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Asthma is classified as a chronic respiratory syndrome that may have unpredictable effects on the quality of the life of its victims. The pathophysiology of the asthma entails a circular advancement of the physical expressions owing to the airflow obstruction because of the inflammation of the air passages. The nature of inflammation tends to differ from patients to patients, though the same mechanisms are involved. Asthma patients respond differently to various stimuli and even to the same stimuli at varying times. Consequently, the response to the treatment may also vary significantly.
The patients, who are well-informed about the aspects of their condition and are compliant, tend to be less affected. On the other hand, those who are not informed of the syndrome and are not treated on time; tend to be severely affected by the chronic respiratory inflammation. It has been tested and proved through researches that an advanced control and management of the asthma greatly impairs the quality of the affected person’s life, while any level of the symptom has an influence on the quality of life of people who experienced occasional asthma symptoms.
Logically, the control and management of the condition significantly affects the level of life of the people affected by asthma. The victims who attend outpatient in most medical centre in Saudi Arabia for health check-up tend to remain in a state of untreated asthma with deprived lungs functions and increasing needs for reliever treatment. According to the study that was carried out by Stickells et al., their quantitative research aimed at discerning the provenance of the untreated disease while setting out the determination of the knowledge on asthma, regulation of asthma, and the life standards of people who are suffering from this disease. Their research was conducted in the respiratory outpatients department .The data applied in their study was collected with the help of questionnaires, such as the asthma standard of life questionnaires, the asthma knowledge questionnaire, and the treatment of asthma questionnaires.
The written asthma action plan (WAAP) is applied in the process of educating the asthmatics on the early identification and treatment of the deteriorating asthma condition. Local asthmatics may be chosen to be treated by private practitioners. In the past studies5 half of the physicians in a primary care self-reported that they had formulated an asthma action plan for asthmatics, though little is recorded of their exact practices. Their qualitative research examined family doctor’s perceptions on the WAAP and its implementation in the primary care.
According to the statistics and guidelines released by the Global Initiative (GINA) and the World Health Organization (WHO), the prevalence of asthma is rising across the world. It is estimated that approximately 5 per cent of the adult population and between 10 and 15 per cent of children globally are victims of asthma. It is more pronounced in developing economies. According to the report by International Survey on Asthma and Allergy in Childhood (ISAAC), asthma was estimated at 9 per cent in African children between the age of 13 and 14. The mortality and the morbidity related to asthma are substantial. The statistics that were established by the British Thoracic Society highlighted that the asthma death rate were about 2000 per annum for half a century. Most of the people suffering from asthma tend to experience a significant morbidity as indicated by frequent episodes of escalation of asthma manifestation, Limitations of their activities and the paralysed lung performance. It may have probably indicated a greater severity of the underlying syndrome. Smoking is significantly related with an increase in the poor compliance with the treatment regimens since it leads to improper manifestation regulation and the related impairment of the quality of life. The increasing costs related to the lack or poor compliance originate from the high number of the emergency hospitalization, room visits, and lowered productivity at working place.
The asthma condition ranges from mild episodes of exacerbations to a severe chronic syndrome that requires frequent medical attention, hospitalisation, and the high doses of management therapy. Due to the typical characteristics of the asthma, they are a potential ground for non-compliance by the patients. Knowledge about asthma seemed to influence the level of victim to manage their asthmatic attacks. It was contrary to the general belief in health fraternity that compliance is directly associated with the level of knowledge among the patients. According to the earlier research conducted in Scotland, it reported low levels of knowledge about asthma among the out-patient clinics.
Davis et al. (2002) identified inadequate knowledge of the disease in approximately 78 per cent of the adults and 68 per cent of the parents of asthmatic children. During a conference on asthma in Africa in 2001, it was found that every patient suffering from asthma adopted certain personality at varying levels of understanding of the disease. Thus, their cares and needs will tend to differ in treatment and management of their condition. Though the understanding of asthma as a chronic condition and its treatment has increased over the past two decade, the verbal asthma action plan suggests that asthma is poorly treated. There are many subjects that may identify the triggers of asthmatic symptoms, though they often intervene to assure the abolition of the symptoms since they tend to have a minimal expectations of attaining success from their efforts. The insufficient knowledge and inappropriate perceptions concerning asthma are major obstacles to the self-management of asthma.
