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Non-Communicable Diseases (NCDs) are long-term chronic illnesses that often develop as a result of genetic, physiological, behavioral or environmental factors (World Health Organisation 2019). Asthma—a Chronic Respiratory Disease—is one such NCD that affects the Respiratory System. Asthma can be defined as a chronic disease wherein resistant flow in the airways incites breathlessness and chest tightening as a result of narrowed and inflamed airways (Australian Institute of Health and Wellness 2019; Godfrey 1985). In 2018, 339 million people globally suffered from asthma-related health conditions with lower and middle-income countries having the highest mortality rates for asthma-related deaths (The Global Asthma Report 2018). Recent reports indicated that 2.7 million Australians, and 112,000 Indigenous Australians, suffered from asthma in 2018; with Indigenous Australians being 1.9 times as likely to develop asthma compared to non-Indigenous Australians (The Australian Bureau of Statistics 2018; The Australian Bureau of Statistics 2013). Further analysis of Australian asthma patients revealed, females (12.3%) were more at risk of developing asthma-related health conditions as opposed to men (10.2%); and male children under the age of fourteen (12.1%) and women between the ages of sixty-five and seventy-five (>15%) were the most at risk of developing asthma-related illnesses according to age (The Australian Bureau of Statistics 2018). Thus, this paper proposes that asthma is a serious long-term condition whereby educational awareness of asthma-related conditions can be utilized to ascertain to what extent asthma impacts health and society. Through a health science framework, this essay will discuss the function, anatomy and physiology of the Respiratory System; analyze the pathophysiology of the Respiratory System post-asthma diagnosis; discuss current and new trends in asthma-related treatments; explore the social impact asthma has on sufferers’ quality of life; examine the impact asthma has on society, and consider public health initiatives to determine in what ways society can facilitate the empowerment of individuals living with asthma-related health conditions.
Oxygen plays a vital role in the function and continued maintenance of the body. The Respiratory System is the system of organs that are responsible for gas exchange: providing oxygen to the body’s cells, ensuring air quality and removing carbon dioxide (Barclay 2018). The Respiratory System contains six major structures: the pleura, the lungs, the trachea, the bronchi, the bronchioles and the alveoli. Additionally, the Respiratory System has comprised of two zones: the conducting zone and the respiratory zone. The conducting zone includes all structures in the Respiratory System that forms a continuous passageway allowing air to travel throughout the system; whereas the respiratory zone is found deep within the lungs and includes the structures responsible for oxygenating blood and exchanging oxygen for carbon dioxide (Get Body Smart 2019). The Respiratory System can be further categorized as the upper respiratory tract and the lower respiratory tract.
Image 1: The Upper Respiratory Tract (Barclay 2018)
Image 2: The Lower Respiratory Tract (Barclay 2018)
The upper respiratory tract is where oxygen first enters the body. There are four main structures within the upper respiratory tract: the nose and nasal cavity, the oral cavity, the larynx and the pharynx. The upper respiratory tracts’ main function is to enable smell and speech and ensure air quality via air filtration processes. Hair fibers lining the nose act as protective agents preventing large dust particles from entering the system; whilst mucus and blood-warming capillary cells in the nasal cavity trap finer dust particles whereby passing cilia cells transport these dust particles to the pharynx where they can be expectorated (Peate 2018). The pharynx and the larynx act as passages for food and air, with the larynx being located between the pharynx and trachea, protected by the epiglottis. The epiglottis prevents food from entering the airways.
Diagram 1: Structures of The Upper Respiratory Tract (Peate 2018).
The lower respiratory tract is primarily responsible for gas exchange: oxygenating blood, removing carbon dioxide and carrying oxygenated blood around the body. There are six main structures in the lower respiratory tract: the trachea, bronchi, lungs, bronchioles, alveoli and diaphragm. The trachea transports oxygen from the larynx to the lungs where it diverges into two separate bronchioles and delivers oxygen to their respective lungs (Get Body Smart 2019). The bronchioles have cartilage embedded into the walls to keep airway passages in the bronchi open. The lungs are divided into lobes: two on the left and three on the right, which are protected by the ribs, sternum and vertebrae. The bronchioles, the alveoli and the diaphragm assist the lung muscles by contracting and dispersing oxygen throughout the alveolar ducts (Peate 2018). In pre-asthma-diagnosed individuals, this process allows the human body to breathe without difficulty.
