Intervention to improve health of kids with asthma 5-15 years in Boltmore

Pre-post analysis of intervention to improve health of kids with asthma 5-15 years in Boltmore city, Maryland

Introduction

            Asthma defines a chronic inflammatory illness that affects the air passage in the bronchus, and it is usually characterized by varying symptoms that include wheezing, chest congestion, dyspnea and coughing. The disease is tentatively caused by the integration of hereditary and environmental factors (Polk, 1997). The short-functioning B2 adrenergic agonists and the oral corticosteroids can be used to cure the sensitive symptoms of asthma. Intravenous injection of corticosteroids and hospitalization may however be required under severe circumstances to help keep any severe consequences under control (Office of the Surgeon General, 2014).

Background of the study

            The history of Asthma dates back to the Ancient Egypt where it was first discovered and treated mainly by use of a mixture that was commonly referred to as Kyphi. The ancient Babylonian scholars further recorded symptoms of shortened breathing, which is a condition they associated with panting lungs especially when a person engaged in hard work. Asthma was officially recognized by Hippocrates as a particular respiratory disease in 450 BC (Lara, 2001). He was especially considered to be the first physician that discovered the relationship prevailing between environmental factors and respiratory illnesses (Polk, 1997). In 200 BC, the disease was believed to be mainly associated with emotions, and this formed the basis for a wide range of interventions intended to cure emotional distress. Roman doctors in 50 AD however interpreted asthma as a state of difficulty breathing without producing any sound. They observed that individuals exhibited difficulties in breathing after hard work, and as such, this condition could be described as being asthmatic (Condon, 2004). A Roman elder further noted that foreign objects that included pollen grains were a source of respiratory problems. They thus recommended that ephedra could be used with red wine to treat the respiratory problems. Jewish physicians recommended rest, hygiene and special diet as the best treatment for asthma. By 1873, scholars published the first paper in contemporary medicine that attempted to demonstrate the pathophysiology of the disease (Polk, 1997). Another paper intending to prove that the disease could be treated by rubbing chloroform on the throat was published in 1872. A more advanced medical treatment was however introduced in 1880, and this mainly included the use of intravenous injection that was particularly based on a drug known as the pilocarpin. In 1886, a scholar named Bosworth founded a theory that exhibited significant relationship between the ailment and hay fever. This saw Epinephrine as well as the oral corticosteroids being used to treat Asthma for the first time 1900s (Office of the Surgeon General, 2014). The dawn of 1950s and 1960s saw an extensive use of inhaled corticosteroids and selected types of short-acting agonists. A well known instance when this form of intervention was used can be traced from a well-documented case of a renowned scholar named Roosevelt. While there was still no effective treatment for Asthma, Roosevelt had the greatest part of his life as a young person shaped by his poor health that was mainly due to his asthmatic condition. He experienced recurrent conditions that were linked to asthma attacks but his condition was managed by use of inhaled corticosteroids (Lara, 2001). The Allergy and Asthma Group and Research Center, which was established in 1969 has however seen significant advancement in asthma-related interventions and varying therapeutic remedies have been discovered. Inhaled bronchodilator medications are commonly used to treat this ailment mainly because they are not bound to stimulate the heart thereby causing further respiratory implications (Polk, 1997). Inhaled corticosteroids are particularly important in addressing the challenge of asthma as they suppress the impact of underlying inflammation as well as minimize possible cortisone effects that are often associated with tablet and liquid medical products.

