Improving the Quality of Life in Children with Asthma

1. Improving the Quality of Life in Children with Asthma Presented by: Ivy Woodroff

2. About Asthma Asthma is an inflammatory disease caused by sensitivity to a certain stimuli, and results in swelling of the airways and airway obstruction (Janson, 1998). Inflammation of the airways results in wheezing, tightness of the chest, difficulty breathing, and coughing (Lewis, Heitkemper, & Dirksen, 2000). The symptoms of asthma are reversible with proper treatment and intervention.

3. Prevalence and Incidence The 1998-99 national Population Health Survey, stated that over 2.4 million Canadians had been diagnosed with asthma by a physician. An estimated ten percent of children and five percent of adults have active asthma. Asthma is most common during childhood, and it affects at least twelve percent of Canadian children. It is the most common reason for hospitalization in school aged children. Asthma among people aged 15 and over has been increasing over the last 20 years. 1979 � 2.3 percent 1988 � 4.9 percent 1994 � 6.1 percent (Asthma Society of Canada, 2004)

4. Factors that TriggerAsthma Allergens Dust mites Animal dander Pollen Grass Molds Air pollutants Smog Cigarette smoking Dust and exhaust fumes Respiratory Infections Viral Bacterial Drug and food additives Exercise Dry and humid weather Stress (Lewis, Heitkemper, & Dirksen, 2000).

5. Treatment Options Use of Inhalers Drug therapy is the best way to take control of asthma. Two medications used for asthma are bronchodilators and corticosteroid medications. Bronchodilators (e.g. Ventolin) are use to keep the airways open, and corticosteroids (e.g. Flovent) are used to reduce inflammation (Lewis,et al, 2000). The importance of patient knowledge regarding drug therapy must be assessed in order to make treatment effective (e.g. drug dosage, method of administration, and schedules). Patient and family education about the illness and the resources available in the community Family education for asthma management has had some effects on improving school attendance and decreasing emergency department visits and hospitalizations (Horner, 2004).

6. More Treatment Options Asthma management plan Work collaboratively with healthcare professionals Lifestyle modifications Providing education regarding the benefits of physical activity in improving quality of life in children with asthma (Welsh, Kemp, & Roberts, 2005). Stress management Avoid stimuli that triggers asthma

7. Kurt Lewin�s Change Theory Our goal is to improve the quality of life in children with asthma; the use of Kurt Lewin�s theory of change will be used as the guideline in order to achieve this goal. The three stages of Lewin�s change theory are the unfreezing stage, moving to a new level, and the refreezing stage. The unfreezing stage is a method of change in which old patterns that were counterproductive in some way are let go (Kaminski, 2006). The next stage is the moving to a new level stage, which involves a process of change in thoughts, feeling, and behavior that are more productive (Kaminski, 2006). The last stage is the refreezing stage. It is at this stage that change is established as a new habit (Kaminski, 2006).

8. Unfreezing Stage 1.��Identification of the determinants of health In this stage, it is important to recognize the predisposing factors resulting in asthma. Other determinants of health such as income, level of education, health beliefs, family functioning, and urban dwelling also must be addressed as contributing factors to the illness (Wallace, Scott, Klinnert, & Anderson, 2003). The amount of sustainable resources and education level of parents impact their understanding of the illness and affect how the illness is managed. Furthermore, family dynamics are also a contributing factor that affect treatment plan and adherence to medication, and thus must be identified.

9. ��� Unfreezing Stage 2. Identification of family values and beliefs ���The family�s health values and beliefs, and their culture have an impact on how the illness is perceived and managed. Different languages and their understanding of the illness, and what to do during an asthma attack is a concern. It is important, therefore, to ensure that healthcare professionals and the parents work collaboratively in making a treatment plan based on the individual�s and the family�s needs.

10. Moving to a New Level Stage In order to move to a new level, the patient�s perception of their asthma, accurate assessment of prior knowledge, education to promote changes in behavior, influence of culture, and values and beliefs must be addressed to increase patient compliance to treatment (Wrench & Morice, 2003). Patient�s perception of their asthma and accurate assessment of prior knowledge: Work collaboratively with healthcare professionals to create an asthma management plan based on the parents� and the child�s needs. Use of a questionnaire that will assess the parents� and child�s prior knowledge of the illness before making a treatment plan. Asthma management will involve understanding the importance of drug therapy, and proper use of peak flow meters.

11. Education to promote changes in behavior Parents and other primary caregivers of the child need to engage in an educational program that is done in the hospital and/or school setting. Have an in-service in the hospital and incorporate patient teaching about the importance of drug therapy. Incorporation of an exercise treatment plan based on the severity of the illness. Work collaboratively with healthcare professionals for a desired exercise plan. Use the media to educate the public about the illness, how to manage it, and where to find appropriate resources.

12. Cultural considerations Healthcare professionals must work one-on-one with the patient and their family to ensure greater understanding of the illness and the treatment plan. Create a treatment plan available in various languages to address the different cultures. Important consideration on literacy, thus creating a plan that is easy to read with simple words.

13. Refreezing Stage This stage allows application of new knowledge to improve the quality of life in children with asthma. ��� The use of questionnaires to evaluate the effectiveness of the intervention must be continuously updated and evaluated. Providing a booklet for the patients and their families that allows them to record the wheezing episodes, the duration, and intensity of the attack, and thus will be beneficial for future treatment plan. ����� Educational intervention providing guided self-management in either the hospital or a school setting must be consistently updated and based on an evidence based approach. ������Impose starting guided self-management plan during admission in the hospital to reduce developing bad habits. ����� Update patient knowledge about the importance of peak flow meters, and metered dose inhalers (drug therapy).

14. References Asthma.ca (2004). Asthma society of Canada. Retrieved March 18, 2006, from http://www.asthma.ca/adults.community/pdf/Bookslets/ACS_Fact_Shet_Asthma Statistics.pdf. Google.ca (2006). Google Images. Retrieved March 21, 2006, from www.google.ca. Horner, S.D. (2004). Effect of education on school �aged children�s parents� asthma management. Journal of Specialist in Pediatric Nursing, 9(3), 95-101. Janson, S. (1998). National asthma education and prevention program, expert panel report II. Overview and application to primary care. Lippincott�s Primary Care Practitioner, 2, 578-588. Kaminski, J. (2006). Learning Activity 1. The Change Process & Selected Theories. Nursing 411 Course Manual. Surrey, BC: Kwantlen University College, 9-14. Lewis, S.M., Heitkemper, M.M., & Dirksen, S.R. (2000). Medical-Surgical Nursing. St.. Louis Missouri: Mosby, Inc.

15. Wallace, A., Scott, J., Klinnert, M., & Anderson, M.E. (2003). Impoverished children with asthma: a pilot study of urban health care access. Journal for Specialist in Pediatric Nursing, 9(2), 50-57. Welsh, L., Kemp, J.G., & Roberts, R.G. (2005). Effects of physical conditioning on children and adolescents with asthma. Sport Medicine, 35(2), 127-141. Wrench, C., & Morice, A.H. (2003). The effectiveness of asthma nurse intervention: the need for change. Disease Management Health Outcomes, 11(4), 225-231.