Asthma in Children Essay

Introduction

“Asthma can affect anyone, any age, anywhere, but it is particularly common among children. Nowadays asthma affects one in five households in the United Kingdom, and it is increasingly common. So how do you recognize the condition and minimize the impact on you, your child, and your family? “(Barlow 2007). Often times parents of children with asthma are not given much information on what to do with their child after discharge from the Emergency department, especially in patients who are newly diagnosed with asthma.

This results in them bringing back their child even though the asthma attack is mild due to parents'/carers' knowledge about asthma or on-home care being limited. Recent developments in the management of chronic illnesses such as asthma offer many possibilities for optimal control, but parents/main carers of children with asthma need to take on responsibilities for self-care. This paper reflects an informative approach to pediatric asthma.

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The aim is to give information about asthma, give a brief definition, explain the symptoms of asthma, what the treatments are, what exacerbates the symptoms, and what to do if an asthma attack occurs.

The better the parent/carer and the child understand asthma and its treatment the better they will be able to manage and control it. It will also set out why a patient information leaflet should be introduced to help patients and carers to better manage symptoms at home and help reduce hospital attendance.

Overview

Whilst working in a busy north London Accident and Emergency ( A&E ) department It has been noted that when children attend with asthma they are discharged from the Department with no further information or support with regards to home care, especially the ones who are newly diagnosed.

What happens often is that the parents are given the medications by the nurse without even explaining what to do next or what to watch out for with regard to their child's asthma because the nurse has limited time due to the fact that the department is often busy and there is no time to sit down and chat with the parents prior to discharge. After collaborating with the pediatric section of the department a need has been identified for giving information to parents/carers about asthma in children to help reduce/prevent A&E attendances and help children be cared for at home by means of their parents and general practitioners(GP).

Through writing an action plan I have identified what areas of information needed to be covered in the information leaflet, these being: What is asthma? What are the signs and symptoms? What can make asthma symptoms worse? What is the treatment for asthma? What are peak flow and its importance in managing a child’s asthma? What to do when an asthma attack occurs? An action plan after discharge from the department Useful contact numbers and website address What are asthma? At work, I have encountered parents who have limited knowledge about asthma.

It is a key issue for parents/ carers to know what asthma is In the leaflet, I have briefly mentioned the definition of asthma as derived by the World Health Organization. The World Health Organization defines asthma as a condition that affects the airways, it is due to the inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. in an attack, the lining of the passages swells causing the airways to narrow and reducing the flow of air in and out of the lungs. The leaflet also contains what signs and symptoms to look out for prior to an asthma attack. Based on my own experience growing up with my youngest brother who suffered from asthma, I can remember my parent's panic as soon my brother developed a cough with mild shortness of breath which often times become a trip to the nearest hospital. What are the signs and symptoms? The information leaflet includes what symptoms to look out for when an asthma attack occurs. Out of all the research and reading that I have done, I have come up with four common symptoms.

The common symptoms of asthma, are cough and wheezing which are constant or intermittent in nature. The child may also become breathless, and develop a feeling of chest tightness. the severity of symptoms differs from child to child – from mild to severe. The leaflet serves as a guide on what to do when these symptoms occur. What can make asthma symptoms worse? A part of the information leaflet is about what makes the symptoms of asthma worse. What factors can cause the exacerbation of asthma or “ trigger factors “?

According to the American Lung Foundation, “ the cause of asthma is not fully understood, but it is thought that it may be a combination of genetic and environmental factors, that asthma attacks are often triggered by certain conditions or stimuli. ” The common triggers of asthma are exercise, infections, allergies, irritants, weather, and emotions. “Exercise-induced asthma (EIA) affects about 40-90% of children with asthma and occurs when a child's asthma is triggered by exercise or physical activities. Symptoms f coughing, wheezing, chest pain, and difficulty breathing usually begin a few minutes after starting the activity and worsen over the next 5-10 minutes. Symptoms usually continue for about 20-30 minutes. Severe episodes of asthma are often triggered by respiratory tract infections including flu. Research shows that these infections are most frequently caused by viruses more than bacteria. Bronchodilator medication, sufficient hydration, and steroids (if indicated) are needed to control an asthma attack caused by viral infections.

Allergies can trigger an asthma attack in children with asthma.

