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                                                                       INTRODUCTION

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                                                                       INTRODUCTION

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DIET IS A KEY FACTOR IN ASTHMA MANAGEMENT, AND NEEDS TO BE MODIFIED TO REDUCE THE RISK OF ASTHMA EXACERBATIONS. AGREE/DISAGREE?

Dietary change is one of several causal factors implicated in this trend and in the past two decades, the evidence base on the relation between diet and asthma has increased substantially (Peacock et al., 2000).

This eposter aims to discuss whether diet is a key factor of asthma by the means of evidence based research. Nursing implications will be researched, discussed and both side of the statement including agreement and disagreement will be researched and a conclusion will be provided in the end.

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                                         PATHOPHYSIOLOGY OF ASTHMA EXACERBATION

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                                         PATHOPHYSIOLOGY OF ASTHMA EXACERBATION

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Understanding the Pathophysiology of asthma provides a better insight on the disease process and progression in the body, which in turn provides nurses the knowledge to critically apply the appropriate skills and interventions suited to their client’s health care needs (Kaufman, 2011).

Asthma is a chronic inflammatory airway disorder with recurrent symptoms that ranges from tightness of the chest, shortness of breath, wheezing and coughing. These episodes are mostly relieved with treatments and are typically associated with airflow obstruction (Casey, 2012).

The lower respiratory tract that are affected by the disease are the trachea, bronchi and the bronchioles are affected (Lynn & Kushto-Reese, 2015. Asthma causes bronchospasm and muscle damage, oedema, over-production of mucus and bronchoconstriction (narrowing of airways) the caused by epithelial damage (Lynn & Kushto-Reese, 2015).

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                                                                            AGREE

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                                                                            AGREE

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                                  HOW DIET MODIFICATION CAN REDUCE ASTHMA ATTACK?

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                                  HOW DIET MODIFICATION CAN REDUCE ASTHMA ATTACK?

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National Asthma Council Australia (2013) suggests having dietary choices can help control asthma. A diet high in antioxidants may help reduce the risk of asthma exacerbations and improve lung function. This will include five servings of vegetables and two servings of fruit every day. A meal high in tran-saturated fats leads to higher concentration of sputum inflammatory markers then a meal with no transaturated fat. Further studies have shown high fat and low fibre diets have been associated with worsen airway inflammation and lower lung function in people with asthma.

High in fish, fruit and vegetables nutritional consumption is known as the ‘Mediterranean diet’. This diet has been associated with reducing the risk of wheeze and asthma in childhood. McCloud and Papoutsakias (2011) describes how the beneficial aspect of this diet is to protect against asthma symptoms. The characteristic of the diet includes low amount of saturated fats, high monounsaturated fats and carbohydrates.

Recent studies in children have examined adherence to the Mediterranean diet in relation to asthma and supported a protective effect of the Mediterranean diet, fruit, vegetable, nut, and fish intake against current asthma symptoms (McCloud and Papoutsakias, 2011).These results verify that close adherence to the Mediterranean diet can have a beneficial effect on inflammatory response and lung function in children with asthma (McCloud and Papoutsakias, 2011).

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                                                                            DISAGREE

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                                                                            DISAGREE

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INHALED CORTICOSTEROIDS, SMOKING CESSATION, AND PREVENTION FROM ALLERGENS IN REDUCING AND MANAGING ASTHMA EXACERBATION.

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INHALED CORTICOSTEROIDS, SMOKING CESSATION, AND PREVENTION FROM ALLERGENS IN REDUCING AND MANAGING ASTHMA EXACERBATION.

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According to Anderson & Szelfer (2015), adult and pediatrics’ medication adherences should be addressed first when reducing risk for asthma exacerbations. The person should be provided with verbal and written instructions concerning medications prescribed (Peate, 2016).

On a research study conducted amongst children with acute asthma exacerbations, appropriate pharmacologic therapy is found to be adequate to control and avert acute asthma attacks other than diet modifications (Guibas, Makris & Papadopoulos, 2012). The cornerstone in controlling and treating asthma found to be more efficient was inhaled corticosteroid (ICS) (Guibas, Makris & Papadopoulos, 2012).

