Improving the Quality of Life in Children with Asthma

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Improving the Quality of Life in Children with
Asthma

• Presented by Ivy Woodroff

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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.

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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)

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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).

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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).

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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

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Kurt Lewins Change Theory

• Our goal is to improve the quality of life in
  children with asthma the use of Kurt Lewins
  theory of change will be used as the guideline in
  order to achieve this goal. The three stages of
  Lewins 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).

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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.

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•     Unfreezing Stage
• 2. Identification of family values and
  beliefs
•    The familys 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 individuals and the familys needs.

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Moving to a New Level Stage

• In order to move to a new level, the patients
  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).
• Patients 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 childs needs.
• Use of a questionnaire that will assess the
  parents and childs 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.

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Moving to a New Level Stage

• 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.

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Moving to a New Level Stage

• 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.

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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).

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References

• Asthma.ca (2004). Asthma society of Canada.
  Retrieved March 18, 2006, from http//www.asthma.c
  a/adults.community/pdf/Bookslets/ACS_Fact_Shet_Ast
  hma 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 childrens 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.
  Lippincotts 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.

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• 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.