Diagram 2: Structures of The Lower Respiratory Tract (Peate 2018).
Three major pathophysiological changes occur within the Respiratory System of asthma-diagnosed individuals: firstly, the lining of the bronchial tubes are exposed to abnormal swelling; secondly, the formation of excess mucus obstructs air passages resulting in the buildup of excess fluid in the system (mucus hypersecretion); and lastly, the smooth muscles lining the airways narrows (bronchoconstriction), restricting oxygen travel throughout the body (Ellis 2018; Kaufman 2011). These pathophysiological changes can lead to symptoms of breathlessness, sporadic wheezing, tightening of the chest, excess coughing that intensifies over an extended period of time and limited airflow; and may be triggered by environmental exposure to allergens and pollutants, exercise, stress, allergies, food preservatives and smoke (Global Asthma Network 2018; Kaufman 2011).
O'Byrne et al (2013) argue that despite access to medication and interventions to control the effects of asthma, a high percentage of asthma-related diseases remain uncontrolled due to fear of the possible side effects that may develop as a result of prolonged exposure to inhaled corticosteroids medications, which help to alleviate the swelling of the bronchial tubes. Additionally, empirical research suggests that prolonged exposure to inhaled corticosteroids medications escalated hospital admissions, and increased the risks of fractures and the contraction of cataracts in elder patients (Jick, Vasilakis-Scaramozza & Maier 2001; Kaufman 2011; Lee & Weiss 2004). In children, uncontrolled asthma can lead to learning disabilities and impaired cardiovascular fitness; whereas, in adults, uncontrolled asthma can negatively affect concentration, and increase the risk of depression and contraction of respiratory infections (O'Byrne et al 2013). Thus, Kaufman (2011) stresses the importance of maintaining control of asthma as a preventative measure against the contraction of preventable diseases.
Current treatments for asthma can be categorized in two ways: “pharmacological treatments” and “preventative measures”. Both, pharmacological treatments and preventative measures, rely heavily on self-management strategies and interventions whereby patients administer treatment based on personal monitoring of symptoms and seek guidance from healthcare professionals when symptoms progress or regress to ensure adequate needs are addressed. Pharmacological treatments involve the use of prescription medication and can be further defined as “relievers” (medications that relieve symptoms) or “preventers” (medications that prevent symptoms). These medications include short-acting beta2-agonists (medications that provide short-acting pain relief); inhaled corticosteroids medications (medications that prevent the cell production of asthma-related symptoms); long-acting beta2-agonists (medications that encourage mucociliary clearance, relax the airways and decreases vascular permeability); Leukotriene receptor antagonists (medications that reduce hyper-responsiveness and inflammation of the airways, bronchoconstriction and mucus production); Methylxanthines (high-risk medications that can help trigger breathing responses in the brain); and oral corticosteroids (a medication comprised of synthetic hormones that can reduce inflammation in the Respiratory System and the Immune System) (Kaufman 2011). Preventative treatments implement control measures to minimize exposure to asthma-induced triggers. The Asthma and Allergy Foundation of America (2019) recommends the use of Asthma Action Plans as a “preventative measure” regarding self-management and relief of symptoms. A well-executed action plan should reduce hospital admissions and the side effects of pharmacological treatments whilst allowing patients to maintain and facilitate quality of life (Asthma and Allergy Foundation of America 2019). That is to say, physical activity, sleep and regular attendance of school and work should not be impeded upon as a result of asthma-related symptoms.
