Can Self-Efficacy Improve Your Asthma Symptoms?



What is Asthma?

 Asthma is an airway disease that manifests through chronic inflammation. The airway hyperresponsiveness in asthma patients occurs under the impact of various triggers including exercise, allergens, and viruses (Quirt et al., 2018). The airspace narrowing leads to the development of respiratory symptoms including coughing, chest tightness, breathlessness/shortness of breath, and wheezing. The reversibility of airflow obstruction in asthma patients is either spontaneous or based on the administration of fast-acting bronchodilators. Asthma exacerbation progresses through acute wheezes that lead to life-threatening respiratory complications if left untreated. Asthma of childhood often associates with hay fever, eczema, or atopy. Asthma not only elevates health care costs but also increases the risk of multiple hospital admissions (Hashmi, Tariq, & Cataletto, 2020). 
What are the Various Types of Asthma?
Asthma is categorized into the following phenotypes. 
1.     Severe asthma 
2.     Asthma in aged/elderly people 
3.     Occupational asthma 
4.     Obesity asthma 
5.     Asthma associated with fixed airflow obstruction 
6.     Late-onset asthma 
7.     Recurrent obstructive bronchitis or pediatric asthma 
8.     Nonallergic asthma 
9.     Allergic asthma 
What are the Differential Diagnoses Associated with Asthma?
The physicians require to rule out the following conditions during asthma assessment (Horak et al., 2016). 
1.     Central airway obstruction 
2.     Pulmonary embolism 
3.     Parenchymatous lung disease 
4.     Drug-related cough 
5.     Left ventricular heart failure 
6.     COPD (Chronic Obstructive Pulmonary Disease)
7.     Alpha-1 antitrypsin deficiency 
8.     Hyperventilation 
9.     VCD (Vocal Cord Dysfunction) 
10.  Bronchiectasis 
11.  Chronic cough 
12.  Cystic fibrosis 
13.  Congenital heart defects 
14.  Foreign body aspiration 
15.  BPD (Borderline Personality Disorder) 
16.  PCD (Primary Ciliary Dyskinesia) 
17.  Immunodeficiency 
18.  Protracted bacterial bronchitis 
19.  Tuberculosis 
20.  Congenital malformations, including vascular ring and tracheomalacia 
21.  Gastroesophageal reflux
22.  Recurrent viral infections 
What Causes Asthma?
The below-mentioned outdoor and indoor pollutants/allergens elevate the risk of asthma in predisposed or high-risk individuals (Chabra & Gupta, 2020). 
1.     Waste materials from combustion devices 
2.     High ozone levels 
3.     Fumes containing various pollutants 
4.     Irritant chemicals 
5.     Smoking 
6.     Smog 
7.     Biological allergens, including mold, animal dander, cockroaches, and dust mites 
8.     Excessive physical activity or exercise 
9.     Humidity 
10.  Temperature changes 
11.  Flu, cold, sinusitis, and other respiratory infections 
12.  Pollens and spores 
What is the Pathophysiology of Asthma?
The reversible respiratory manifestations of asthma rely on the following pathophysiological mechanisms (Hashmi, Tariq, & Cataletto, 2020) (Bush, 2019). 
1.     Elevation in airway mucus/inflammation due to bronchial hypersensitivity 
2.     A remarkable elevation in airway resistance 
3.     Smooth muscle contraction 
4.     Mucus plug formation and hypersecretion 
5.     Inflammatory cell infiltration 
The irreversible asthma complications reciprocate with the development of the following conditions. 
1.     Epithelial desquamation 
2.     Collagen deposition 
3.     Basement membrane thickening 
4.     Smooth muscle hyperplasia/hypertrophy
5.     Airway remodeling 
6.     Impaired lung growth trajectories 
The asthma progression mechanism is based on the following processes (Sinyor & Perez, 2020). 
1.     The early phase of asthma exacerbation begins with the triggering of plasma cell-based IgE antibodies. 
2.     The accumulation of IgE antibodies in asthma patients occurs under the influence of environmental triggers and genetic factors.  
3.     The basophils and mast cells effectively bind with IgE antibodies. 
4.     The exposure of asthma patients to various environmental triggers or pollutants leads to the degranulation of mast cells. 
5.     The mast cells eventually release cytokines, leukotrienes, prostaglandins, and histamine. 
6.     The release of toxicities under the influence of environmental triggers leads to airway tightening based on smooth muscle contraction. 
7.     The production of GM-CSF and interleukins (IL-13, IL-5, and IL-4) occurs under the impact of Th2 lymphocytes that eventually leads to respiratory passage inflammation.      
8.     The survival of basophils and eosinophils occurs under the impact of IL-5 and IL-3. 
9.     The development of hyperplasia, fibrosis, and remodeling occurs under the influence of IL-13. 
10.  The late phase of asthma exacerbation manifests through the localization of memory T-cells, helper cells, neutrophils, basophils, and eosinophils across the lung surface, thereby leading to inflammation and bronchoconstriction.
11.  The transport of late-phase reactants to the inflamed locations occurs under the impact of mast cells. 
12.  The intensity of airway inflammation and bronchoconstriction determines asthma severity. 
13.  The narrowing and thickness of airways determine the overall asthma duration. 
14.  The increased breathing work reciprocates with intermittent flow obstruction. 
15.  The exaggerated bronchoconstrictor responses to various environmental triggers lead to airway hyperresponsiveness in asthma patients. 
16.  The respiratory manifestations of asthma progress under the influence of elevated airway smooth muscle mass and histamine production (from mast cells). 
17.  The increased contractility of airway smooth muscle cells occurs under the influence of intracellular free calcium elevation and vagal tone. 
18.  The extent of lung function decline determines the intensity of asthma exacerbation. 
