RTs Can Assume Vital Role to Stop Unnecessary Asthma Fatalities
RTs Can Assume Vital Role to Stop Unnecessary Asthma Fatalities
We’ve all witnessed this scene: an asthmatic is wheeled into the ER, desperately struggling to breathe despite supplemental oxygen. RTs give her repeated nebulizer treatments while the MD administers steroids. Despite intensive care, her lips turn blue and breath sounds are almost absent. Worried family members tell health care professionals the girl’s breathing has been getting worse, but she thought she would get better with a little rest. Unfortunately, this type of sequence occurs far too frequently.
With 17 million asthmatics in the United States, nearly half the population is familiar with someone suffering from asthma. Forty-one percent of asthmatic adults and 54 percent of asthmatic children require frequent hospitalizations, costing billions of dollars annually.
Asthma affects each patient differently, but similarities in symptomatology typify asthma: Wheezing, shortness of breath, chest pain, coughing and expectoration of mucoid secretions.
Those symptoms signal the need for nebulized beta agonists as those medications offer quick, effective relief—if used properly. However, beta agonists will not always work if the patient has waited too long for treatment or failed to follow instructions. In some instances, RTs provide repeated ER treatments, but the patient’s airway closes anyway.
Reported asthma fatalities increased from 2,603 in 1979 to 5,434 in 1997, with women and African-Americans among the fastest growing groups of victims. In the midst of new mortality data, new theories are emerging regarding female asthma fatalities.
Hormonal changes during the menstrual cycle may cause asthmatic women to experience sudden, irreversible airway closure, according to an article in the August 2000 issue of the American Journal of Respiratory and Critical Care Medicine. Visits to the ER tend to increase among menstruating women, with a 59 percent increase in mortality among that group compared to a 34 percent fatality rate among males.
Most health care professionals have been traumatized after observing an asthmatic child suffer a debilitating attack. Physical deterioration occurs rapidly as the child’s airways close, making intervention critical. Despite medicine’s best efforts, mortality statistics among U.S. children have climbed from 54 asthma-related deaths in 1977 to 191 in 1996.
Lack of medication compliance remains a colossal problem in the battle against asthma. Many patients don’t take prescribed medications at appropriate times for countless reasons: inhalers or prescriptions run out and patients forget to fill them; patients feel a little better and stop using them; and some uninsured patients simply cannot afford the cost of expensive inhalers and pills.
Medication compliance is only part of the picture, noted the January 2001 issue of the American Journal of Respiratory Care and Critical Care Medicine. The article reminded health care professionals to factor in smoking—patient smoking and inhalation of second-hand smoke—alcohol abuse and inept peak flow meter use as other problems. Correct peak flow usage helps patients instantly recognize escalating airway inflammation, thus alerting them to increase or alter medication intake.
Failing to follow a treatment plan may also have roots elsewhere. Many times, patients experience adverse reactions to medications and hesitate to report such reactions to physicians. Still other patients who have taken certain medications for years may undergo metabolic changes, such as menopause, negating the medication’s efficacy.
Patient perceptions regarding their breathing status may play an even larger part in asthma fatalities. Patients may recognize increased shortness of breath but either downplay or ignore it, noted a paper submitted at the 96th International Conference of the American Thoracic Society. Patients say, “I’m imagining this chest tightness. If I sit down and relax, it will go away.” But by then, it might be too late.
Procrastination delays aggressive pulmonary care, one of the primary causes for fatal asthma attacks. Most fatal asthma attacks occur if a patient experiencing an exacerbation waits 24 hours or longer to seek help.
Psychological reasons may cause procrastination. D. McLean, PhD, of Columbia University in New York City, has suggested depression, anxiety and stress may contribute to worsening asthma and the delay in seeking care.
While depression’s link to asthma has not been fully researched, explanations may center on a depressed patient’s tendency to delay or miss treatments. Or just the opposite, perhaps the struggle to breathe creates depression. Either way, treatment regimes fall by the wayside.
Severe asthmatics also have cellular differences within their airways, according to the January issue of the American Journal of Respiratory and Critical Care Medicine. An increase in eosinophils, white blood cells participating in immune-based inflammatory reactions, are present in larger numbers within the severe asthmatic’s airways. If those patients experience a sudden flooding of additional eosinophils, such an inflammatory surge could completely seal off airways.
The American Thoracic Society has reported more than 10 percent of patients who experience a near-fatal asthma attack die within one year. A near-fatal asthma attack should serve as a wake-up call that serious problems lie ahead. That coupled with non-compliance, psychological and physical reasons have led the American Thoracic Society to believe asthma-related deaths will continue to climb.
Self-management and empowerment may be the way to prevent fatal asthma attacks, said A. Sonja Buist, MD, of Oregon Health Sciences University, Portland. Self-management can be divided into five areas: Providing adequate asthma education; teaching medication administration skills; helping patients learn self-monitoring; teaching recognition of triggers; and medication compliance methodology.
The door is open for RTs to play a greater role in educating asthmatics, particularly those who have had near-fatal attacks. Research has not shown education or treatment plans alters asthma itself, but it does show that a patient’s strict adherence to an action plan will reduce symptoms and fatalities.
Katherine Lesperance is an ADVANCE Assistant Editor.