From a recent review, it was found to be significantly effective to reduce the prevalence of severe wheeze events in preschool children and adults who’s under ICS (inhaled corticosteroid) maintenance therapy (Anderson & Szelfer, 2015).

In addition, lifestyle changes may be required that can have a serious impact on reducing and managing asthma exacerbations (Bullock, Clark., & Rycroft-Malone, 2012).

According to Divekar, Ameredes & Calhoun (2013), smoking is conclusively correlated with loss of asthma control and acute attacks in the adult population; accordingly, second hand smoke (SHS) plays such a role in pediatric patients.

On the basis of a large meta-analysis of 70 studies, a recent UK Royal College of Physicians report indicated a twofold increase in the risk of children developing asthma due to SHS exposure (Divekar, Ameredes & Calhoun, 2013).

Alongside tobacco smoke, another important exacerbating factor that should be avoided is the exposure to allergens and infectious agents. Therefore, avoidance of causes involved are abstaining from cigarette smoking, eliminating pets from households, removing carpets and dust mites (Peate, 2016).

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                                                                          AGREE

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                                                                          AGREE

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OTHER EVIDENCES ON THE USE OF DIET MODIFICATION IN REDUCING THE RISK OF ASTHMA.

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OTHER EVIDENCES ON THE USE OF DIET MODIFICATION IN REDUCING THE RISK OF ASTHMA.

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According to Robertson-Malt (2010), once linked with other factors that are threatening, the nourishment or diet of frugally industrialized countries and urban vicinities of the developing world is now approximately low in cereals, tubers and starchy foods and more or less elevated in sugar, fat, meat, protein of animal origin, dairy produce, salt and alcohol, possibly will cause an exacerbation of symptoms of asthma.

Fruits and vegetables contain antioxidants and other biologically active factors which may contribute to the favorable effect of fruit consumption in asthma.

·     Vegetables and fruits consisting antioxidants and other biologically active components which may supplement to the favorable effect of fruit intake in asthma.

In particular, foods rich in Vitamin C have been reported to relate to better lung function and fewer asthma symptoms.

Avoid sulfites by scrutinizing labels on packaged foods, and eat as many whole unprocessed foods as possible, such as fruits, vegetables, nuts, meats and fish (Blumenfeld, 2013).  Although the precise reason isn’t quite known, sulfites, a preservative found in processed foods, wine and dried fruit, trigger attacks in 5 percent of people with asthma (Blumenfeld, 2013).

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       NURSING IMPLICATIONS ON UTILISING DIET MODIFICATION IN MANAGING ASTHMA.

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       NURSING IMPLICATIONS ON UTILISING DIET MODIFICATION IN MANAGING ASTHMA.

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Family education about dietary manipulation are found to increase the intake of natural foods particularly fresh fruits and vegetables in a balanced diet throughout life (Robertson-Malt, 2010).

Nutritional intake plays an important role in increasing or decreasing the prevalence of asthma exacerbations. This is evident in studies showing the effectiveness of dietary modifications including a greater intake of vitamins, fruits, vegetables and a recommendation of the ‘Mediterranean diet.

Encouraging the patient to be physically active for the benefits of physical and mental health but be reminded that physical exercise induce bronchoconstriction would not be a reason to avoid being active as it could be managed properly are found to be effective (Smeltzer et al, 2010). Encouraging to modify diet when reducing the risks of asthma exacerbations (Smeltzer et al, 2010).

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                                                                   CONCLUSION

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                                                                   CONCLUSION

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Nurses play a unique role in planning, administering, supervising and evaluating programs with regards to asthma management.  It is nurses responsibility to be fully informed and updated about the current trends and researches that pertains to asthma. Based on the evidences researched, it is therefore conclude that diet modification can greatly reduced the exacerbation of asthma. Part of health care professionals role is to give health teaching on the importance of diet modifications to patients with asthma and improve the quality of their life.

REFERENCES

Anderson, W., & Szefler, S. (2015). New and future strategies to improve asthma control in children. Journal Of Allergy And Clinical Immunology, 136(4), 848-859. http://dx.doi.org/10.1016/j.jaci.2015.07.007

Blumenfeld, J. (2013). Asthma relief. Delicious Living. 29(4), 24-252p.