19.  The breathing difficulty of asthma patients increases under the impact of bronchiolar mucus, exudate, granular white blood cell accumulation, and airway inflammation.     
20.  The collagen deposition in airways occurs due to increased myofibroblasts that lead to epithelium elevation and narrowing of lamina reticularis/smooth muscle layer. 
21.  The basement membrane thickening could lead to irreversible airflow obstruction under the impact of airway remodeling. 
What are the Diagnostic Approaches for Asthma Evaluation?
The following clinical methods assist in diagnosing asthma and its complications (Saglani & Menzie-Gow, 2019) (Lab Tests Online, 2020). 
1.     The elevated fraction of nitric oxide in exhaled air indicates a marked increase in eosinophilic-mediated airway inflammation. 
2.     The complete physical examination and review of symptoms are paramount to the assessment of asthma signs and symptoms. 
3.     The assessment of blood eosinophil count helps in diagnosing asthma among children. Eosinophilia in children is indicated by the eosinophil count of greater than 500. 
4.     Spirometry assists in evaluating pulmonary function based on FEV1 (Forced Expiratory Volume in One Second). FEV1/FVC value of less than seventy-percent indicates airflow obstruction.  
5.     A chest x-ray helps to rule out structural and functional abnormalities in the lungs.  
6.     IgE assessment also helps to evaluate asthma development. 
7.     Sputum culture helps in ruling out pulmonary infections. 
8.     Sputum cytology helps to determine the extent of airway inflammation. 
9.     The organ function assessment of asthma patients relies on a comprehensive metabolic panel. 
10.  Complete Blood Count (CBC) helps to evaluate inflammation and infection in asthma patients. 
11.  The assessment of arterial blood gases helps to evaluate the levels of carbon dioxide, oxygen, and blood pH. 
12.  Allergic sensitivity testing helps to evaluate the impact of asthma triggers, including pollens, pet dander, mold, mites, and dust.     
The Asthma Control Cycle 
Evidence-based clinical literature documents the following asthma control measures based on the review of symptoms/lung function, diagnostic assessment, and medication adjustment (Horak et al., 2016). 
1.     The asthma review process relies on the systematic evaluation of symptoms, respiratory exacerbation patterns, medication side effects, patient satisfaction, and lung function. 
2.     The assessment is based on the meaningful evaluation of asthma diagnosis, risk factors, medication inhalation compliance, and patient preference. 
3.     The adjustment of asthma medications, non-pharmacological interventions, and modifiable risk factors is highly necessary to reduce the frequency of asthma attacks. 
4.     Inhalation therapy is the first-line treatment for asthma management. This treatment method is increasingly used by asthma patients based on high tolerance and limited side effects. 
5.     The regular intake of controller medication not only minimizes inflammation and respiratory symptoms but also reduces the risk of exacerbations. 
6.     The controller medications include methylxanthines, long-acting anticholinergics, leukotriene receptor agonists, long-acting beta-2-agonists, and inhaled corticosteroids. 
7.     The reliever medications include short-acting anticholinergics and short-acting beta-2 agonists. 
8.     Add-on therapy includes phenotype-oriented medications, anti-IL5 therapy, oral/systemic corticosteroids, and anti-IgE therapy.   
What are the Non-Pharmacological Asthma Management Options?
You may opt from the following list of physical activities and dietary interventions for managing your asthma exacerbations. However, the careful selection of the prevention strategies undoubtedly warrants medical supervision. 
1.     Water-based activities 
2.     Swimming 
3.     Inspiratory muscles training 
4.     Breathing exercises 
5.     Physical activity 
6.     Vitamin E/C Supplementation 
7.     Selenium-enriched diet 
8.     A diet based on marine fatty acid 
9.     A diet with reduced monosodium glutamate 
10.  Low-salt diet 
11.  Elevated caffeine intake 
What is the Role of Self-Efficacy in Asthma Improvement?
Self-efficacy improvement is the preliminary requirement for the systematic management of asthma symptoms (Mancuso, Sayles, & Allegrante, 2010). Greater awareness of asthma causes, pathophysiology, treatment requirements, compliance measures, medication dosages, and therapeutic outcomes potentially assists asthma patients to effectively control their respiratory complications. An improved self-efficacy not only reduces asthma exacerbations but also helps to prevent asthma-related comorbidities. Some of the tested self-efficacy improvement measures for asthma patients are listed below.  
1.     Increased socialization is the need of the hour for reducing the risk of asthma-related depression. 
2.     Asthma patients need to improve their knowledge of environmental triggers that cause respiratory exacerbations. They must take necessary dietary precautions, physical activity measures, and other safeguards for reducing their health adversities based on weather variations, pollution, upper respiratory infections, allergies, and stress. 
3.     The thorough knowledge of asthma medications and their adverse effects is highly needed to reduce the frequency of asthma attacks. The asthma patients require managing the appropriate stack of medicines and carry the steroid inhalers to manage their respiratory stress. 
4.     Asthma patients need to improve their knowledge of their perceived health care outcomes.   
5.     The acquisition of regular feedback from physicians and caretakers also proves helpful in managing the stressful complications of asthma exacerbations. 
6.   The establishment of favorable expectations and high motivation are paramount to reducing the frequency of asthma attacks.