Allergies can trigger an asthma attack in children with asthma. “Histamine is released during an allergic reaction causing mucous to be excessively produced, the lining of the airway becomes swollen then muscle contraction in the airway thus leading to an asthma attack. Allergens associated with asthma are common things like dust mites, feathers, molds, pets, insects, pollens, and ingested food such as eggs, soy milk, etc.

These causative agents can cause minimal reactions sometimes which are of no obvious consequence but daily exposure to the allergens can cause in gradual worsening of asthma. Irritants such as air pollution, cigarette smoke, fumes, chemicals, and strong odors can irritate the respiratory system causing reactions such as cough, wheezing, and mucous secretions. “Weather or climatic conditions can trigger an asthma attack; it basically affects outdoor inhalant allergens (pollens and molds).

On a windy day, more allergens will be scattered in the air, while a heavy rainfall will wash the air clean of allergens on the other hand, a light rain might wash out pollen, but actually, increase mold concentration.

“Emotional factors are not the cause of asthma, though emotional stress can infrequently trigger asthma”. A child’s asthma might only be noticeable after crying, laughing, or yelling in response to an emotional situation. These normal emotional responses involve deep breathing which in turn can trigger asthma.

Emotional stress itself like anxiety, anger, or frustration can also trigger asthma, but the asthmatic condition precedes the emotional stress. Emotions are associated with asthma for another reason, many children with asthma suffer from severe anxiety during an episode as a result of suffocation caused by the asthma attack. The anxiety and panic can then produce rapid breathing or hyperventilation, which worsens the asthma condition. The panic and anxiety should be controlled as much as possible; the parent should remain calm, encourage the child to relax and breathe easily and give appropriate medications. The aim is to control asthma with the appropriate treatment, and when the asthma is well controlled the emotional stress level will be reduced”. It is an important part of the care of asthma for the parents/carers to know what these factors are, knowing these triggers can help minimize an asthma attack, though some are unavoidable like weather or the fact that a child tends to be more active, the aim of management of the child’s asthma is to enable the child to live a normal life by teaching the parents/carers to recognize their own triggers as avoidance will prevent symptoms from occurring.

A part of the information leaflet enumerates the most common triggers with given examples that can act as a stimulus to set off an asthma attack. What is the treatment for asthma? “There is no cure for asthma, although it can always be controlled”. “ For most children, asthma is a condition that can be controlled by inhaled medication at home. Continuity and stability of treatment are important.” The devised information leaflet enumerates and briefly defines the medications for asthma.

It is quite important for the parents/carers to know what the medications are, what are they for, when to use them, and how to use them properly. Hopefully, the literature will help parents/carers to understand asthma medications, for it is worthy of consideration that asthma medications must be taken properly. This helps in the care of the child’s disease. Together with the Asthma Action Plan, an appropriate assessment of the child’s symptoms and administering the proper asthma medication at the right time help in the control of the disease at home.

The primary goal for the treatment of the child’s asthma is to achieve the greatest possible control over the disease by reducing exacerbations, and limiting symptoms in order to optimize the quality of life of the child. “ the potential for limitation of normal living is immediately apparent, but the actuality is related to a patient’s ability and willingness, to adhere to, and the nature of, a health professional’s recommended regimen”.

Peak flow and its importance

Peak flow has its place in the care and management of asthma. The information leaflet briefly defines what is peak flow and justifies why it should be monitored. The literature emphasizes that in managing asthma in children, parents are encouraged to obtain their child’s peak flow rate for measuring the peak flow helps in monitoring their asthma. The correct technique in obtaining the peak flow should also be reiterated for a false reading can greatly affect the management.

However, in children who are under five years, it is unreliable due to the fact that their ability to use the peak flow meter properly is doubtful, therefore it should only be attempted in children who have formerly and regularly used the peak flow devise. A criterion in the Asthma Action Plan is to measure the child’s peak flow rate for it helps to determine the severity of the episode, it helps decide when to use the prescribed asthma medications, and decide when to seek emergency care.

Asthma Action Plan

In managing the child’s asthma, it is important to know what symptoms to look out for, what medicines to take, and how much and when to take them, all of this should be recorded in the Asthma Action Plan. Prior to discharge from the emergency department, the Asthma Action Plan together with the information leaflet is given to the parents/ carers to use at home to act as a guide in managing an attack of their child’s asthma. It contains the symptoms to look out for and what to do if they occur.

