Asthma is regarded of the commonest chronic childhood diseases in developed nations. Notably, the incidence of the disease has risen the world over during the last two and half decades. The objective of this essay is to report the pathophysiology of the disease through synthesizing literature on the same. The author appraises three studies and reports that the disease is characterized by inflammation and remodeling of the airways in patients suffering from the condition. The paper also reports that several genetic and environmental factors could have a contributing role in the development of the different phenotypes of the condition. The practice guidelines that are included in this paper inform the ethical practice for nurses in the provision of care to patients who experience the condition, including the need to provide patient-based care.
The Purpose, Methodology and Findings of the Three Studies
Bonsignore, Profita, Gagliardo, Riccobono, Chiappara, Pace, and Gjomarkaj (2015). Advances in asthma pathophysiology: stepping forward from the Maurizio Vignola experience. European Respiratory Review , 24 (135), 30-39.
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The authors of the this study summarized the latest works on several topics in the study of asthma, including the biology of asthma as it is currently known and other clinical aspects of the disease. Their work is a continuation of Maurizio Vignola whom they identify as having pioneered research on the topic of asthma. They adopted a qualitative methodology in their research, in which they described the ailment in detail. The researchers found and reported significant levels of progress in the comprehension of asthma over the last ten years from the time of their publication. Precisely, the paper reported increased knowledge concerning the complex interactions between remodeling and inflammatory pathways, improved levels of recognition of the clinical and biological asthma phenotypes and the creation of new strategies of treating asthma, especially among patients with severe asthma.
Kudo, Ishigatsubo, and Aoki. (2013). Pathology of asthma. Frontiers in microbiology , 4 , 263.
The authors of the study adopt a descriptive qualitative methodology in explaining the pathophysiology of asthma. While the study does not describe a direct objective that the others sought to accomplish, it explains the pathophysiology of the disease at length, including the histopathology of asthmatic airways, airway epithelium, and other elements that characterize the disease. Since the paper does not have a set objective, there are no other findings that the author report apart from the detailed pathophysiology of asthma.
Melen and Pershagen. (2012). Pathophysiology of asthma: lessons from genetic research with particular focus on severe asthma. Journal of internal medicine , 272 (2), 108-120.
Using a descriptive qualitative methodology, the authors of the study discuss recent—recent is relative to the time of the study—findings from genomic and genetic research on asthma, especially severe asthma. The study also purposed to highlight specific genes that have multiple evidence lines for their involvement in the pathogenesis of the ailment. The article reports that bio-ontological enrichment analysis suggest attributes, such as signal and molecular transducer activity and immune system processes that suggest the critical role that immunoregulation and inflammatory responses play in the pathogenesis of the disease. The authors also discuss the several ways in which environmental and genetic factors jointly affect the susceptibility of people to asthma. The summarized findings, the authors suggest, contributes to increased understanding of the pathophysiology of asthma related ailments.
The Ethical Efforts Made by the Authors of the Three Studies
When researching using human samples, it is always required that researchers stick to specific codes of ethics that would promote the wellbeing of the researchers and their respondents alike. However, the appraised studies did not use any respondents since they were descriptive secondary studies that drew from the findings of other researchers. Consequently, the authors were not obliged to report any steps that they took to ensure that they conducted their researches in an ethical way, which is why none of them reported their ethical considerations.
Comparing and Contrasting the Primary Findings of the Three Studies
Much as the studies appraised different research work, they report a common idea about the pathophysiology of asthma. Precisely, the authors acknowledged the fact that asthma is a serious socioeconomic and health issue the world over since it affects more than three hundred million persons globally. They also noted that the disease is perceived as an inflammatory infection in the airway that results in the hypersensitivity of the airway, its obstruction, mucus hyper-production as well as the remodeling of the airways. Furthermore, the studies indicate that the presence of inflammations of the airway in people suffering from asthma was not discovered until the 19 th century, and that since then, information on the pathophysiology of the disease has continued rising around the world. The growth in the levels if information concerning patients living with asthma has been associated with a change in the molecular biology and immunology paradigm that has led to an extensive study of the inflammatory cells and mediators that are involved in the pathophysiology of asthma. Furthermore, the studies unanimously report remodeling the airway into detail, which is always characterized by the thickening of the airways, could be among the most profound consequences on the airway narrowing mechanics, which is one of the reasons why the disease progresses rapidly in some patients.