Problem statement

            Asthma has been classified as the most chronic illness affecting children across the globe. Statistics indicate that more than nine million children are living with asthma in the United States. The prevalence of this condition in most western countries has continued to intensify probably due to increased prevalence in allergy. With diagnoses of childhood asthma increasing over the last twenty years, statistics indicate that over 40% of children developing asthma have one or both parents having history of this ailment (Office of the Surgeon General, 2014). In most of the pediatric hospitals operating in the United States, asthma has proven to be the most common disease that most children are diagnosed for at admission. The current statistics indicate that the prevalence of this ailment stands at around 6.7% among adults but over 8.5% among children. Research has shown that asthma among children can attribute to fatal outcomes but proper diagnosis and timely treatment can help to address a wide range of fatalities related to childhood asthma (Condon, 2004). Although symptoms that range from wheezing, coughing and obstructed breathing may be common among infants and other children under the age of five years, accurate diagnosis is not always obvious, which makes management of this condition among children a complex activity. Diagnosis errors among pediatric patients are usually common particularly because differential diagnosis in a wide range of symptoms is usually extensive among children (Gershwin, 1992). This indicates that accurate diagnosis of this ailment can be challenging among children particularly because there is no particular biological, physiological or immunological indicator of asthma among children. Clinicians seeking to offer interventions for this condition usually base their diagnosis pertaining to existence of asthma among children on a wide range of factors (Polk, 1997). Such factors can include family history, results of diagnostic analysis, pattern of the symptoms as well as the patient’s response to medication. Childhood asthma usually starts early in life and can have a wide range of courses that attribute to varying asthmatic phenotypes that can progress or be suppressed over time. Children can for example start wheezing while still pre-scholars due to a number of conditions but become asymptomatic by the time they reach school age irrespective of the type of intervention they may have received. Conversely, symptoms for asthma can persist for a life time particularly when the condition persists in atopic among other acute cases (Office of the Surgeon General, 2014). The overall implications of asthma on a child’s quality of life as well as the cost of medication can be extremely high. Application of the proper asthma management approach is thus important as it can have significant impact on the patients, their families as well as the ultimate public health outcomes (Lara, 2001).

Justification of the study

            With asthma-related implications among children being reported on a day to day basis, scholars have argued that a wide range of anti-inflammatory measures would be appropriate in managing this condition thereby helping to enhance health among children. Pathological as well as the epidemiological inquiries have continually suggested that anti-inflammatory medication that mainly include the use of inhaled corticosteroids should be given to children living with asthma (Joan & Lynn, 2006). Scholarly evidence has however indicated that timely interventions using inhaled corticosteroids have not been effective in promoting health of children living with asthma. There is limited evidence on any negative impact associated with anti-inflammatory medication. On this note, ineffectiveness of such interventions has greatly been associated with lack of quality knowledge among parents pertaining to how they can effectively manage their children’s asthmatic conditions to help improve their overall health. Studies have mainly concentrated on evaluating cases of asthma among children as well as the type of anti-inflammatory medications that children living with this condition receive. There is however no specific study that has investigated effectiveness of the knowledge-based intervention in improving the health of children living with asthma (Gershwin, 1992). It is however obvious that parents ought to be equipped with quality knowledge relating to how they can effectively take care of children living with asthma to help improve their overall health. This study aims at conducting a pre-post analysis of a knowledge-based intervention to determine its overall effectiveness in improving health of children living with asthma. Conducting this study will particularly be important as it will contribute to the general knowledge relating to how relevant skills can help parents to take care of asthmatic children thereby contributing to their overall wellbeing. The study will as well create a basis through which other studies relating to the various skills that parents can be equipped with to enhance their effectiveness in promoting health of children living with asthma can be conducted (Polk, 1997).

Study objectives

            This study intends to:

  • To establish whether there are any children between the age of 5 and 15 years living with asthma
  • To equip parents living with asthmatic children with knowledge on causes and best treatment for asthma
  • To equip parents with knowledge on how and when asthmatic children can experience health-related problems
  • To equip parents living with asthmatic children with quality knowledge on how to use anti-inflammatory medication
  • To equip parents with knowledge on how to prepare an asthma management plan
  • To identify areas where training can be optimized

Research questions

  • Is your child living with asthma?
  • How many times per month does your child fail to attend school because of his condition?
  • Which heredity, environmental and physical factors can lead to asthma?
  • How and when can children living with asthma experience health-related problems?
  • Is your child on any inflammatory medication?
  • How can you correctly use the anti-inflammatory medication to treat asthma?
  • How many times per month does your child get admitted in hospital because of his condition?
  • How can you prepare an effective asthma management plan?
  • In what areas would you wish training to be optimized?

Literature review

            Asthma has continued to be a major issue of concern especially because more than twelve million people that mainly comprise of children are living with the condition. With more 7% of all children living in United States living with asthma, cases of asthma-related mortality are growing at an alarming rate particularly among children residing within the inner city environment. Although there has been significant understanding of various issues associated with pathophysiology of asthma, proper guidelines pertaining to management of asthma is important to help improve the quality of life for children living with this condition. The main aim for this review is to evaluate what different scholars have reported on different issues related to asthma (Office of the Surgeon General, 2014).

