Asthma: Medical Aspects and Vocational Implication

In general, asthma starts out in childhood with 80 percent of cases being diagnosed by the age of 6. It is usually characterized by wheezing and coughing (especially at night) and is clinically diagnosed by pulmonary function testing. Females, those with allergies, those with a family history of allergies, people exposed to cigarette smoke, and those with poor intrinsic lung function are all more prone to the disease (Slaving & Reisman).

Some evidence has suggested that patients can "outgrow" the illness; however, it has been estimated that only about 20% of those childhood sufferers will indeed outgrow it. In one study that followed asthmatic patients for a mean period of 15 years, it was found that 76% of the patients were symptomatic as adults and 54% used asthma medications. The best predictor of the continuation into adulthood was the severity of the illness in childhood (Slavin & Reisman). Adult-onset asthma (after age 40) is also more common in females (Morris & Perkins, December 2004: Asthma).

Asthma is a costly illness. In 1998, 11.5 billion dollars was estimated to be spent on asthma. For children, it is the most prevalent cause for school absences, causing almost 10 million absences per year. Furthermore, it is the fourth leading reason for adults to miss work; almost nine million workdays are lost each year due to this illness.

MEDICAL ASPECTS

Asthma is a disease of the lungs, where airways can become temporarily constricted or blocked when a person encounters a trigger. This leads to shortness of breath, breathing trouble, and other symptoms. Most people have this tendency from infancy, and many are known to have allergic rhinitis, which means they are allergic to pollen, grass, molds, and other airborne particles (Asthma FAQs and Answers).

During an attack, the bronchioles and alveoli become narrowed or blocked. This can happen in three ways. Firstly, the muscles around the airways tighten, narrowing the passageway. Furthermore, this reaction causes fluid, blood, and irritating chemicals to enter the bronchioles; this causes the lining to become inflamed, further narrowing the passageway. Lastly, this inflammation causes mucous glands in the bronchioles to secrete more mucus than usual causing the airways to become plugged (The American Lung Association Asthma Advisory Group & Edelman, 1997).

In asthma patients, the airways are consistently inflamed. Therefore, asthma is not only an episodic illness, but also a chronic one. At any time, the airways can be irritated and constrict, causing an attack.

Common Triggers of an Attack (From Clinicians' Guide to Asthma)

· Allergens:

House dust mites-these creatures can be found on floors, in carpets, mattresses, and soft furnishings. They can irritate the bronchial tubes.

Pets-dander from the skin is carried in small respirable particles.

Fungi-present indoors and outdoors and have been associated with the risk of asthma deaths.

Cockroaches and mice-a large part of inner city asthma patients have positive allergy tests to cockroaches and mice urine.

· Pollen-particles of starch granules are released from pollen.

· Cold air

· Pollution

· Cigarette smoke

· Respiratory infections

· Influenza

· Stress

OCCUPATIONAL ASTHMA

It should also be noted that irritants in the workplace can cause asthma. Essentially, occupational asthma is the reversible narrowing of the airways caused by inhaling particles or vapors that cause irritation or allergic reactions from substances at a workplace. More than 250 chemicals and organic dusts have been identified as causes for this illness (Slavin & Reisman, 2002). Some examples of persons at risk for this condition are animal handlers and bakers. In situations such as these, the best treatment is to change professions. The illness is treated with the same types of medications (Beers (Ed.), 2003).TREATMENT

Asthma is a chronic illness with no cure; therefore, it is important to realize that a person can lead a normal life, with treatment. The most important factor for a person with asthma is to avoid triggers and manage their environment. Many medications and therapies can also be used to treat asthma. They are broadly grouped into quick relief and long-term control. It is also important to note that these treatments may cause some side effects.

Removing Factors that Trigger Asthma

The American Lung Association suggests that indoor air pollution should be reduced, by cleaning indoor air (as in an air purifier), ventilating buildings adequately, and limiting sources of pollution. Dusting and cleaning should be utilized to remove dust mites and other irritants. Persons with asthma should also take into consideration the chemicals in perfumes, cleaning solutions, and cooking devices (The American Lung Association Asthma Advisory Group & Edelman, 1997).

