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Asthma is a chronic disease caused by the inflammation of the respiratory tract. It is characterized by obstructions in the airflow and bronchoplasm, shortness in breathing, tightness of the chest, coughs and wheezes. Furthermore, its prevalent rate is higher among children in crowded inner-city places or among homeless children. Statistics have indicated that there is a rise in the rate of diagnosis especially among children below the age of five. The main reason behind this observed trend has not yet been established but air pollution, environmental toxins and smoke have been considered as contributing factors (Fanta, 2009). Other factors that have been attributed to the varying rates of diagnosis are socioeconomics, demographics and the physician's diagnostic practice. Asthma can be managed through regular medication and monitoring.
Recent studies established that the rate of diagnosis, in California for instance, was 15.4% among children aged between 1 and 17 in 2007. This implied that one in every six children was diagnosed with asthma. However, the rate of hospitalization between 1998 and 2008 declined from 16.2 to 10.3. In adults, the prevalence rates increased between 1997 and 2001 in America. It was mostly characteristic in female adults who exhibited more hospitalization rates as compared to male adults. However, as the population got older, the prevalent rates also went down. For instance, people aged between 18 and 44 were represented by 135 cases, 45-64 120 cases, 65-74 118 cases and ages above 75 years, a record of 110 cases per 1,000 cases (O'Rourke, 2006). These statistics show the impact of asthma over a period of time hence it is important for medical practitioners and the public to know its epidemiology hence help reduce the rate of its occurrences.
Causes of asthma are influenced by genetic and environmental factors. These factors determine its severity and response to medication. A history of atopic disease was identified as one of the risk factors of being diagnosed with asthma. The atopic disease increases the chances of getting asthma 3 to 4 times. For children, particularly, increases in immunoglobulin E and positive tests for skin allergies heighten the chances of the child getting asthma. For adults on the other hand, chances of being diagnosed with it depend with the number of allergens they react to in skin tests. Furthermore, with asthma being greatly associated with indoor allergens, exposure to these allergens at infancy has been observed as one of the most notable factors contributing to asthma in childhood. Nonetheless, we shall evaluate six factors that are believed to contribute to increases in asthmatic reactions. These are environmental factors, socioeconomic factors, hygiene factors, exacerbation, genetic and Gene-environment interactions (Custovic, Smith & Woodcock, 1998, p.155-158).
Smoking during pregnancy is one major environmental factor that has been identified to contribute to asthma. Smoking increases chances of respiratory infections which in turn lead to respiratory inflammations. Moreover, smoke emanating from traffic and industrial effluences also lead to the inhalation of low quality and intoxicated air. Endotoxins found in polluted air lead to exacerbation which influences the development of asthma. Psychological stress has also been observed to modulate the immune system thereby increasing the respiratory tracts' reaction to allergens. This is a recent scientific finding which suggests that psychological stress affects one's respiratory process thus leaving them vulnerable to respiratory infections (Huang, Shiao & Chou, 1998).
The use of antibiotics in a child's early life modify gut flora in children already diagnosed with atopic diseases thus affecting access to the beneficial bacteria and increasing susceptibility to asthma. Furthermore, immune system modulators which are vital aspects of a child's growth are also affected. Lastly, contact with volatile organic compounds (in paints, Chlorofluorocarbons and chlorocarbons) is a major risk factor for pediatric asthma.
Statistics have indicated that asthma related deaths have been mostly common among low-income populations in low and middle income nations. In the first world nations like the United States, asthmatic complications are mainly observed in neighborhoods with majority ethnic minorities. Moreover, cockroaches are believed to be associated with vulnerability to asthmatic attacks (Huang, Shiao & Chou, 1998). These roaches are found in poor and dirty homesteads which are characteristic of low-income areas. Lastly, the mode of treatment also affects its prevalent rate. For the low-income earners, they cannot get access to quality healthcare and therefore they remain vulnerable to infections.
Exposure to different bacteria and viruses contribute to a decrease in the asthmatic infection rate. This is according to the "hygiene hypothesis". This hypothesis asserts that when children, especially in the modern society, are exposed to highly hygienic environments, they fail to interact with some bacteria and viruses hence become susceptible to allergic and asthmatic infections. For the children who live in relatively dirty places, develop resistance to asthmatic allergens hence are safer as opposed to their counterparts in tidier areas. This is however contrary to most beliefs that asthma is caused by viruses (which are mostly found in dirty areas).