Risk factors leading to asthma among children

            Research has shown that certain factors can expose children to the risk of developing asthma. Heredity is a major factor that can increase a child’s probability to develop asthma. A study by Lara (2001) showed that children having parents or siblings that have asthma are at a greater risk of developing asthma compared to children from families that do not have any relatives living with asthma. Lara further realized that children whose two parents have asthma stand at higher risk of developing asthma than children with one parent having the disease. He also realized that children can be at higher risk of developing asthma when the mother is living with the condition than when the father does. Atopy, which defines a certain type of allergic sensitivity, is another important factor that can increase a child’s risk to develop asthma. An inquiry conducted by Conti (2006) showed that children that are prone to develop allergies when exposed to different allergens stand at a higher risk of developing asthma than children that are not prone to allergies. Conti particularly discovered that atopy can cause the body to produce antibodies intended to safeguard the body against allergens. Such responses may translate to a wide range of asthma-related symptoms that include coughing, wheezing and obstructed breathing (Joan & Lynn, 2006).

Viral infections are equally important in raising children’s risk to develop asthma. Research has shown that certain forms of viral infection that mainly include RSV and parainfluenza viruses can trigger development of asthma among children. As explained by Joan & Lynn (2006), viruses can for example affect the respiratory system in children thereby causing inflammation of the respiratory track and bronchial system as well as pneumonia. Such infections can cause wheezing among children thereby increasing their probability to develop asthma. Tobacco smoke is equally a major factor that can raise the risk of developing asthma among children. Although most people in the modern world are aware that tobacco smoke can lead to development of cancer and heart disease, they are not aware that this factor can raise the risk of developing asthma among children. A study conducted by Schwartz (1991) showed that passive smoking can lead to development of various asthma-related symptoms. Schwartz particularly found that passive smoking had a close link with asthma among young people. He further realized the link was even intense among children and teens as passive smoking attributed to more than 26,000 cases of new asthma-related infections on annual basis. Exercise is another important factor that has proven to trigger development of asthma particularly during cold weather. A study conducted by Roberts (2005) showed that exercise-induced type of asthma can often be triggered by physical activities. Although symptoms relating to this type of asthma may not appear immediately, patients exhibiting the symptoms only after a few minutes of sustained exercise indicate persistence of an acute form of exercise-induced asthma that might demand for significant adjustment of medication. The symptoms of exercise-induced asthma may however disappear after a few minutes, and as such, children living with this condition do not necessarily have to limit their physical activities (Panzera, 2011).

Medication measures for asthma

            Research has shown that different medication approaches can be employed to help manage asthma among children. Different medication approaches can suit different treatment needs depending on the type of asthmatic condition that every child could be living with. A general rule applying to any type of medication approach employed for each case is that children living with the disease should be separated from environmental factors triggering development of asthma. This can include keeping the level of allergens that include dust, debris, mites, pollen and animal waste at their lowest level (Conti, 2006). The National Institute of Health has however devised new treatment guidelines that demand for employment of “stepwise” approach when seeking to manage this condition. According to these guidelines, patients should be given the lowest dose of effective treatment but the dosage can frequently be raised when the condition worsens.

A study conducted by Roberts (2005) showed that patients living with asthma can be given quick-relief medications so as to provide instant relief from asthmatic symptoms thereby relaxing muscles along the respiratory track and around airways. Roberts found that the quick-relief medications start working immediately when they are used and their impact can last for up to six hours. Most of these medications are usually inhaled using a pocket-sized gadget that patients can easily learn to use whenever they feel unease or when symptoms come on. The quick-relief treatment can also be used prior to any physical activity to help keep away symptoms of asthma. A slower form of quick-relief medication that mainly includes ipratropium can be inhaled to help ward off asthmatic symptoms. This medication is however less effective compared to other quick-relief medications, and as such, it cannot be used by patients living with exercise-induced asthma (Conti, 2006).

Research has equally shown that long-term management treatment can as well be used to help control asthma among children. Although long-term medication may include oral and inhaled medicines, they do not provide instant relief like the quick-relief medicines. These medicines thus cannot be used to provide immediate relief when symptoms of asthma arise but they usually work over a long duration of time to help manage the frequency at which these symptoms occur as well as reduce severity of the symptoms’ attacks. The long-term medicines can for example take several weeks of continuous use to realize their full effect (Carol, 2008).