References

Bush, A. (2019). Pathophysiological Mechanisms of Asthma. Frontiers in Pediatrics. doi:10.3389/fped.2019.00068
Chabra, R., & Gupta, M. (2020). Allergic And Environmental Induced Asthma. In StatPearls. Treasure Island (Florida): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526018/
Hashmi, M. F., Tariq, M., & Cataletto, M. E. (2020). Asthma. In StatPearls. Treasure Island (Florida): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430901/
Horak, F., Doberer, D., Eber , E., Horak, E., Pohl, W., Riedler, J., . . . Studnicka, M. (2016). Diagnosis and management of asthma – Statement on the 2015 GINA Guidelines. Wiener Kilinsche Wochenschrift, 541-554. doi:10.1007/s00508-016-1019-4
Lab Tests Online. (2020). Asthma. Retrieved from https://labtestsonline.org/conditions/asthma#
Mancuso, C. A., Sayles, W., & Allegrante, J. P. (2010). Knowledge, Attitude and Self-Efficacy in Asthma Self-Management and Quality of Life. Journal of Asthma, 47(8), 883-888. doi:10.3109/02770903.2010.492540
Quirt, J., Hildebrand , K. J., Mazza, J., Noya , F., & Kim, H. (2018). Asthma. Allergy, Asthma, and Clincal Immunology, 14(2). doi:10.1186/s13223-018-0279-0
Saglani, S., & Menzie-Gow, A. N. (2019). Approaches to Asthma Diagnosis in Children and Adults. Frontiers in Pediatrics, 7(148). doi:10.3389/fped.2019.00148
Sinyor, B., & Perez, L. C. (2020). Pathophysiology Of Asthma. In StatPearls. Treasure Island (Florida): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551579/



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