Exacerbation contributes to the development of asthma. Exacerbations on the other hand are triggered by animal dander, dust, house mites, molds and allergens from cockroaches. Strong scents or smells such as perfumes also influence exacerbation. Persistent exacerbations are associated with bouts of asthmatic attacks which can lead to acute instances of asthma.
One genetic association study has related more than 100 genes to the development of asthma. Some of the genes which have already been associated with asthma include: GSTM1, SPINK5, GRPA, IL10, CC16, GSTP1, STAT6, CTLA-4, NOS1, TBXA2R, TGFB1, IL4, CD14, NOD1, IL4R, IL13, HLA-DRB1, ADRB2 (Î²-2 adrenergic receptor), CCL5, HLA-DQB1, TNF, FCER1B, ADAM33, LTA and LTC4S. These are at least 25 genes that, by the end of 2005, had been directly linked to the development of asthma. Inasmuch as some of the results of gene association study have not been consistent, most of these genes have been linked either to modulating inflammation or to the immune system. However, further research has been recommended regarding gene association with asthma.
When one has been diagnosed with asthma, he or she exhibits a number of symptoms. These symptoms are exemplified by wheezing, tightening of the chest, heavy breathing, and coughing. It results in breathing difficulties when the bronchial tubes are blocked. This is as a result of the constriction of the respiratory tract and excess mucus produced from the tract lining. These blockages mostly happen at night when the patient develops breathing problems and begins wheezing and coughing. The patient further begins to experience some discomfort with pressure in his/her chest. Muscle soreness causes this discomfort after being initiated by the persistent coughs (Jarvis, Chinn, Luczynska & Burney, 1997).
Some asthmatic patients cannot participate in sporting activities. This results from complex medication exercises which may not favor activities that trigger high respiratory performances. Some patients with severe asthmatic attacks cannot even take a walk around or even go out for a trip as they require persistent medical care. Furthermore, they have greater chances of contracting pneumonia and lung infections. Medications on the other hand can also cause serious side effects. For instance, inhaled corticosteroids may result in oral candidiasis, dysphonia and bronchospasm. It may further lead to a decrease in the bone density, poor growth, cataracts and glaucoma and adrenal gland suppressions. With the use of leukotriene modifiers and montelukast, the patient may experience frequent stomach upsets, headaches, skin rashes, liver test abnormalities and even Churg Strauss syndrome. Lastly, the use of cromolyn and nedocromil may result in persistent coughs, sneezing and stuffy nose, headaches, itching, bad tastes in the mouth and sore throat. When asthma is left untreated, it may result in death (Jarvis et al. 1997).
Asthmatic patients should make sure that they have proper medical care and access to medical services. For parents, they should ensure that they provide a comfortable growing environment for their children to avoid chances of getting asthma. The use of pollutants and strong scented sprays should also be reduced. For physicians, they should make sure that they make proper diagnosis so as to avoid poisoning and other related complications. Under proper care, asthma can be managed. Therefore, efforts should be directed towards finding a convenient way of managing asthmatic patients without compromising their health. In case a child exhibits signs and symptoms of asthma, he should be taken for proper medical care. We should aim at bringing asthma at a complete manageable level if not eliminating it from our social domain.
Custovic A., Smith A. C., & Woodcock A. "Indoor allergens are a primary cause of asthma: Asthma and the environment." Eur Respir Rev, 1998: 155-158.
Fanta C. H. "Asthma". Med, 2009.
Huang S. L., Shiao G. M. & Chou, P. "Association between Body Mass Index and Allergy in Teenage Girls in Taiwan." Clin Exp Allergy, 1998.
Jarvis D., Chinn S., Luczynska C., & Burney P. "The Association of Family Size with Atopy and Atopic Disease." Clin Exp Allergy, 1997.
O'Rourke S. T. "Interior Surface Materials and Asthma in Adults: A Population-based Incident Case-Control Study". American Journal of Epidemiology, March 2006.