Comparing Management of Chronic Diseases

In the long-term treatment of asthma, the administration of inhaled corticosteroids is often useful in inhibiting the attacks from getting worse to the level of requiring emergency treatments. Among the various permanent treatment methods available for asthma, ICS has been proven to provide the best results in asthma patients regardless of age. It is the prevalent preliminary treatment approach for recurring asthma in juvenile patients. The first dosage of ICS-Rx can be considered as a preventive measure due to the fact that in the course of the therapy, it indicates a change in the level of disease acuteness, persistence of symptoms, and the setting off of a requirement for daily treatment of inflammation. Factors responsible for visits to the ED within a short while after the first administration of ICS-Rx include: recurrent contact with external triggering factors, inaccurate knowledge of the level of severity on the part of the parents, deferred treatment and use of drugs, or a combination of these factors (Rust et al., 2015).
In the enhancement of self-care within various cultural and ethnic societies, most of the investigative studies have been focused and directed on improving increasing the level of awareness and knowledge about diseases. Various factors that affect self-care include Culture, language, and lifestyle. How well a patient can understand, interpret, and apply doctors’ prescriptions and directives is dependent on the level of encouragement from family members and other cultural factors more than the previously mentioned factors like language aptitude, level of education, and social and economic standing (The New York Times, 2013).
COPD patients that have been diagnosed with an increased possibility of aggravated symptoms should be placed on a self-care therapy that ensures that they have the ability to detect recurrence of symptoms and seek/apply appropriate treatment, previous observed cases have shown that such self-care therapies tend to lower the worsening of the COPD cases and also reduce the requirements for hospital admission. Chronic Obstructive Pulmonary Disease (COPD) has often been treated with a continuing bronchodilator- the anticholinergic agent tiotropium bromide (Spiriva) (Bostock-Cox, 2014).
The diagnosis of COPD and asthma can often be impaired by medical problems with similar symptoms, significant among these are psychiatric sickness and cardiovascular disease. A crucial point to note here is that even despite the possibility of striking a proper balance between various conflicting factors, unidentified residual diseases may still not be taken into consideration and therefore influence the eventual diagnosis. Therefore, to prevent the interference of simultaneously occurring diseases, and to take them into consideration, it is advisable to utilize any of the standardized classification systems which have been incorporated into electronic databases for the International Classification of Diseases, Ninth Revision (ICD-9) or ICD, Tenth Revision (ICD-10) codes (McKeage, 2015).
Consequences of a psychological nature are often experienced in young asthma patients when medications are applied. For the treatment of bronchospasm in asthma patients, Albuterol- a temporary bronchodilator is often used. Two long-term adrenetgic agonists in use are Salmeterol and formoterol. In the continuous treatment of asthma, Formoterol is used as a bronchodilator. The use of Formoterol is associated with some psychological consequences such as sleeplessness, nervousness, tiredness, and hyperactivity. Salmeterol acts in almost the same way with the possibility of leading to sleeplessness, hyperactivity, and nervousness. Cardiovascular effects like spiking blood pressure, and high heart rates may often be set off by the release of monoamine oxidase inhibitors, and tricyclic antidepressants when the two bronchodilators- Salmeterol and Formoterol are used. A window period of two weeks after the conclusion of these therapies is advisable for health care providers before starting a therapy involving long-term beta agonists (Gullotta, Blau & Ramos, 2017).
Another inhaled corticosteroid utilized in the extended treatment of asthma is Beclomethasone. Beclomethasone was not found to be accompanied by any of the previously mentioned psychological consequences, it has also not been found to interact with drugs for the treatment of other psychological issues. Yet another inhaled corticosteroid for the extended treatment of recurring asthma is Budesonide. Unlike Beclomethasone however, Budesonide has been found to be accompanied by side effects (also psychological) such as nervousness, fatigue, and insomnia. Fluticasone (another inhaled corticosteroid) also has the same side effects as Budesonide. It should however be noted that interactions with other psychoactive drugs were not observed for both budesonide and fluticasone (Gullotta, Blau & Ramos, 2017). 
All around the world, COPD has been observed to be a significant effect of smoking. Contact with industrial pollutants in poorly aerated work places, smoke from high carbon cooking fuels (coal or firewood), and exhaust smoke from vehicles are also leading causes of COPD in third world countries. COPD is accompanied by depression, anxiety, and psychiatric disorder in about 50% of diagnosed patients, this is quite high when contrasted with the 31% of the general population who are similarly affected. Female COPD patients are more likely to experience psychological issues than men. COPD patients who go through depression and anxiety tend to respond less positively to treatment compared to those who don’t. Victims of COPD that experience depression on a scale that is between moderate and severe have a tendency to die three years earlier than patients with either mild depression or who are not depressed at all. The ability to make use of the mental faculties may be hampered due to low levels of oxygen, memory losses also occur as a result. COPD patients may also benefit from psychological therapy alongside their treatment (The New York Times, 2013).
Chronic sicknesses have been found to be caused by a large number of risk factors, however, these factors are responsible only for a tiny fraction of diseases. While the abuse of alcoholic substances have been observed to cause diseases on the world-wide scale, the effect of alcohol on sicknesses is not quite as simple as it appears. Factors influenced by the surroundings- air pollution for example play a major role in the onset of asthma and other serious respiratory illnesses. Some other risk factors include infectious agents that lead to cervical and liver cancers. Social, psychological, and genetic factors are also important (World Health Organization, 2010). COPD is majorly influenced by factors such as: working in an environment with a lot of dust and chemicals, the habit of cigarette smoking, age (above 40 years), air pollution within households.