The cited studies are also consistent in the manner they report on the epithelial to mesenchymal transition. Precisely, the authors argue that the transition plays a critical role in the remodeling of the airway among patients suffering from asthma. They report that the mesenchymal and epithelial cells bolster the persistence of inflammatory infiltration in addition to inducing histological transformations in the walls of the airways among patients. Consequently, the occurrences raises the thickness of the basement membranes, deposition of collagen, and hyperplasia and hypertrophy of the smooth muscles that line the airway. Originating from the inflammation of the airway, the researchers report that remodeling results in the thickening of the walls of the airway in addition to inducing the smooth muscle mass of the airways that produce asthmatic symptoms. Clinically, the studies suggest that asthma is classified a typical Th2 ailment that is characterized by increased IgE levels as well as eosinophilic inflammations of the airway. The studies also report that emerging Th2 cytokines results in the modulation of the inflammation of the airway that often leads to remodeling.
While the studies have the reported similarity in their findings, they are different for the fact that they covered different topics about the disease. The most notable difference among the findings of the studies is that Melen and Pershagen (2012) dealt a great deal on the biological and environmental factors that affect the development of asthma. They report that asthma is a complex ailment whose risk factors range from environmental to genetic ones. Precisely, the authors suggest that the ailment is caused by a collection of interacting genes, some of which have protective effects while others contribute to the pathogenesis of the condition, with each of the genes have its own propensity to be affected by the environment. The researchers argue that studies on twins, family histories, and familial aggregation and segregation in relation to asthma indicate convincingly that the disease has significant genetic components. They suggest further that a heterogeneous condition of the disease could predominate in varied geographical locations, and is robustly affected by environmental factors, which could differ among populations as well as in people with different ages.
The most interesting finding related to the biology of the disease is the argument that the risk of developing asthma is greatest when the genetic and environmental factors aggregate or when they are present simultaneously. Melen and Pershagen (2012) further report that the inheritance of the disease does not happen in the classic Mendelian inheritance patterns. Nevertheless, as the authors note, rarely monogenic occurrences of atopic condition have been reported, and in this case, a significant proportion of the atopic asthma is most probably a result of many interacting environmental and genetic factors.
The studies also differed in their findings on the fact that one of them, Bonsignore et al. (2015) appraised literature on the phenotypes of the disease under study. Precisely, the study suggested that presently, the categorization of asthma based on the cluster analyses through objectively grasping the diversities in the pathology of the disease is being undertaken, which has resulted in the naming of the diversity of asthma as phenotypes. They noted further that on clinical basis, the categorization of asthma is founded on allergic and aging diathesis that is clinically useful. Nevertheless, the researchers suggest that up to the time of the article, it has not yet come to a point of selecting the diversity of asthma according to its phenotypes.
Integration of the Findings and How They Affect Asthma
The findings of the three studies are useful in three ways. The most important aspect of the findings is their likely contribution to the comprehension of the pathophysiology of the disease. According to Dimsdale and Dantzer (2007), pathophysiology is one of the most useful ways in which researchers study the prognosis of disease as well as develop therapies that could be applied in the management of the condition. The studies have consistently reported the idea that asthma is characterized by inflammation and remodeling of the airway in patients living with the condition. The knowledge on the biology of the disease, consequently could be applied in developing medication and preventive therapies that would decelerate the transition of asthma from mild to severe conditions.