Persons with asthma may also be allergic to pet dander, so if there is a pet in the household, it may be best to place the pet in another home. Furthermore, persons with asthma should not smoke, nor be around those who do smoke. Exercise may induce an asthma attack in some individuals; however, it should not necessarily be avoided.

Long Term Medications

Generally, persons with asthma are placed on medication to relieve some of the inflammation of their airways and to reduce their sensitivity to triggers. These medications should relieve wheezing, coughing, and the number of attacks and allow a person to live an active life, if taken correctly. These medications are usually given in either an oral form or an inhaler (Asthma FAQs and Answers).

Oral corticosteroids are pills taken that reduce swelling in the airways and decrease mucus in the lungs. Often, these pills are prescribed for individuals with severe asthma for long-term therapy. Corticosteroids are also available in inhaler form. These medications may also be used in conjunction with others (Asthma FAQs and Answers).

Long-acting beta agonists are inhalers that are used to control daily symptoms. These drugs can be used for nighttime symptoms or to treat exercise-induced asthma. However, long-acting beta agonists should not be used to treat attacks or as a substitute for anti-inflammatory drugs (Asthma FAQs and Answers).

Leukotriene modifiers are tablets that have recently been introduced. They work to prevent inflammation and swelling in the airways, reduce mucus, and open airways. This medication is also for long-term control (Asthma FAQs and Answers).

Short-term Medications

Short-term medications are used to control the wheezing, tightness, and coughing of asthma attacks. These drugs are also available in both pill and inhaler forms. Asthma attacks are usually brought on by one of the triggers, which is why it is important to remove those triggers from the patient's environment (Asthma FAQs and Answers).

Short-acting bronchodilators offer quick relief by opening constricted airways by relaxing muscles in and around the lungs. Beta agonists are also available in short-term inhaler form, which relieve the symptoms quickly and may prevent asthma induced by exercise. A common beta agonist is Albuterol (Asthma FAQs and Answers).

Again, oral medications are also available for short-term treatment. Beta agonists are available in oral form as well, although they generally do cause more side effects than the inhaled form. This medication must stay at a steady level in the bloodstream to be effective, so blood tests are often performed regularly with this medication. Furthermore, this medication is often most effective when used with other treatments (Asthma FAQs and Answers).

Most individuals with asthma will use medication throughout their lifetime. Medications may vary from time to time, and they may develop a resistance to some drugs. The most important factor in using these drugs is to not overuse them. Overuse over a long period can have serious effects (Asthma FAQs and Answers).

Alternative Therapies

Although most asthma cases are treated using medication, some alternatives are available. Lifestyle changes, biofeedback and stress reduction, and acupuncture are all possible alternatives. It is most important to remember though, that these should not take the place of a doctor's care (Asthma FAQs and Answers). SOCIAL IMPLICATIONS

Many individuals with mild asthma will not have any hindrance in their daily lives. However, those with more severe asthma may need to make some accommodations. An example of this would be, instead of avoiding a department store, the individual could be sure to walk a safe distance away from a perfume counter to avoid a trigger. It is important for the individual with asthma to realize that with reasonable accommodations, they can have an active, normal social life (Freedman, Rosenburg, & Divino, 1998).

Additionally, individuals with asthma may be hesitant to participate in exercise. It can limit physical activities, thus reducing social opportunities. Fear and panic are also often experience during attacks, so individuals (especially those diagnosed in childhood) may have social adjustment issues (Medical and Psychosocial Aspects of Chronic Illness and Disability). However, it is has been shown that exercise is actually very helpful, since it increases lung capacity and makes a person generally healthy. Again, certain accommodations such as inhalers must be used in these circumstances (Freedman, Rosenburg, & Divino, 1998).PERSONAL AND FAMILIAL IMPLICATIONS

Individuals with asthma may also need to make accommodations within their homes to relieve triggers. However, these decisions should be made as a family. The individual's illness should be evaluated and triggers removed as necessary. In example, a person who is not allergic to pets does not need to remove all pets from the home. Creative solutions can make the entire family happy, such as restricting a pet as an outdoor pet or to a particular section of the house, if possible (Freedman, Rosenburg, & Divino, 1998).

