Beth Thompson, Steve Somerfield, Patrick Stoneberg, and John Toldo

Description of Asthma: (http://www.youtube.com/watch?v=S04dci7NTPk)
According to the Centers for Disease Control and Prevention asthma is a disease that affects your lungs. It causes recurring episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing (CDC, 2009). When as asthma attack occurs, the muscles surrounding the airways become tight and the lining of the airways swell. This swelling and tightening of the muscles reduces the amount of air that can pass through (CDC, 2009).
Asthma is considered one of the most frequent long-term diseases of children, but adults can have it as well (CDC, 2009). One of the biggest problems with asthma is that there is no cure for it and no one knows what even causes asthma. The one thing the Centers for Disease Control and Prevention does know is that you are more likely to have asthma if a person in your family has asthma.
Facts:
-The Centers for Disease Control and Prevention estimate that 22 million people in the United States have asthma - Number of visits (to physician offices, hospital outpatient and emergency departments) with asthma as primary diagnosis: 13.3 million (CDC, 2009)
-Number of children who currently have asthma: 7.1 million (CDC, 2009)
-Number of discharges with asthma as first-listed diagnosis: 456,000 (CDC, 2009)
-Average length of stay: 3.4 days (CDC, 2009)


Intrapersonal:
There are things an individual can do to control their asthma. The most important thing is to take the medication your doctor prescribed to you and try to avoid anything that can trigger an asthma attack, such as dust mites, tobacco smoke, pets, outdoor air pollution, mold, strenuous physical exercise, some medications, high humidity, freezing temperatures, smoke from burning wood or other vegetation, and some foods (CDC, 2009). A person should also gain knowledge about this disease so they can control it better.

Treatments: Inhaled corticosteroids and inhalers, Theophylline (a pill that keeps airways open), and allergy shots and allergy medication.

Interpersonal:

Parent-Child:Overall, four routines are looked at and managed by both the children and parents of the children with asthma. These routines are adapted by both the children and adults to which they adjust treatment recommendations to be utilized within their personal ecological context.
          1. Child with asthma given responsibility for medication use
          2. School nurse availability monitored
          3. Air quality analyzed managed at best efforts
          4. Home environment cleaned often

(Yinusa-Nyahkoon, 2007)

Family/Friends:
The education of family and friends on the topic of asthma is very important. If an individual diagnosed with asthma is surrounded by people unaware of the triggers of that individual then that individual will suffer. It is also important that the diagnosed individual is not the only person monitoring their use of medication/inhaler. The more aware and educated the family and friends are of the diagnosed individual the more likely that person will be able to live at a higher quality of life.

Social Support:
The more support and understand that surround the diagnosed individual the more they will accept their condition themselves. As an adolescent it can be viewed as embarrassing to be wheezing and struggling to breath in front of their peer group. With this embarrassment can come the lack of using an inhaler and being physically active (if a trigger.)

Institutional/Organizational:

Various work settings can cause what is know was work related asthma. Work-related asthma accounts for at least 15% of all adult asthma. Work setting that have high exposure to an irritant can produce asthma related symptoms. Prevention is the best management technique for work related asthma. Limited exposure to high  irritant chemicals is essential for preventing work-related asthma. The job of preventing work-related asthma falls on the employees and the employers. According to The National Heart Lung and Blood Institution these are the steps for employers and employees to follow:

Employers

1. Adhere to federal health and safety guidelines. The Occupational Safety and Health Act (OSHA) of 1970 requires employers to provide workplaces free from recognized hazards. About half of U.S. states and territories also set their own standards under OSHA-approved state plans.
2. Institute programs to prevent occupational asthma by reducing exposure to allergens and irritants through elimination or substitution. Personal respiratory protective equipment can reduce the occurrence of occupational asthma but not completely prevent it.
3. Establish a surveillance program to identify affected workers early. Look for symptoms of asthma. Lung function tests and skin tests can help confirm the disease.
4. Train workers on potential workplace hazards, including precautions to take and mechanisms for reporting hazards or problems.
5. Eliminate smoking in the workplace. Offer benefits and smoking cessation programs to encourage employees to quit.