The second way in which the primary findings of the studies appraised in this paper is the fact that they inform the risk factors for the condition. The information in this case could be useful for counselling and occupational therapists who would be concerned with guiding patients concerning the likelihood of the disease occurring in their families. For example, while some people would have thought that asthma has little genetic connections, the findings of the studies suggest that the disease could be inherited down the family pedigrees. Consequently, the information could be applied in screening individuals for the possibilities of them developing the condition in the future. Lastly, the findings of the studies suggest the fact that because asthma could be having different phenotypes, different approaches could be applied in the development of the relevant therapies designed in the management of the condition, such as when the asthma has mild or severe symptoms.
Identification of Clinical Practice Guidelines in the Management of Asthma
According to Myers (2018), New Zealand and Australia were the first nations to publish clinical practice guidelines that would be applied in the management of asthma about forty decades ago. The same study notes that at around the same time, Scottish and British group collaborated to develop the UK version of the same guidelines. Shortly after the creation of the Canadian and New Zealand guidelines, the US created its own version of the same that were first published in the 90s (Myers, 2018). The early guidelines in the management of the disease in clinical settings were vital in the creation of treatment strategies that would infuse new findings into the management of the condition. For the objectives of this paper, the American (EPR-3), UK, and Australian guidelines would be reviewed.
Comparing and Contrasting the Three Clinical Guidelines
The three clinical practice guidelines in the management of asthma are similar in the fact that they share a hierarchal component, which is the fact that randomized clinical trials are always perceived as the highest evidence levels, and expert opinions are always graded the lowest. The guidelines also direct that physicians and other persons concerned with the management of asthmatic patients conduct a frequent assessment of the severity of the condition, use medications optimally, help the patients in avoiding the triggers for asthma, and educate the patients adequately about the disease, including its prognosis. Although the common goal of the guidelines is to better the quality of life of patients suffering from the ailment, they differ in the number of recommended steps that physicians should take while handling patients. For example, while the Australian guidelines have six steps, the American one has four, and the UK one has seven. Notably, the number of steps recommended in each of the guidelines is always subject to change as new evidence emerges, which is why each of the cited guidelines has a period after which they are updated.
Critique of Evidence that Founds Each of the Guidelines
The principles of asthma management guidelines are informed by research. It has already been mentioned that each of the guidelines categorizes randomized clinical trials as the highest levels of evidence and expert opinions as the lowest. Nevertheless, there are limitations associated with the use of evidence-based guidelines. For example, according to Myers (2018), randomized clinical trials are always developed in such a way that they maximize internal validity while minimizing confounding variables in controlled populations and settings, which implies that they are not always concerned with external validity of the findings to the whole population. This finding suggests that the variations between the homogeneity of the trial populations and the general one may limit the generalizability of the findings of randomized clinical trials as evidence. Consequently, while evidence-based guidelines are preferred, their applicability to the whole population raises concerns of their validity.
Integration of the Clinical Guidelines and how they affect Ethical Practice in Nursing
The identified clinical practice guidelines suggest the idea that the approaches to management of asthma varies according to geographies, especially by country. Consequently, they indicate that nurses should always give clinical services according to the set standards of practice in their regions. The guidelines also direct physicians and nurses to give the best levels of care to their patients, which is why it would be unethical for nurses to offer care that does not focus on the needs of their patients.
References
Bonsignore, M. R., Profita, M., Gagliardo, R., Riccobono, L., Chiappara, G., Pace, E., & Gjomarkaj, M. (2015). Advances in asthma pathophysiology: stepping forward from the Maurizio Vignola experience. European Respiratory Review , 24 (135), 30-39.
Dimsdale, J. E., & Dantzer, R. (2007). A biological substrate for somatoform disorders: importance of pathophysiology. Psychosomatic medicine , 69 (9), 850.
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology , 4 , 263.
Melen, E., & Pershagen, G. (2012). Pathophysiology of asthma: lessons from genetic research with particular focus on severe asthma. Journal of internal medicine , 272 (2), 108-120.
Myers, T. R. (2018). Guidelines for asthma management: a review and comparison of 5 current guidelines. Respiratory care , 53 (6), 751-769.