It has posed a problem to the health fraternity, where the modern guidelines are recommending more autonomy in the process of decision making for the patients with the aids of written action plans. The recent advances in the knowledge of asthma and the treatment thereof should be directed towards improving the quality of life of the asthmatics, however, this aspect has been neglected in the modern clinical practice. The quality of life evaluation is a reflection of an individual subjective knowledge on the effects of the asthma on their life. It was initially applied as a mean of measuring the level of management; however, currently it is applied in evaluating the holistic perspective of the asthmatics compared to the functioning of the lung. The management of the asthmatics should be directed towards improving the quality of life of the asthma patient while allowing them to express their concerns. In any case, an individual suffering from asthma should be led to live an esteemed life without a sense of low level of performance.
The individuals suffering from asthma who attend medical centres may be classified from mild condition to a severe condition according to the evaluation of the spirometry on the manifestation to the treatment that is measured against the asthma standards. It indicated that there could be a possible risk of poor treatment of potential non-compliance to the asthma treatment and management strategies. These asthmatics lack knowledge of their health and are frequently underestimating the severity of their condition and the level of management necessary to control asthma. Improper asthma management hinders the quality of life while at the time posing risk of fatal asthma.
The key purpose of the current work is to establish the comparison between written asthma action plan and verbal asthma action plan patients’ knowledge of the respiratory condition (asthma) to determine whether there is a connection between asthma knowledge, life standards of asthmatics, and the asthma management. The current work was motivated by the respiratory outpatient’s interaction with the patients with little knowledge of their asthma condition.
The research was projection of the adults (17 to 45 years) asthmatics who were attending the respiratory medication at health centre. The key objectives were triggered by the research purposes:
- To establish the comparison between written asthma action plan group and verbal asthma action plan knowledge of the adult asthmatics concerning their condition.
- Evaluate the management of asthmas as scaled by a validated disease-centred questionnaire
- To establish the connection existing between the knowledge on asthma and its treatment.
- To identify the optimal control of asthma
The above objectives are designed to attempt to answer the three research questions:
- Is there connection between the written asthma action plan group and verbal asthma action plan group?
- What is the association between the level of knowledge on asthma and its treatment?
- Is there any connection between asthma management and the quality of life of the individual suffering from it?
The asthma has a significant influence on the lives of people. The asthmatics usually have an opinion of what signifies to them. However, their opinions are usually derived from the personal experiences and the consequences of the associated disease. The asthmatics’ contextual framework impacts the manner in which they react to the any information regarding asthma as well as their future decisions to either observe to the treatment or discard the suggested treatment. The patients are on the edge considering the unpredictability of the disease manifestation process. Sometimes, the victims are in remission and are able to regulate the situation; nevertheless a slight variation of the environmental causal agents may easily change the stability into a severe asthma attack. The total management of asthma implies advancement of life quality resulting in enhanced productivity.
Whereas reaching this level of functioning and independence tend to be difficult, it ought to be achievable. The restricted contact time, which medical professionals have to spend with each patient, causes concentration on the symptoms and signs of asthma as well as disease management under various medications.
Although the inhaled corticosteroids tend to be the core of the treatment and are suggested by all the asthmatic standards, a significant proportion of people fail to adhere to the treatment since they do not understand the rationale for the medication. The restricted contact time span limits the health professionals the chance to go into detailed assessment to benefit the knowledge level of the asthmatics. Consequently, asthmatics with the chronic syndrome suffer socially, physically, and psychologically.
The characteristics of life of the asthmatics in the current study apply the health facility that had not been studied previously. The information obtained from the current work will help the health professionals to plan the patient treatment protocols by contributing to the knowledge and control that are required to be addressed in particular population.