Employees

1. Avoid exposure to known environmental allergens or irritants.
2. Get help from a physician for breathing problems before they become permanent.
3. Report respiratory symptoms immediately as well as breakdowns in ventilation and other protective equipment to your employer. Your co-workers also may be at risk.
4. Take care of your asthma. See your physician regularly, take medications as directed, and avoid environmental exposures that worsen your asthma.
5. Avoid tobacco smoke. If you smoke, get help to quit.

There are several ways to get involved with this disease. You can become a part of an asthma support group, such as the Asthma and Allergy Foundation of America Educational Support Group. The AAFA has several different types of support groups for people with asthma. These types include parent groups, pre-teens and teen groups, and adult groups.

For more information on the support groups hosted by the AAFA you can visit http://www.aafa.org/esg_search.cfm#type (AAFA, 2008).

Another way to get involved with this disease is to make a donation in order to honor someone who suffers from asthma, to honor a person who suffered from asthma but has passed away, or to help further research on asthma. To make a donation you can visit http://www.aafa.org/display.cfm?id=10&sub=26&cont=385 (AAFA, 2008).

In addition to support groups and donations you can also volunteer to help support the cause. It is a way for you to raise awareness about asthma and a way for your voice to be heard.

If you have an interest in volunteering then please visit http://www.aafa.org/display.cfm?id=5&sub=76 (AAFA, 2008).

Community:

There are many ways to find out about financial services regarding asthma. One way is by visiting http://www.asthmafoundation.org.au/Financial_support.aspx which discusses different forms of financial services, including information on becoming a financial supporter, an asthma information line, and asthma assist information service (Asthma Foundation).

Facilities:As widely discussed with asthma it is very important that individuals with asthma recognize and avoid their personal triggers. Many possible triggers can be found indoors such as mold, pets, and chemical odors. With this knowledge it is important that thorough inspections are given in any facility that the individual who has asthma finds themselves spending amounts of time in.
Racial/Demographic:
In regards to asthma and the racial disparities of outcomes of the chronic disease African-American children demonstrate poorer clinical outcomes that any other racial group. Among children with asthma a higher level of quality of life is typical for the children who live in rural areas in comparison with those from cities.

Public Policy:
- The Crawford and Fisk power plants, two leading contributors of Air pollution in Chicago area combine for:230 lbs of mercury, 17,765 tons of sulfur dioxide and nitrogen oxide, 260,000 lbs of soot per year. All are known air pollutants that contribute to medical conditions like Asthma.

- In 1977 the Federal Clean Air act was established to combat environmental pollutants. But there are some loopholes for older power plants to still remain.

Some states such as Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wisconsin have all enacted statewide bans on smoking in enclosed public places (Wikipedia, 2010). As of right now Congress has not tried to enact a broad nationwide federal smoking ban in workplaces (Wikipedia, 2010). Smoking was banned on commercial passenger flights in 1998 in the US and in 1997 smoking was banned in all interior spaces leased, owned, or rented by the Executive Branch of the Federal Government (Wikipedia, 2010). By having these bans it makes it easier on the poeple who suffer from asthma because of the fact that one of the biggest triggers is indeed tobacco smoke. The government has also enacted clean air laws that regulate car emission and help decrease outdoor air pollution. State laws are also changing in order to allow kids that suffer from asthma to carry and self-administer lifesaving medications at school (AANMA, 2005). These are all wonderful laws, rules, rugulations, and mandates and they all greatly help asthma sufferers live better lives.

The American Lung Association (ALA) worked with partners to develop the National Asthma Public Policy Agenda to reduce the suffering and death from asthma. The ALA hope that groups and individuals who care about asthma will embrace the recommendations found in the Agenda and push to get them put in place nationwide.

