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Asthma Among African Americans

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Imagine feeling like you cannot breathe; you are drying up like a fish out of water. You start to feel tightness in your chest then you begin wheezing and you look for the device that had often relieved your symptoms of asthma, knowing if you do not find your inhaler you could be flopping on the floor until consciousness is lost. Some asthmatics say it feels like your trying to breathe through a straw. This feeling is due to the inflammation caused by a trigger that causes the narrowing of the airway leading to the chest tightness, shortness of breath, wheezing and coughing. Asthma is the most common chronic disease affecting people today. Asthma is described as an epidemic rather than and endemic because it is not restricted by age, sex, racial group or region. Asthma is widespread throughout the world but higher rates of prevalence are seen in African Americans.
Asthma can affect anyone, despite the development of new treatment options; asthma remains a major health problem in the United States. According to the National Heart, Lung, and Blood Institute (NHLBI), about 15 million Americans have or carry a diagnosis of asthma and it is the third leading cause of preventable hospitalizations in the United States. About 500,000 hospitalizations and 5,000 deaths occur annually from asthma, and the mortality rate continues to rise. This rise is especially dramatic in the African-American community, despite the absence of a known racial preference for asthma. It is now well established that under treatment and inappropriate treatments are the leading contributors to asthma morbidity and mortality in the United States. The African-American community is the most affected from these two factors, and these sobering statistics should convince all of us who care for asthma patients that we could be doing a better job (Blackhealthonline.com). Although the exact cause of asthma is unknown, researchers linked genetic and environmental factors as causes for asthma. “Ethnic differences in asthma prevalence, morbidity, and mortality are highly correlated with poverty, urban air quality, indoor allergens, and lack of patient education and inadequate medical care.” (Asthma and Allergy Foundation of America)
Asthma is caused by the inflammation of the bronchial airways, which are the tubes that carry air in and out of the lungs. The inflammation causes the airways to narrow. As the asthma worsens, three primary asthma pathophysiology changes take place in your lungs. Increased mucus as your airway becomes irritated and inflamed. The thick mucus may clog the airways of the lungs. Inflammation and swelling, just as your ankle swells from the irritation caused by a twisted ankle, the airways of your lungs swell in response to whatever is causing your asthma attack. Muscle tightening, as the smooth muscles in your airways tighten in response to your asthma attack, the airways become smaller which in turn, causes coughing, wheezing, chest tightness and shortness of breath. Not all people who have asthma experience these symptoms and if you do experience these symptoms, it does not automatically mean you have asthma. A physician will conduct thorough testing which should include a physical exam and may include some diagnostic tests such as a lung function test, allergy testing, chest x-ray or an electrocardiogram. Inflammation of the airways is common in all asthma patients. There is no cure for asthma, but most people can control the condition and lead normal active lives especially if they know their triggers. Triggers include allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers. Some irritants include cigarette smoke, air pollution, chemicals, and dust in workplace and household products. Over the counter medications such as aspirins and other non-steroidal anti-inflammatory drugs and non-selective beta-blockers can be triggers as well.
Asthma affects people of all ages, and the prevalence has increased over the past two decades. In 2011, almost 4,300,000 non-Hispanic Blacks reported that they currently have asthma, and African Americans were 20% more likely to have asthma than non-Hispanic Whites in 2011. In 2009, African Americans were three times more likely to die from asthma related causes than the white population. From 2003 to 2005, African American children had a death rate seven times that of non-Hispanic White children. African Americans had asthma-related emergency room visits 2.8 times more often than Whites in 2009, and black children are 3.6 times more likely to visit the emergency department for asthma, as compared to non-Hispanic white children (The Office of Minority Health). When you begin nursing care for a patient with asthma, you will first complete a quick assessment. Try to gather the essential information if possible, such as medication allergies, known cardiac disease, and sleep