The role of the medical professional in the management of asthma is significant since the medical fraternity is the first contact point at the regular follow-up visits. Some patients are more comfortable sharing their suffering with medical professionals rather than with friends. Due to the shortage of staff, their part as health promoters does not materialise. The health professional are assets to the implementation strategies that lead to the lessening of the asthma signs and ultimately enhancing the quality of adult patients’ life.
The use of theory in the nursing study provides a perspective or foundation that can guide the nursing practice in the effort to improve the asthma results. The theory according to Robert et al. (2004) provides a conceptual framework that may be applied to implement the study according to the findings on the practice within the organizations as a part of a quality improvement plan. According to Robert et al., the effective translation of the evidence into practice depends on the diffusion, implementation, dissemination, and sustainability. Whereby, diffusion is the inactive process of passing knowledge, dissemination is the active process that entails action plan and focus directly on the targeted groups that are adopting the intervention. The active dissemination is beneficial when there is implementation of a new strategy such as asthma action plan. A successful implementation of the action plan involves active planning commitment to embrace the innovation at organization level.
The following assumptions were used as a departure point for the current study:
- The lack of asthma knowledge is responsible for the poor quality of life among the adult asthmatics.
- The level of compliance to the medication is directly related to the patient level of knowledge.
- The sustained positive health-promoting conduct tend to improve and directly impact the quality of life of asthmatics.
- Low level of knowledge tends to have a negative impact on the acceptance about the asthma, which may lead to misconception.
The Scope of Problem
WAAP attained prominence after it was published in the Cochrane systematic review on the written individualized treatment and management plans for asthma among the asthmatics in 2003. Nonetheless, there is still a paucity of evidence regarding the components of the WAAP, which were initiated using the traffic light system, the number of the action points as well as the application of inhaled corticosteroid alone or orals. During this study several respondents raised this question, and thus, further study were needed to determine the actual answers that would support and support the confidence of the family physicians to prescribe for WAAP to the asthmatics.
The pace of embracing WAAP at the expense of VAAP as an evidence-based measure tends to vary from one country to the other. According to Wiener-Ogilve et al., about 23% of the asthmatics were given asthma action plan in a survey.
In the view of the outpatient healthcare system, the clinic procedure should be reviewed to take care of the asthmatics with WAAP. WAAP is revisited and reinforced on the subsequent visit and should be revised periodically as the patient’s asthma situation is established. The patient’s behavioural changes in adapting to the WAAP are facilitated in case they experience benefits from it due to result of the streamlined processes. The implementation of WAAP in general practitioners’ clinics in small groups or alone, they need to devote time for training which may not be needed in case of verbal asthma action plan. For larger general practitioner group, practices may emulate the practice-based interventions on the poly-clinics. Health practitioners are encouraged to transform their verbalised asthma action plans into written format, these are supposed to serve as the reminders to the patients to adjust their medications schemes accordingly in case they experience deteriorating asthma symptoms during off-hours of the general practitioners.
The resulting outcome indicates that general practitioners’ personalised approach on educating the asthmatics, such as reviewing the asthmatics’ condition by phone calls. Written Asthma Action Plan may be reinforced using telephone; this could increase action plan ownership, facilitation, and application of WAAP.
There are several definitions that are given to asthma, but there is no single definition that has fully described the condition. According to a report by the Global for Asthma Management and Prevention, a proper definition should be based on the asthma pathology and functioning procedure of the syndrome.
Asthma may be said to be an inflammatory disorder of the respiratory in which eosionophils, mast cells, lymphocytes, and many other types of cells play a role in air passage constriction that is partially reversible either through treatment of just spontaneously. The causal agents that may lead to asthmatic attack include cold air, common colds, smoking, and respiratory allergens such as pollen, pet hairs and dust. The other factor that are implicated includes, stress and laughter. The disease is known to have a strong seasonal cycle that may be attributed to the sudden changes of weather or environment. According to Stempel et al. (2002), asthma is a condition of high prevalence, cost and morbidity though studies have indicated that asthma has not been understood.
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