Nursing Interventions to Prevent Asthma Hospitalizations

Introduction: Asthma as a Chronic Condition

Asthma is a common chronic disorder of the airways that results in recurrent attacks of breathlessness, generally accompanied by wheezing, chest tightness, and cough. It predominantly affects five percent of the adult population and ten to fifteen percent of children (Anadarajah, 2000).

In the medical profession, nurses are often charged with the intervention and education of their patients. People who have asthma frequently look for ways to avoid hospitalization. Being hospitalized can interfere with school schedules, work schedules, and other life events. Asthma is a chronic condition, and without proper care and treatment, patients can begin to feel trapped in a revolving-door cycle of attacks and hospitalizations. Nurses who specialize in the treatment of asthma patients can provide educational expertise in intervention methods that assist in the reduction or elimination of hospitalizations for asthma.

The Key to Success: Education as the Foundation

Many experts agree that the key to controlling and treating asthma and its symptoms is education. Seminars, pamphlets, books, and other methods are used to reach and teach asthma patients nationwide how to handle their disease. Asthma nurses are often charged with the routine care and treatment of people who have asthma. The patients will see a doctor as well, but the nurse who sees an asthmatic patient — both during an attack and for preventative care — has a significant impact on the interventions used to prevent hospitalization.

Patient Education and Trigger Identification

Asthma nurses have become acutely aware of the importance of education when it comes to intervention with asthma patients who want to prevent and reduce hospitalizations. Years ago, the treatment of asthma consisted of reactive actions. When a patient had an attack that was not easily controlled with a rescue inhaler, the doctor would hospitalize them until symptoms could be brought under control (Learning, 2003). More recently, the medical community determined that a more effective approach was a proactive one. Currently, education is one of the key intervention methods being used to prevent or reduce asthma attacks and thereby reduce or prevent hospitalization.

Teaching patients who have asthma how to recognize and identify their asthma triggers is one important step in the preventive education process. Education of the patient is an important intervention for nurses to implement with their asthma patients (Learning, 2003).

Disease Management Programs

Another intervention for asthmatic patients that can help reduce or eliminate the need for hospitalization is a disease management program. One study explored such programs and concluded that they were an effective intervention method for patients who have asthma. Nurses can intervene with asthma education and assist with treatments during attacks, but if they can engage their patients in actively managing their disease, they will achieve a higher success rate in avoiding hospitalization (Children, 2003).

This study showed that the asthma disease management program administered by McKesson Health Solutions, a business unit of McKesson Corporation, significantly reduced hospitalizations and emergency department visits for children and adolescents suffering from the chronic lung condition, according to research published in the November issue of Disease Management & Health Outcomes (Children, 2003).

The matched-control study followed 318 children and adolescents under the age of 18 who participated in McKesson's telephonic asthma disease management program. The research compared this group to 318 matched non-participants who received standard care for their asthma. Both groups were members of a commercial HMO located in the southwestern United States (Children, 2003).

Compared to those who received standard asthma therapy, those enrolled in the disease management program experienced (Children, 2003):

— 35.6% fewer inpatient admissions
— 32.5% fewer emergency department visits
— 51.6% more influenza immunizations

For those participating in the program, McKesson registered nurses developed and reinforced a self-management plan that included written materials, informal and formal education, and 24-hour access to a nurse advice telephone line (Children, 2003).

The Asthma Insights and Reality in Asia Pacific (AIRIAP) survey is an international survey designed to identify the major issues concerning asthma treatment in the Asia-Pacific region. It aims to assess the level of patient satisfaction with care received and to investigate patients' understanding of asthma, as well as gauge the level of education required (Anadarajah, 2000).

Conclusion

The presence of asthma can be life-altering for patients who struggle with symptom reduction or control. The role of the asthma nurse is not only to assist in treatment during an attack but also to educate and provide interventions that reduce or eliminate hospitalizations. Education, stress-reduction assistance, and the development of a disease management program are three effective interventions that can reduce or eliminate the need to hospitalize asthma patients.