disruption. Then immediately take action to relive symptoms. After the patient is more comfortable go ahead and complete the data intake process. A complete health history should be obtained. Questions such as, what is the patient’s trigger? How does having asthma affect their daily living? What kinds of preventative measures are being taken to avoid future attacks? At what level is the patient’s knowledge about their disease? Another huge factor is their ability to afford medical and drug therapy. I believe this is often over looked by health care professionals, leaving patients in a vulnerable state. After gathering your data then move on to your physical examination. Start by obtaining your patient’s vital signs and auscultation of their lung sounds. While obtaining these look closely at the patient and observe their skin color and respiratory effort along with body language. Asthma could be triggered by many different causes; the patient could be ineffectively breathing. Observe the patient’s respiratory rate, pattern, and effort. Make sure the patient is in a comfortable up right position and oxygen in place if order. At this time administer any bronchodilator agents and stay with your patient to monitor for improvement or adverse effects. Another nursing diagnosis would be impaired gas exchange. Signs and symptoms to look for would be tachypnea, shallow respirations, diaphoresis, reddening skin, tachycardia, cardiac dysrhythmias, initial hypertension, later hypotension, restlessness, or drowsiness. If these symptoms persist, they may even lead to a loss of consciousness. As a nurse, you would want to check the arterial blood gas values and notify the physician if the partial pressure of oxygen of the blood gases decrease or the partial pressure of carbon dioxide in atrial blood increases and the pH falls (Linton, 2012). In that case, you would administer oxygen as ordered, usually 4 to 6 L/min (Linton, 2012). Suctioning may be needed if patient has tenacious secretions that cannot be expectorated on their own. Also increase fluid intake to help thin out secretions. Life with asthma can affect not only the patient but also the family and loved ones involved. As a nurse, you are responsible to promote and ensure that all patients affected with an infirmity now how to control and manage their symptoms and get the best quality out of life. Some important teaching points for an individual with asthma to understand include: taking long-term control medications to prevent symptoms, avoid irritants that trigger attacks such as tobacco smoke, pet dander and outdoor irritants such as ragweed, ensure that they patient fully understands how to administer their medication(s) so the proper dose is administer and provide the patient and family members with organizations that can help them cope with the effects of asthma such as the Asthma and Allergy Foundation of America.(Linton, 5thed). Another topic to highlight on is that long acting medications should not be used as source of a rescue inhaler. It is important to inform the patient and loved ones that they can still lead and enjoy a productive life and just because asthma is a diagnosis does not mean that they have to stop living and give up what they love.
Asthma continues to be an ever-threatening endemic that has been frustrating the health field since Hippocrates first described it in 450 B.C. (fraserhealth). As members of the health care field, we are expected to treat every and all patients to the utmost of our abilities. As nurses working with those with asthma, we should be performing complete assessments of our patients and always paying attention to our ABC’s. We need to assess patients’ triggers and teach them the proper ways of using their medications. No matter a patient’s race, size, gender, religious beliefs, we need to understand that disease does not discriminate and neither should we. African-Americans are more susceptible to asthma morbidity and mortality because of under treatment and inappropriate treatments. This is totally unacceptable in any part of the medical field whether it be at the nursing level or physician level. Asthma may never be eradicated, but the incidence of asthma being more prevalent in African-Americans is capable of being reduced.

Reference List
U.S. Department of Health and Human Services. (10, May 2012). Retrieved from The Office of Minority Health: http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=3&lvlid=149
Asthma and Allergy Foundation of America. (2013). Retrieved from www.aafa.org: http://www.aafa.org/
Blackhealthonline.com. (2013). Retrieved from www.blackhealthonline.com: http://www.blackhealthonline.com/asthma.html
The Office of Minority Health. (2013). Retrieved September 23, 2013, from http://www.minorityhealth.hhs.gov: http://www.minorityhealth.hhs.gov/
Linton, A. D. (2012). Introduction to Medical - Surgical Nursing 5th edition. St.Louis: Elsevier Saunders.

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