An investigation conducted by Lieberman (1997) showed that asthma medication can be combined to render better results. The quick-relief and long-term medications can for example be combined to help provide better treatment for asthmatic patients thereby allowing patients to have restful sleeping time, undergo shorter durations of hospitalization as well as take part in normal play among other school extracurricular activities.

Theoretical framework

            Different theories have been established to help explain the issue of asthma, and as such, they can be used to explain the dire need to employ correct medication approach to treat the condition. The time trends theory by Van Schayck is an important theory that explains significant changes in asthma prevalence over time. According to this theory, symptoms of asthma are usually intensified by the impact that strong environmental factors can have on the growing prevalence of Chlamydia Pneumoniae over a certain period of time (Carol, 2008). This theory explains exposure to strong environmental factors over a certain period of time can attribute to polymorphisms that may ultimately influence adaptive immunity within an organism thereby affect its ability to respond to infections from C. Pneumoniae. While the C. Pneumoniae organism can be detected in a huge number of human populations, research has shown that its probability to promote the onset of asthma can be suppressed by the use of certain types of treatment. This theory is important in this study as it helps to explain that environmental and heredity factors are important in contributing to the development of asthma. The theory equally explains the importance of continuously using medication to help manage asthma-related symptoms to promote good health (Roberts, 2005).

Strachan’s Boime Depletion Theory is equally important in explaining the issue of asthma as well as the dire need to use medication to manage this condition. This theory states that lack of exposure to infectious microorganisms at an early age raises children’s susceptibility to a wide range of allergic ailments that usually result from developmental defects of the immune system. According to this theory, reduced exposure to infectious microorganisms increases chances of developing inflammatory illnesses that individuals may have inherited from their parents in latent or carrier state (Lieberman, 1997). This theory is important in this study as it helps to explain the fact that children can develop asthmatic conditions as a result of heredity factors. While prior infections attribute to the production of antibodies that can help strengthen the immune system, children that may have not had any infectious illnesses at an early age may be at a higher risk of developing asthma. This explains that quality knowledge of different issues related to asthma is important to help employ the correct type of medication to improve the overall health of children living with the condition (Roberts, 2005).

Conclusion

            A review of documented literature has shown that several scholars have conducted extensive study on various issues related to asthma among children. An inquiry on documented literature has for example shown that different factors that include heredity, tobacco smoke, atopy, viral infections, and exercise increases the risk of children to develop asthma. Literature has equally shown that different types of medication have been employed to help manage asthmatic conditions thereby helping to improve the wellbeing of people living with asthma. Various theories explaining the issue of asthma has equally been developed and they help to explain the dire need for using medication to treat the condition. There is however no single study that has analyzed any type of intervention that can be used to promote heath of children living with asthma. In order to bridge this gap, this study will conduct a pre-post analysis of knowledge based intervention to determine how it can contribute to improved health of children living with asthma. Undertaking this study is important as it will help to device a reliable intervention strategy through which proper management of asthma can be achieved thereby contributing to the overall wellbeing of children living with this condition.

Methodology

            The challenge of pediatric asthma has continued to attract a great deal of medical attention especially because development of this condition at childhood is highly linked to greater risk of experiencing recurrent asthma even at fifty years of age. Research has shown that most children particularly in the United States are experiencing a great deal of poor health that results from their asthmatic conditions. Most children that frequent in hospitals as well as those relying on a wide range of medications are living with asthma. High quality medicines that can be used to treat this condition have continually been discovered. The health of children living with the condition has however continued to deteriorate, and this has been attributed to lack of suitable intervention measures that can help to improve health of children living with asthma. This section intends to outline methods that will be employed in a pre-post analysis of an education-based intervention to help determine how the health of children living with asthma can be improved.

Research design

            The study methodology will be experimental in nature as the researcher will employ an independent variable to manipulate the outcomes of the dependent variable so as to help improve health of children living with asthma. The independent variable will in this case include introduction of learning materials while the dependent variable will include administration of asthma medication among other management practices. Employing the experimental method of inquiry will be important in this study as it will help the researcher to test existing theories that support possible improvement of quality of health after employing an education-based approach. Questionnaires will be also employed to help collect data from parents so as to determine if there is any improvement that may realized throughout the study period. Among the various questions that will be asked in these questionnaires will include:

  • Is your child living with asthma?
  • How many times per month does your child fail to attend school because of his condition?
  • Which heredity, environmental and physical factors can lead to asthma?
  • How and when can children living with asthma experience health-related problems?
  • Is your child on any inflammatory medication?
  • How can you correctly use the anti-inflammatory medication to treat asthma?
  • How many times per month does your child get admitted in hospital because of his condition?
  • How can you prepare an effective asthma management plan?
  • In what areas would you wish training to be optimized?