It also acts as a tool for the parents and their doctors to monitor the child’s asthma, prior to discharge from the Emergency Department the doctor and the Pediatric nurse should have completed and discussed the form with the parent.

Patient Information leaflet

In the current political climate of patient autonomy, patient information leaflets can aid patients, parents, and carers to achieve this autonomy. Research has shown that patients may forget half of what they have been told within five minutes of a medical consultation and retain only twenty percent of the information conveyed to them. “Providing patients and families with written information may reduce anxiety, improve the use of preventative or self-care measures, increase adherence to therapy, prevent communication problems between health care providers and patients and lead to more appropriate and effective use of healthcare services” (Moult et al, 2004). The importance of written patient information has been recognized by the Department of Health and the NHS. The NHS Plan states that patient information is an integral part of the patient journey. The Centre for Health Information Quality identifies three key attributes of quality healthcare information materials:

1. The information should be clearly communicated;
2. be evidence-based;
3. involve patients in the development of the materials.

Research has exposed problems with the readability and usability of a wide range of patient information leaflets (PILS) on diverse matters. The majority of PILs, regardless of their subject, require relatively high reading skills that may not exist in a large proportion of their target population.

In 2002, the Department of Health published the ‘Tool kit for providing patient information which provides detailed guidelines for writing and designing health care information. The toolkit includes guidelines in the form of ‘points to consider’ and checklists for the presentation of various types of information. Readability is often mentioned as a measure of the quality of written healthcare information several scales have been deployed to evaluate the reading level of written information and several scales have been developed to evaluate the reading level of written information. Moult et al. (2004), explain that the lower the reading level, the more likely that the information can be read and understood by a large proportion of the public.

Summary

The purpose of this essay is to discuss the need which has been identified and to implement change in the pediatric area in the Emergency Department ( ED ) with regard to patient information about asthma in children. “The appropriate selection of medications is only one aspect of the provision of a comprehensive approach to all aspects of managing asthma.

In particular, parents/carers need education, support, and guidance, on how to manage their child’s condition” I have accessed many online websites and read articles to see what information was available to combine together to produce such information leaflet. The intention of the devised information leaflet is to give information to parents/carers about asthma in children to help reduce or hopefully prevent ED attendance and help children with asthma be cared for at home by means of their parents and GPs. Technological and pharmaceutical developments make feasible the more effective control of chronic conditions, but clinician’s perception of optimal management may result in patients carrying increased responsibilities for the maintenance of their physical well–being that can compromise the quality of their daily life” ( Christie et. al. 1993 ), hopefully, the information leaflet can facilitate and provide advice, as a part in the holistic approach in managing the child’s asthma at home when the child is discharged from the Emergency department.

The information leaflet can also be utilized as a useful tool to teach junior staff in the Emergency Department. A reading material for the newly qualified staff members to read and use to further enhance their nursing knowledge about asthma, can aid the nurse as guidance in their initial assessment and help in anticipating the needs of a child who presents in the Emergency Department with asthma.

Hopefully, in the future, the information leaflet can be used as a useful tool for health promotion which can be utilized by other members of the healthcare setting such as health visitors, school nurses, and others in the community settings.

Reference:

1. American Lung Association (2007): childhood Asthma Overview http://www. lingua. org/site/pp. asp? c=dvLUK9O0E=22782.
2. Barlow(2007) http://www. children first. NHS. UK/families/features/illnesses/managing_childhood_asthma.
3. Christie et. l (1993) Development of child-centered disease-specific.
4. Questionnaires for living with asthma, Psychosomatic medicine 55:541 – 548 Department of Health.
5. Toolkit for Producing Patient Information. London: HMSO, 2002. London: Department of Health Gal, I & Ayelet Prigat.
6. Why organizations continue to create patient information leaflets with readability and usability problems: an exploratory study: Health Education Research Vol. 20 no. 4 pp485 – 493.
7. Keep Kids Healthy (2007): Exercise Induced Asthma http://www. keepkidshealthy. com/asthma/exercise_induced_asthma.
8. Moult, B. et al (2004) Ensuring Quality Information for Patients: development and preliminary validation of a new instrument to improve the quality of written care information: Health Expectation Vol 7 pp165 – 175.
9. National Institute for Clinical Excellence: Inhaler devices for routine treatment of chronic asthma in older children.
10. WorldHealthOrganization: Asthma in children.

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