Fanta, C. (2009). Asthma. New England Journal Of Medicine, 360(10), 1002-1014. http://dx.doi.org/10.1056/nejmra0804579

Casey, G. (2012). Asthma - obstructing the airflow. Kai Tiaki Nursing New Zealand, 18(9), 20-24 5p. Retrieved from: http://web.b.ebscohost.com.ezproxy1.acu.edu.au/ehost/pdfviewer/pdfviewer?sid=b298842e-61ef-4677-a18c-769bb36f386e%40sessionmgr198&vid=0&hid=106

Divekar, R., Ameredes, B., & Calhoun, W. (2013). Symptom-Based Controller Therapy: A New Paradigm for Asthma Management. Curr Allergy Asthma Rep, 13(5), 427-433. http://dx.doi.org/10.1007/s11882-013-0375-7

Guibas, G., Makris, M., & Papadopoulos, N. (2012). Acute asthma exacerbations in childhood: risk factors, prevention and treatment. Expert Review Of Respiratory Medicine, 6(6), 629-638. http://dx.doi.org/10.1586/ers.12.68

Kaufman, G. (2011). Asthma: pathophysiology, diagnosis and management. Nursing Standard, 26(5), 48-56 9p. Retrieved from: http://web.b.ebscohost.com.ezproxy1.acu.edu.au/ehost/pdfviewer/pdfviewer?sid=3da1f399-a68d-4bce-856f-b99f3cc271cc%40sessionmgr198&vid=0&hid=106

Kohlstadt, I. (2009). Food and Nutrients in Disease Management. Retrieved from https://books.google.com.au/books

McCloud, E., & Papoutsakias, C. (2011). A Medical Nutrition Therapy Primer for Childhood Asthma: Current and Emerging Perspectives. Journal of the American Dietetic Association. 111(7), 1052-1064 (Peer Reviewed Journal) doi: 10.1016/j.jada.2011.04.005

Lynn, S. J., & Kushto-Reese, K. (2015). Understanding asthma pathophysiology, diagnosis, and management. American Nurse Today, 10(7), 49-51 3p. Retrieved from: http://web.b.ebscohost.com.ezproxy1.acu.edu.au/ehost/detail/detail?sid=5e720fb3-2a71-4b08-a8a4-aad197675dd8%40sessionmgr198&vid=0&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d##AN=109824543&db=ccm

Nagel, G., Weinmayr, G., Kleiner, A., Garcia-Marcos, L., & Strachan, D. (2010).  Effect of diet on asthma and allergic sensitisation in the International Study on        Allergies and Asthma in Childhood (ISAAC) Phase Two. Thorax, 65(6), 516-522 7p. doi:10.1136/thx.2009.128256

National Asthma Council Australia. (2013) Asthma and Healthy Living. An information paper for health professionals. Retrieved from http://www.nationalasthma.org.au/uploads/publication/asthma-healthy-living-hp.pdf

National Asthma Council Australia. (2013) Asthma and Healthy Living. An information paper for health professionals. Retrieved from http://www.nationalasthma.org.au/uploads/publication/asthma-healthy-living-hp.pdf

Peacock, J., & Dolan, C. (2000). Asthma. Mankato, MN: LifeMatters.

Peate, I. (2016). Medical-surgical nursing at a glance. United States: John Wiley & Sons.

Roberston-Malt, S. (2010). Overview of review. Non-medical management of asthma  in adults. International Journal Of Nursing Practice, 16(2), 208-219 12p.            doi:10.1111/j.1440-172X.2010.01835.x

Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheerver K.H. (2010) Handbook for  Brunner &   Suddarth's textbook of medical-surgical nursing (12th ed.). Philadelphia : Wolters Kluwer Health/Lippincott Williams & Wilkins

Statistics - An Asthma Australia site. (2016). Asthmaaustralia.org.au. Retrieved 20 March 2016, from http://www.asthmaaustralia.org.au/nsw/about-asthma/what-is-asthma-/statistics

WHO | Asthma. (2016). Who.int. Retrieved 20 March 2016, from http://www.who.int/topics/asthma/en/