J. Butler, J., 2003. Sequelae of Severe Respiratory Syncytial vrus Infection in Infancy and Early Childhood among Alaska Native Children. PubMed.gov. Retrieved from www.ncbi.nlm.nih.gov.
U.S Department of Health and Human Services. Asthma Care Quick Reference. Retrieved from www.nhlbi.nih.gov.
References
Weinberger, M., 2003. Clinical Patterns and Natural History of Asthma. [Abstract] . US National Library of Congress. Retrieved from www.ncbi.nlm.nih.gov

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