National Asthma Public Policy Agenda
Health-Care:
1.All health-care systems, including public and private providers, purchasers and payers, should provide access to services and medications consistent with the National Asthma Education and Prevention Program (NAEPP) guidelines. 
The health-care needed is not provided to many people with asthma as a means of controlling it. Asthma is an individualized disease and each person needs a specific diagnosis and plan of attack in order to properly control their struggle with asthma. With that said each asthma patient should be given acces to adequate care, medications, and education.
2. Standardized national performance measures should be adopted for monitoring and evaluating asthma quality of care.
Monitoring performance measures will allow for the tracking of hopeful progress of asthma patients. In doing so not only will the patients be looked after but the quality of care for these patients will be studied.
3. Promote quality improvement activities and develop and disseminate tools that support achievement of performance goals. 
Support for these activities can help make sure the quality of care is at its best.
Homes:
1. Housing code ordinances should protect people with asthma against indoor air problems. Housing codes are an established tool that can and should be used to reduce asthma triggers in homes. However, these codes vary considerably in their requirements and are often underused.
2. Housing code enforcement should be strengthened to reduce prevalence of indoor air quality problems.  Unhealthy indoor air can be a threat to anyone at home, especially those with asthma. Reducing these risks can lead to better management of the disease.
3.  Multi-unit housing should be smoke-free. Second hand smoke is a threat for people with asthma and a serious indoor air pollutant that should be eliminated. Having smoke-free housing is an important step to help those with lung disease. (ALA)

   

References

AAFA. (2008, August). Asthma and Allergy Foundation of America - Information About Asthma, Allergies, Food Allergies and More! Retrieved November 11, 2010, from http://www.aafa.org/esg_search.cfm#type

AANMA. (2005, December 31). State Laws Allow Students To Carry Asthma, Anaphylaxis Medications, USA. Medical News Today: Health News. Retrieved November 11, 2010, from http://www.medicalnewstoday.com/articles/35559.php

American Lung Association (ALA) Asthma, Asthma-Friendly School Initiative, Asthma-Friendly School Initiative toolkit. November 2010 (http://www.lungusa.org/)

Asthma Foundation. (n.d.). Financial support | Asthma Foundation. Welcome to the Asthma Foundation. Retrieved November 12, 2010, from http://www.asthmafoundation.org.au/Financial_support.aspx

Asthma Inhalers : Asthma ... : Asthma Inhalers Photos, Wallpapers, Galleries. (n.d.). Explore Profiles and Express your Opinions on People, Places, Trends and Events. Retrieved November 11, 2010, from http://connect.in.com/asthma-inhalers/photos-1-1-1-73041662f7a452de0d127ae0b29adf8b.html

CDC - Asthma - Basic Information. (2009, October 20). Centers for Disease Control and Prevention. Retrieved November 11, 2010, from http://www.cdc.gov/asthma/faqs.htm

Children's Health Fund. (2010, May 13). Best Practice Asthma Program Saves the US Healthcare System More Than $4500 A Year Per Child | News | Mailman School of Public Health. Mailman School of Public Health - Columbia University. Retrieved November 11, 2010, from http://www.mailman.columbia.edu/news/best-practice-asthma-program-saves-us-healthcare-system-more-4500-year-child

Friedman, S. (2005, November 1). AAAAI - Patients & Consumers Center: November 2005: Keys to managing childhood asthma. AAAAI - American Academy of Allergy Asthma and Immunology - www.aaaai.org. Retrieved November 11, 2010, from http://www.aaaai.org/patients/topicofthemonth/1105/

National Heart Blood and Lung Institute (NHBLI). Employees, Employers, and Worksites. Nation Institutes of Health. U.S. Department of Health and Human Services. November 2010 (http://www.nhlbi.nih.gov/index.htm)

NHLBI. (n.d.). Learn about asthma attacks, symptoms, and treatment. NHLBI Healthy People 2010 Gateway. Retrieved November 11, 2010, from http://hp2010.nhlbihin.net/asthma/

Rachelefsky, G. (2006, July 20). Google Image Result for http://img.medscape.com/slide/migrated/editorial/cmecircle/2006/5606/images/rachelefsky/slide004.gif. Google. Retrieved November 12, 2010, from http://www.google.com/imgres?imgurl=http://img.medscape.com/slide/migrated/editorial/cmecircle/2006/

Wikipedia. (2010, November 12). List of smoking bans in the United States. Wikipedia, the free encyclopedia. Retrieved November 12, 2010, from http://en.wikipedia.org/wiki/List_of_smoking_bans_in_the_United_States

Yinusa-Nyahkoon, L., Cohn, E., Tickle-Degnen, L., Cortes, D., Lieu, T., & Bokhour, B. (2007). Examining routines to understand the ecological context: managing childhood asthma. OTJR: Occupation, Participation & Health, 2797S-99. Retrieved from CINAHL with Full Text database.