Population sample

            The study population will comprise of 200 school going children aged between 5 and 15 years that are living with asthma. The study participants will randomly be selected from Baltimore city in Maryland. The researcher will however ensure that all participants are living with asthma as this will allow for participation in controlled or non-controlled study environments. The participants will be selected from ten local elementary schools distributed throughout the city.

Data collection technique

            The researcher will begin by randomly selecting ten schools distributed in Baltimore City in Maryland. He will then write letters to the principles in these schools requesting for permission to undertake the study. He will then request for assistance from class teachers to be able to identify ten children aged between 5 and 15 years that may be living with asthma from each school. The identified children will then be sent home with letters requesting for permission from their parents to have the children take part in the study experiment. Parents that agree to have their children take part in the experiment will then be issued with questionnaires to help collect information about their children’s medical progress before any controlled condition is applied. Children taking part in the study experiment will then be divided into two groups that will comprise of an intervention and a control group. Children under the intervention group will then be sent home with study materials for their parents comprising of a wide range of information on asthma management. Their parents will also be engaged in regular meetings where the researcher will educate them on different topics relating to proper management of pediatric asthma to help improve their children’s health. Conversely, children in the control group will neither be sent home with study materials nor will their parents be educated on any topic relating to proper asthma management. After a six-month period of training, parents will be issued with similar questionnaires as those issued at the beginning of the study to determine whether responses to various questions will have varied.

Ethical issues

            Among the various ethical issues that might arise during this study include exposing children’s health statuses to unintended parties that might include teachers and other non-asthmatic children. This can however be prevented by maintaining a high degree of confidentiality when choosing the study participants to ensure that non-intended parties do not get the information.

Instrumentation

The validity of the study instruments that mainly include questionnaires will be enhanced by first giving them to a panel of qualified experts to be tested. Their reliability will be enhanced by ensuring that they all contain similar information that can easily be understood. Confidentiality will also be confirmed to ensure that respondents answer all questions as appropriately as possible.

Data analysis

The collected information will be analyzed through the use of the SPPS computer program and the results presented using various statistical instruments. The two categories of questionnaires will be analyzed separately and their results compared to determine if there would be any improvement before and after the education-based intervention was employed.            

Summary and conclusion

            The methodology section outlines the various methods that will be employed in the pre-post analysis to determine whether an education-based intervention is effective in promoting health of children living with asthma.

 

 

 

 

 

 

 

 

 

 

 

 

References

Carol, P. (2008). Do Bacteria Promote Asthma, Environmental Health Perspectives, 116(1):23-44.

Condon, K. et al. (2004). Tracking Pediatric Asthma: The Massachusetts Experience Using School Health Records, Journal of Health Perspectives, 112(14):12-31.

Conti, C. et al. (2006). Creating Asthma-Friendly Schools: A Public Health Approach, Journal of School Health, 76(60: 15-41.

Gershwin, E. (1992). Asthma: Stop Suffering, Start Living, Reading MA: Perseus Books.

Joan, M. and Lynn, G. (2006). Asthma Agents: Monitoring Asthma in School, Journal of School Health, 76(6):89-104.

Lara, M. et al. (2001). Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action, Santa Monica, CA: Rand.

Lieberman, P. (1997). Understanding Asthma, Jackson, MS: University of Mississippi Press

Office of the Surgeon General. (2014). The Health Cosequences of Smoking, 50 Years of Progress: A Report of the Surgeon General, United States Public Health Service, 73(3):12-26.

Panzera, M. et al. (2011). Benefits and Barriers of Pediatric Healthcare Providers towards Using Social Media in Asthma Care, American Journal of Health Education, 42(4):51-77.

Polk, I. (1997). All About Asthma: Stop Suffering and Start Living, New York: Insight Books.

Roberts, M. (2005). Handbook of Pediatric Psychology, New York: Guilford Press.

Schwartz, M. (1991). Maternal-Infact Bonding and Pediatric Asthma: An Initial Investigation, Pre and Peri-natal Psychology Journal, 5(4):67-81.