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Asthma is a chronic disease that impacts more than 300 million people around the world. There is evident heterogeneity in the pathogenesis of asthma in the phenotypes of visible traits and endotypes of molecular mechanisms. Asthma is directly correlated with immune system activation as well as airway hyperresponsiveness (AHR), mucus overproduction, and epithelial cell activation. Innate and adaptive types of immunity are active in immunological responses to asthma. There are two major groups of asthma. Type 2 asthma is characterized by esosinophilia and compromises type 2 T helper cells, lymphoid cells, and IgE-secreting B cells. Meanwhile, non-type 2 asthma is characterized by heterogeneous endotypes and phenotypes such as exercise and obesity-induced asthma (Boonpiyathad et al., 2019).
Asthma is seeing an increased prevalence, incidence, and subsequently mortality worldwide. Asthma not only has a genetic origin but can be the effect of various environmental and lifestyle-associated risk factors. There are approximately 180,000 asthma-related deaths each year. Meanwhile asthma healthcare costs vary internationally, being $1,900 in Europe and $3,100 in the U.S. However, many countries are not seeing asthma as healthcare priority due to its non-communicable nature, and its having a tremendous social and economic burden (Nunes et al., 2017).
Interleukin5 (IL5) is the primary cytokine involved in activating the eosinophils, creating the inflammation which defines asthma. One of the primary developed treatments are monoclonal antibodies which target IL-5 and its receptor. The majority of studies of anti-IL5 treatments showed clinically significant reduced rates of asthma exacerbation in half of severe asthma patients. Even non-eosinophilic patients saw improvements and reduction in exacerbation rates when treated with benralizumab (Farne et al., 2017).
Uncontrolled asthma is associated with aspects such as smoking, a lower educational level, use of reliever treatment, and acute healthcare visits. Poor adherence to asthma treatment is the primary reason to decrease asthma control and healthcare visits (Selberg et al., 2019). One nursing intervention that has shown to be moderately effective is the use of patient education to teach inhaler techniques. The majority of interventions of this type in a meta-analysis demonstrated a 95% improvement in inhaler technique use, which is likely to prevent exacerbations of asthma. However, notably this intervention may require follow ups, and is more effective in adults while in children, the knowledge of the technique may wane over time. However, on the short-term educational interventions are highly effective and clinically relevant while being cost-effective (Klijn et al., 2017).
References
Boonpiyathad, T., Sözener, Z. C., Satitsuksanoa, P., & Akdis, C. A. (2019). Immunologic mechanisms in asthma. Seminars in Immunology, 46, 101333.
Farne, H. A., Wilson, A., Powell, C., Bax, L., & Milan, S. J. (2017). Anti-IL5 therapies for asthma. Cochrane Database of Systematic Reviews. Web.
Klijn, S. L., Hiligsmann, M., Evers, S. M. A. A., Román-RodrÃguez, M., van der Molen, T., & van Boven, J. F. M. (2017). Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: A systematic review. NPJ Primary Care Respiratory Medicine, 27(1).
Nunes, C., Pereira, A. M., & Morais-Almeida, M. (2017). Asthma costs and social impact. Asthma Research and Practice, 3(1).
Selberg, S., Hedman, L., Jansson, S., Backman, H., & Stridsman, C. (2019). Asthma control and acute healthcare visits among young adults with asthmaA populationbased study. Journal of Advanced Nursing, 75(12), 35253534.
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