Another demographic at a high risk of falling victim to COPD includes workers who experience exposure to industrial pollutants such as smoke and dust, and potentially poisonous chemicals like Silica or Cadmium (The New York Times, 2013).
So as to consider the several diseases which could possible occur concurrently and reduce the effectiveness of prescription, diagnosis and therapy, it could be helpful to apply a standard classification process which has been previously applied in electronic archives housing ICD (International Classification of Diseases) or Ninth Revision (ICD-9), ICD itself and the Tenth Revision (ICD-10) ciphers. Database versions like the Charlson-Deyo Index and the Charlson Comorbidity Index are popular for identifying and ranking important comorbidities, notwithstanding that the previous ranking methods have restrictions as changes have been carried out on the impact of diseases ever since the first edition went into print more than 20 years Ago. (Maple & Roberts, 2014).
More comorbidities are documented with the Elixhauser framework which has a software for the versions that are modified for database applications which are available to the public on the website for the USAHRQ (Agency for Healthcare Research and Quality). Some illnesses that deserve special attention (which often interfere with the diagnosis and treatment of COPD and asthma) like Cor pulmonale, gastroesophageal reflux, allergic rhinitis, obstructive sleep apnea, cardiac arrhythmias, and vascular disease are often left out by the standardized systems discussed previously. It is therefore expedient to augment the systems for the classification of comorbidities with other known respiratory conditions that have been identified with asthma and COPD which have the tendency to interfere with treatment outcomes (Mapel & Roberts, 2014).
The system of Noninvasive Positive Pressure Ventilation (NPPV) is used for patients who still have the ability to carry breathe, with oxygen been passed via a tube, pressure is kept on the airway with a closely fitting oxygen mask. NPPV has been proposed by a number of doctors as an initial treatment alongside the administration of drugs for the treatment of respiratory failure in the event of a serious aggravation of symptoms. The advantages of this system include the allowance for patients to communicate and ingest fluid as opposed to throat tubes and nose tubes. NPPV can however not be used on COPD patients who are in worsening conditions and are unresponsive, also, NPPV should not be used on patients who have a cranial and facial structure that does not allow oxygen masks to fit properly. (The New York Times, 2013).
For doctors who are exposed to financial risks while working with a management care agreement, Asthma can be quite cost intensive to treat. Therefore, in drawing up contracts for health care, asthma treatment costs should be exclusively considered and estimated. A possible ethical quandary arises when doctors stand to make monetary profits while providing reduced treatment on a management care agreement. The ethical quandary thus posed may easily be solved by recommending suitable procedures for the treatment of the disease. In the event where the management of health care organizations refuse to approve the required treatment, this chapter lists different existing medical care procedures. Patients with asthma (most importantly critical cases) are protected by law from job segregation under the Americans with Disabilities Act or the Federal Rehabilitation Act, these acts provide insurance for them despite the fact that divergent opinions still exist on the level of access to insurance (Gershwin & Albertson, 2011).
The application of mechanical ventilation to patients suffering from COPD often leads to an ethical quandary due to the nature of the disease as a progressive disorder accompanied by repeated cases of failure in breathing. It is quite amazing however that there have been no declarations by any professional organization about the ethics and morals surrounding this exclusive demographic of COPD patients. For a proper analysis of the advantages of mechanical ventilation in COPD patients, doctors need to evaluate the medical data from this group of patients. Various surveys within the last quarter of a century have suggested that a large proportion of COPD patients tend to stay alive for a period of time between 1 and 2 years following a respiratory failure that led to hospitalization which was serious enough to require a rigorous session of therapy. Furthermore, no surveys have been carried out to recognize patients for whom intubation is not an advantage. Before treatment choices are made about the withdrawal of aid for COPD and respiratory failure patients, discussions must be held and agreements reached between the doctors and their patients with the medical conditions and requirements of the patients taken into consideration. Armed with information about their diagnosis and medical condition, patients can plan and prepare wills and testaments for medical care which will influence and direct decisions relating to death. There are still many impedances for the implementation of prior instructions; doctors involved in providing care and treatment for COPD patients can help them surmount these impedances by providing advice and help that will guide patients in making medical choices (Heffner, 1996).


References
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Gershwin, M. E., & Albertson, T. E. (2011). Bronchial asthma: A guide for practical understanding and treatment. New York: Springer.
Gullotta, T. P., Blau, G. M., & Ramos, J. M. (2017). Handbook of childhood behavioral issues: evidence-based approaches to prevention and treatment. New York: Routledge, Taylor & Francis Group.
Heffner, J. E. (1996). Chronic Obstructive Pulmonary Disease: Ethical Considerations of Care. CLINICAL PULMONARY MEDICINE, 3, 1-8.
Mapel, D. W., & Roberts, M. H. (2014). Management of Asthma and Chronic Obstructive Pulmonary Disease with Combination Inhaled Corticosteroids and Long-Acting ?-Agonists: A Review of Comparative Effectiveness Research. Drugs, 74(7), 737–755. http://doi.org/10.1007/s40265-014-0214-8
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The New York Times. (2013). COPD In-Depth Report. Retrieved August 01, 2017, from http://www.nytimes.com/health/guides/disease/chronic-obstructive-pulmonary-disease/print.html
World Health Organization. (2010). Chronic diseases are the major cause of death and disability worldwide.