Public Health Problem

Asthma is a chronic lung disease affects more than 235 million people worldwide today, and approximately 25 million in the U.S. (NHLBI) The disease is caused by an inflammation of the airways, which is characterized by wheezing, chest tightness, coughing, and shortness of breath, due to airway narrowing and or obstruction. There is currently no identification of a specific reason for the occurrence of asthma, however, studies show that asthma exists in society due to many genetic and environmental factors. Environmental factors include certain allergens and irritants such as mold, pet dander, the weather, tobacco smoke, dust mites, inorganic strong smells, pollen, certain insects, and industrial dusts. (NHLBI) Asthma is also caused by genetics as some people are born with the inherited tendency to have the disease, especially if their biological parents have had the disease.

Asthma can occur anywhere in the world and is not geographically restrained, as the aforementioned environmental risks factors can be found everywhere, but certain ethnic and racial groups are at higher risk for asthma such as African Americans and Puerto Ricans, who are three times more likely to be hospitalized because of the disease. (Holgate, 2010) Additionally, a group that is at high risk for asthma are children who have had respiratory infections in their childhood, as it can result in weaker and more sensitive airways. If an infant or toddler is exposed to viral infections or certain airborne allergens during the development of their respiratory system, the likelihood of having the disease is higher as well. Although there is no exact origin for asthma, respiratory complications similar asthma have been recorded in China since 2400 B.C.

Occupational asthma, which is a type of asthma that is developed due to industrial dusts and chemical irritants in the workplace, is a lung disorder that many laborers are at risk of having. (NHLBI) This can continue to be a risk for the community if regulations for improved and safe ventilation and air quality are not ensured or enforced to protect workers from irritants and allergens that could lead to asthma. Another risk is that the quality of life will continue to decrease for asthma patients if the allergens and irritants continue to be exposed and produced. Asthma can lead to a reduction in the quality of life due to asthma attacks, which can be fatal. This can affect the school life of a student, causing missed time learning at school, or it can affect a worker by reducing their available time and energy spent on work due to of hospitalizations or emergency room visits. (NIAID, 2018)

How to Solve the Problem

Although the number of asthma patients who die from asthma every year is not very significant, many of these deaths can be avoided with the proper care and treatment of the disease. (AsthmaMD) Although no cure for the disease, a strategy to reduce the pervasiveness of asthma is for asthma patients to follow the Asthma Action Plan, which is produced by the National Heart, Lung, and Blood Institute. The action plan is a chart form guide for people who suffer from asthma to properly take medication, avoid triggers with the exception of exercise, responding to symptoms that appear to be worsening, track their level of asthma control, and provides directions to seek emergency care if needed. The action plan is split in three categories of wellness for asthma patients to identify their specific needs at their current condition.

There are two main types of medication for asthma patients. The first type is the long-term control medicines. This type of medicine is generally used more for preventative measures and controlling of symptoms, rather than an immediate alleviation of the symptoms. Long-term control medicines help prevent asthma symptoms and can reduce airway inflammation; therefore a common long-term control treatment is anti-inflammatory inhaled corticosteroids, with the dose being dependent on a person’s symptoms. (NHLBI) The second type of medication for asthma patients is quick-relief medicines. Also called rescue medicines, this type of medicine is taken for a short-term relief of the symptoms of an asthma attack, which helps the airway temporarily open up. A common quick-relief medicine is a beta 2-agonist inhaler. (NHLBI)

Another strategy used to acquire a solution to asthma is targeted research through clinical trials, which are funded by the National Institute of Allergy and Infectious Diseases. This research is performed with the aim of understanding the specific immune responses that may lead to asthma, and discovering how environmental exposures interact an individual’s genetics that causes a certain response which results in asthma. (NIAID) An understanding of the responses can support and further the development of asthma treatments and prevention strategies to improve the quality of life for asthma patients. The research program has identified main reactions to asthma, which include rapid heartbeat, drowsiness, chest tightness, and shortness of breath, coughing, wheezing, and more.

Yang Yong Qing, a professor in Shanghai, China, did extensive research on asthma medication, where the asthma rate is very high due to the growing city smog. After the professor and his research team tested over thousands of drugs, they came to the development of a drug that goes by the name of TSG12. In comparison to the traditional and preferred short-term medication beta 2-agonist, TSG12 activates a protein that reduces airway resistance, and causes the relaxation of smooth muscle cells in the throat, which is the root of the asthma problem. (Yin, 2018) Additionally, repeated usage of beta 2-agonist may result in desensitization and a decrease in effectiveness, but studies on the TSG12 medication showed that desensitization was not induced. (Yin, 2018) The drug is expected to enter the market soon, however, more clinical trials have to be passed before the public can use TSG12.

A cohort study in Amsterdam, Netherlands, exhibited an effective high-altitude treatment that took place in an asthma center located in an altitude of 1600 meters above sea level and offers personalized and multifaceted treatment for patients who have severe asthma in a low-trigger environment. (Hashimoto, 2018) The results of the treatment showed an increase in quality of life and lung function for asthma patients. The high-altitude climate therapy had a significant decrease in blood eosinophil levels, which suggests an anti-inflammatory effect that may be a result of the diminishing or absence of triggers and allergens at sea level. Despite the positive results of the high-altitude treatment, the effects of the treatment differed for each individual, consequently, the study addressed that effects can be predicted by patient characteristics such as age, blood eosinophil level, and degree of asthma control before admission into the program at the asthma center. (Hashimoto, 2018)

Public Health in the Future

Due to the fact that asthma could be caused by genetics, it is difficult to prevent asthma in some cases. In order to prevent recurrences of fatal asthma symptoms, such as asthma attacks, following the NHLBI’s Asthma Action Plan can be used. With the advancement of technology, an electronic edition of the action plan has been created. A recently conducted study of a randomized control trial, which tested the effects and impacts of a web-based action plan in comparison to the traditional written action plan. As a result, it was proven that text messaging check ins and other electronic methods of following through the action plan can be more effective. The study had successful outcomes, and resulted in improvements of asthma control, decreased asthma exacerbations, and improved quality of life. (Poureslami, 2018)

Another way to prevent asthma in the future is to promote allergen specific immunotherapy. Although there is a risk of severe reactions, injecting the allergens that cause asthma under the skin can lead to hypo-sensitization or desensitization, also resulting in improved bronchial hyper reactivity. It has been addressed in the study that reactions may be fatal. (Abramson, 2010) Regardless of the risk, the clinical trial revealed immunotherapy could reduce asthma symptoms, and its effects were comparable to inhaled steroids.

Although there are many difficulties and obstructions that come with the prevention of asthma, there are many simple things that can be done to better the lives of those who suffer from asthma, such as the avoidance and reduction of exposure to asthma irritants and allergens. In my opinion, I believe that the following through of electronic asthma action plans may be more consistent and effective, especially since a technology has become so advanced today and many people are dependent on its functions. Alerts and reminders to treat, record, and prevent the symptoms of asthma may be aided by the use of electronic devices, and can help individuals who require assistance in remembering to take medication for asthma, especially long-term medication that is used in occasions where symptoms of the disease cannot be detected. I also believe that the TSG12 medication may be more effective than the common beta 2-agonist inhaler, as it does not induce desensitization, and can therefore improve the health of asthma patients in the future, and better the quality of life for those who suffer from the chronic lung disease.