Quality of life is the measure by which individuals who suffer from chronic illnesses rate their own personal satisfaction utilizing five primary domains: physical, social, psychological, spiritual and economic well-being (Australian Centre for Asthma Monitoring 2004). The Australian Centre for Asthma Monitoring (2004) proposed that individuals who suffer from asthma self-reported a lower quality of life in areas of physical, psychological and social well-being, compared to those who did not suffer from asthma-related conditions. Individuals who suffered asthma-related illnesses reported impairment of physical functioning (limitations of activities of daily living, restricted physical movement, exhaustion and chest pain); negative effects on psychological well-being (symptoms of distress, anxiety and depression, feeling embarrassed, inadequate or burden); and impairment of social relationships (prolonged absences from work or school, inability to partake in social events and loss of contact with family and friends) (Australian Centre for Asthma Monitoring 2004). Furthermore, The Australian Centre for Asthma Monitoring (2004) indicated that familial and personal relations were also impacted: family members undertook carer responsibilities. That is to say, family members and spouses were often relied upon for assistance; suffered sleep deprivation upon subjection to physical symptoms; impaired mental well-being due to stress and worry, and were often subjected to family life disruptions that involved rescheduling of social activities.
The burden of Asthma on society is one that carries both resource and monetary significance. Over the years, an increasing trend of the hospital, emergency room and physician visits has meant a burden of the healthcare system leaving healthcare professionals unable to offer adequate support (Ford & Mannino 2010). The Hidden Cost of Asthma Report (2015) revealed that $27.9 billion was spent on asthma-related treatments in 2015. From these figures, the cost on the Australian economy neared $3.3 billion which included annual health system figures, productivity losses, government programs and formal care, whereas, individual patients spent $24.7 billion in the burden of disease costs, where predominant spending included medications and treatments; additionally, carers of individuals who suffered from asthma lost $72.9 million in wages with the average patient spending $11,740 a year on asthma-related treatment costs (Hidden Cost of Asthma Report 2015). This figure seemed high given that the median gross average for personal income in Australia was $65,572 (Australian Bureau of Statistics 2017). However, Nunes, Pereira and Morais-Almeida (2017) offer one reason as to why this may be the case: non-communicable diseases are non-priority diseases with little access to government subsidies for those who suffer from them. Thus, the burden that asthma plays on society is one that has many economic implications, resulting in a lack of resources and the potential to accumulate unpayable debt.
The National Asthma Council Australia (2019) highlights several Public Health Initiatives aimed at improving the quality of life for individuals who suffer from asthma-related conditions: The Asthma Handbook (a free flagship publication that compiles resources and educational material to empower asthma management); Asthma and Respiratory Education Programs (a free, community-based workshop approach to training healthcare professionals in the latest intervention methods to respiratory management in asthma sufferers); The National Asthma Strategy (an initiative that aims to develop a national strategy and action plan to deal with asthma-related illnesses); and The Sensitive Choice Community Program (an initiative that seeks to enable and empower asthma sufferers to make healthier lifestyle choices by connecting companies with educational resources in order to produce asthma-suitable products). Public Health Initiatives are beneficial to the greater public and those who suffer from asthma-related conditions. In other words, Public Health Initiatives have the ability to empower the quality of life in asthma sufferers through social, educational and practical intervention methods, utilizing socializing agents, validation therapy and community orientation to negate the psychological and physical limitations of asthma symptoms.
Asthma is a serious long-term chronic illness that affects the Respiratory System whereby resistant flow in the airways incites breathlessness and chest tightening as a result of narrowed and inflamed airways. Educational awareness of asthma-related conditions can be utilized to understand the extent asthma impacts health and society. In asthma sufferers, normal respiratory functions are impaired. As a result, major pathophysiological changes occur within the Respiratory System: firstly, the lining of the bronchial tubes are exposed to abnormal swelling; secondly, the formation of excess mucus obstructs air passages resulting in the buildup of excess fluid in the system; and lastly, the smooth muscles lining the airways narrows. To treat these symptoms two self-management interventions exist: “pharmacological treatments” and “preventative measures” to reduce the impact these symptoms have on the physical, social, psychological, spiritual, and economic well-being of asthma sufferers. Although symptoms have a significant impact on individuals, who report a lower quality of life, family members and significant others of sufferers also reported similar physical, social, psychological, spiritual and economic impairments on well-being. Therefore, Public Health Initiatives should be utilized and implemented to negate the negative effects of asthma-related symptoms and empower the quality of life in asthma sufferers through social, educational and practical intervention methods, utilizing socializing agents, validation therapy and community-based approaches.
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