Additionally, members of the family should be educated on the illness, and what to do in an emergency. Children should know the appropriate emergency contacts if the individual has an asthma attack. Older children may be instructed on where medication is kept. Furthermore, if the individual with asthma is a child, their friends and friends' parents should be educated on how to handle emergencies (Freedman, Rosenburg, & Divino, 1998).

VOCATIONAL REHABILITATION

Individuals with asthma can be productive workers, with or without accommodations. Employers and employees should be educated on the illness and how to handle emergencies. It may also be necessary for the workplace to be modified for the individual with asthma. For instance, the individual with asthma may need a workstation free of dust, or may need to be seated away from individuals wearing perfumes. It should be noted though, that some individuals with asthma may not need any accommodations.

Individuals with asthma may need the assistance of a vocational rehabilitation counselor in developing appropriate career goals. In some situations, the individual with asthma may need to change jobs or accommodations to keep their current job. Rehabilitation counselors, physicians, and the individual should work together to determine what types of work would be most appropriate.

In example, if vigorous activity triggers an attack, the individual may need employment at a slower pace. Furthermore, if stress is a major trigger, the individual may not be a good fit for a high stress job with major deadlines (Wray, 1998). Individuals with asthma may not be appropriate candidates for janitorial positions where strong chemicals are used for cleaning.

Once a goal is determined, accommodations in the workplace should be considered. Some examples of accommodations may be to install an air purifier in the individual's workplace, or working a part-time shift instead of full-time if the individual's condition causes them to miss work often. Often, these individuals are more prone to opportunistic diseases, which could require extensive sick leave. Additionally, individuals with asthma should always use the proper safety gear provided, such as masks and goggles (Wray, 1998). Accommodations for individuals with asthma often are healthier for the entire group.

Those persons with asthma can lead normal, productive lives. Many of these individuals may not even need the services of rehabilitation. Each individual is different, so the counselor must tailor the plan to reach his or her goals. In conclusion, individuals with asthma may need accommodations, but they are often healthier for the entire work environment. Individuals with asthma should be very successful candidates for vocational rehabilitation.

REFERENCES

The American Lung Association Asthma Advisory Group & Norman Edelman, M.D. (1997). Family Guide to Asthma and Allergies: How you and Your Children Can Breathe Easier. Boston: Little, Brown, and Company.

Asthma FAQs and Answers. Retrieved December 9, 2004 from http://www.aafa.org/templ/display.cfm?id=2&sub=29

Beers, M. (Ed.) (2003). The Merck Manual of Medical Information (Second Home Editions, ed.). Whitehouse Station, NJ: Merck Research Laboratories. (Original work published 1997).

Bernstein, I. Leonard; Chan-Yeung, Moira; Malo, Jean-Luc; &David I. Bernstein (1999). Asthma in the Workplace. New York: Marcel Dekker, Inc.

Chung, Kian Fan, M.D. (2002). Clinicians' Guide to Asthma. London: Arnold.

Falvo, D. (1999). Medical and Psychosocial Aspects of Chronic Illness and Disability (second ed). Gaithersburg, MD: Aspen Publishers.

Freedman, Michael R., Rosenburg, Samuel J., & Cynthia Divino (1998). Living Well with Asthma. New York: The Guildford Press.

Morris, Michael J. & Patrick Perkins (December 2004). Asthma. Retrieved December 9, 2004 from http://www.emedicine.com/med/topic177.htm

Slavin, Raymond G., M.D. & Robert E. Reisman, M.D. (2002). Asthma. Philadelphia: American College of Physicians.

Wray, Betty B., M.D. (1998). Taking Charge of Asthma: A Lifetime Strategy. New York: John Riley & Songs, Inc.