One of the major public health problems facing Australia today is Asthma. It is disturbing that there has been an apparent increase in its prevalence and severity, and increased rates of hospital admissions. (E.J.Comino, 1996) For the diagnosed patient, the degree to which he or she suffers is related to severity of the condition, compliance with recommendations by medical experts, the immediate environment and the effectiveness of education programs.
Like other major health problems, asthma has varying degrees of symptoms. As such, the degree and frequency of the symptoms limits many aspects of the asthmatics life. To describe the main limitations suffered by those with chronic asthma, asthma must be defined.
Asthma is a condition whereby the sufferer has difficulty breathing due to widespread narrowing of the airways of the lungs. This narrowing can be caused by a local inflammation of the air-ways, muscle contraction or the production of excess mucus with in bronchi. (R.Roberts, 1996) Most common is bronchial asthma. Medical definitions of asthma suggest that environmental triggers can substantially contribute to the occurrence of an asthma attack.
The review of asthma in Victoria (1988) by the Asthma Foundation of Victoria outlined infection, exercise, climatic conditions, exposure to airborne irritants and emotional upsets as the main trigger factors. However, doctors use a general classification to identify a patients pattern of asthma…classifying people who experience some symptoms of asthma on most days as having a chronic asthma condition.
The classification system also extends to the categories of children, occupational asthma and asthma in later life. Usually regular medication is required to keep the lungs functioning as normally as possible. Some chronic asthmatics have severe symptoms over a long period of time and may require long term or indefinite medication to be able to lead a normal life. (Lane, 1996)
The most obvious limitations suffered relate to the asthmatics physiological dysfunction. However, physiological dysfunction can in turn contribute to greater social and psychological limitations. This area is related more specifically to quality of life and morbidity and will be discussed further on. The main physiological limitation is related to the presence of the bronchial narrowing slowing the movement of air into and out of the lungs. Thus, there is difficulty both breathing in and out.
Asthmatics commonly describe the feeling – tightness of the chest, congestion and wheezing. Although these symptoms can commonly occur in other chest diseases, in asthma it is a characteristic that can occur in an aggravated attack. This may be either brief episodes of chest tightness lasting a matter of minutes or a prolonged episode of wheezing lasting up to and hour, which can merge into a full blown attack of asthma. (D.J.Lane, 1996)
Other physiological limitations relate to the sufferers sensitivity to known triggers factors and the consequential effect on their daily functioning. The Global Strategy for Asthma Management and Prevention (1995) states that triggers are risk factors that cause asthma exacerbation’s by inducing inflammation or provoking bronchio-constriction.
This report also describes the main triggers as allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, allergies to foods, additives and drugs, and emotional stress. For example it is well established that viral respiratory infections can exacerbate asthma, especially in children under the age of 10. (Busse, 1993) Because the triggers may vary from person to person and from time to time, it is important to take the sufferers natural history into account and identify each individuals triggers.
Therefore, an individuals identified trigger can restrict the sufferers ability to function normally. For example – an asthmatic child may try to avoid exercise for fear that it may trigger an asthmatic attack. This may in turn limit the sufferers physiological development over the long term and hence further contribute to the problem. (Global Strategy, 1995)
Some psychological and social problems can also be considered as a consequence of the interaction with physiological limitations. The Global Strategy for Asthma Management and Prevention (1995) states that “asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients and may have an impact on their careers”. Chronic asthma sufferers have to live with the need for treatment and with the limitations that having asthma places on their everyday lives. It is in this context that the asthmatics life area’s are most likely to be handicapped.
In general, the chronic asthmatics activity choices are particularly handicapped. …. especially physical education. Exercise incites airflow limitation in most children and young adults who have asthma. Exercise appears to be a specific stimulus for people with asthma because it seldom leads to airflow limitation in people without asthma. (Global Strategy, 1995) More specifically sports where sustained effort is needed over a considerable period (eg long distance running) are not recommended.
From a psychological point of view, the development of a positive sense of self (ie self-esteem) can be adversely affected by asthma. In one study, nearly 41 percent of parents of children with asthma said that asthma caused their children to feel self-pity. These children also were found to have low self-esteem as well as poor relationships with their peers. (Charmaz, 1983)
For an adult, occupation and social life may be handicapped. A comparative study from Edinburgh (1996) between asthmatics and people with other forms of physical disability were found to have similar levels of anxiety or neuroticism. It was found most asthmatics exhibited varying levels of anxiety in relation to their beliefs and, in particular, their constant fear of another attack and anxiety over school and work prospects. (Lane, 1996).
Similarly, fear also plays a predominant role in children who suffer from asthma…. with one in four Victorian children fearing not being able to breathe as a result of asthma (King, 1988). Furthermore, the relationship between asthma and emotional and /or severe behavior problems is documented in a 1995 study by R,Bussing et al. In particular they tend to suffer from limited school functioning, inability to attend school and need for special school or special classes.
In Australia, school loss caused by asthma accounted for approximately 965,000 days annually. (Aust Bureau Statistics, 1991) In particular poor academic performance and greater risk to learning difficulties were found to be the greatest negative consequences. (Fowler, 1992)