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overall, the information is presented succinctly. more evidence based resources, such as research papers, should be used to further strengthen the arguments.
Dont forget to include an introduction, to introduce the reader to the topic.
Th graphics are closely linked to the topic.
marked by linda zhou

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inconsistencies and inaccuracies noted in the  in-text citations

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good examination of other factors that may exacerbate asthma

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it is written clearly and articulately. Try to incorporate EBP, such as research articles, to illustrate milk does not exacerbate asthma

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the discussion of obesity and asthma is not directly linked to topic,  dietary changes can manage asthma

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Good reference to research articles in your discussion. Include a introductory sentence prior to exploring the impact of vitamin D and asthma.

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the graphics are relevant to discussion of asthma

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is there an introduction to this e-poster?

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(Paul et al., 2012)

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Belli, B. (2013). Fighting for air: How climate change is leading to more ozone, more pollen and more asthma problems. E, 24(3), 20.

Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey. … Stanley, D. (2012). Kozier and Erb's fundamentals of nursing (Vols, 1-3.). Frenchs Forest: NSW. Pearson.

Brehm, J., Schuemann, B., Fuhlbrigge, A., Hollis, B., Strunk, R., & Zeiger, R. et al. (2010). Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. Journal Of Allergy And Clinical Immunology, 126(1), 52-58.e5. http://dx.doi.org/10.1016/j.jaci.2010.03.043

Busse, W. W., Lemanske Jr, R. F., & Gern, J. E. (2010). Role of viral respiratory infections in asthma and asthma exacerbations. The Lancet, 376(9743), 826-834.

Dairy Nutrional . (n.d.). Understanding the relationship between milk producs and asthma . Retrieved from https://www.dairynutrition.ca/facts-fallacies/health-concerns/understanding-the-relationship-between-milk-products-and-asthma

D'Amato, G, Cecchi, L, D'Amato, M, & Liccardi, G. (2010). Urban Air Pollution and Climate Change as Environmental Risk Factors of Respiratory Allergy: An Update. Journal of Investigational Allergology and Clinical Immunology, 20(2), 95-102.

Forno, E., & Celedón, J. C. (2012). Predicting asthma exacerbations in children. Current opinion in pulmonary medicine, 18(1), 63.

Gupta, A. &. (2011). Importance of patient/parents education in childhood asthma. Indian journal of pediatrics, 68, S53-64.

Korn, S., Hübner, M., Jung, M., Blettner, M., & Buhl, R. (2013). Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency. Respiratory Research, 14(1), 25. http://dx.doi.org/10.1186/1465-9921-14-25

Koutoukidis, G., Stainton, K., Hughson, J (2013). Tabbner’s Nursing Care Theory and Practice (6th ed.). Chatswood: NSW. 6

Levett-Jones, T., Hoffman, K (2013). Clinical Reasoning: Learning to think like a nurse (1st ed). Frenches Forest: NSW. Pearson Australia.

Mandelcwajg, A., Moulin, F., Menager, C., Rozenberg, F., Lebon, P., & Gendrel, D. (2010). Underestimation of influenza viral infection in childhood asthma exacerbations. The Journal of Pediatrics, 157(3), 505-506.

Man, L., Zhang, Z., Zhang, M., Zhang, Y., li, J., Zheng, N., Xu, B. (2015). Association between vitamin D deficiency and insufficiency and the risk of childhood asthma: evidence from a meta-analysis. International Journal of Clinical and Experimental Medicine, 8(4), 5699–5706.

McCarthy, M. J., Herbert, R., Brimacombe, M., Hansen, J., & al, e. (2002). Empowering parents through asthma education. Pediatric Nursing, 28(5), 465-73. Retrieved from http://search.proquest.com/docview/199390037?accountid=8194

Murphy, D. M., & O’Byrne, P. M. (2010). Recent advances in the pathophysiology of asthma. Chest Journal, 137(6), 1417-1426.

National Asthma Council Australia . (2015). Frequently asked questions about managing asthma for individuals and their families, plus extra details for health professionals. Retrieved from http://www.nationalasthma.org.au/understanding-asthma/faqs#7

Nursing File. (2010.) Nursing Interventions For Asthma. Retrieved from: http://nursingfile.com/…/nursing-interventions-for-asthma.h…

Nutrion Australia . (2009). Promoting optimal health by encouraging food vaiety and physical activity . Retrieved from http://www.nutritionaustralia.org/national/resource/asthma

Ober, C., & Yao, T. C. (2011). The genetics of asthma and allergic disease: a 21st century perspective. Immunological reviews, 242(1), 10-30.

Paul, G., Brehm, J., Alcorn, J., Holguín, F., Aujla, S., & Celedón, J. (2012). Figure 1. Potential protective effects of vitamin d against asthma morbidity. Retreived from http://www.vitamindwiki.com/Vitamin+D+reduces+asthma+-+Jan+2012

Poon, A., Mahboub, B., & Hamid, Q. (2013). Vitamin D deficiency and severe asthma.Pharmacology & Therapeutics, 140(2), 148-155. http://dx.doi.org/10.1016/j.pharmthera.2013.06.006

Rance, K. (2013). The emerging role of Vitamin D in asthma management. Journal Of The American Association Of Nurse Practitioners, 26(5), 263-267. http://dx.doi.org/10.1002/2327-6924.12062

Robert, W (2011). Obesity and Asthma: The Journal of Pediatrics. 159(1), A2.

Sakimura, J. (2015). Food- what to eat. Everyday Health. Retreived from: http://www.everydayhealth.com/lifestyle/food/

Siroux, V., Basagaña, X., Boudier, A., Pin, I., Garcia-Aymerich, J., Vesin, A., ... & Sunyer, J. (2011). Identifying adult asthma phenotypes using a clustering approach. European Respiratory Journal, 38(2), 310-317.

Thiara, G. &. (2012). Milk consumption and mucus production in children with asthma. Canadian Family Physician, 58(2), 165–166.

Trevor, J. L., & Deshane, J. S. (2014). Refractory asthma: mechanisms, targets, and therapy. Allergy, 69(7), 817-827.

Vera, M. (2012). Medical-Surgical Nursing: Asthma. Retrieved from: http://nurseslabs.com/asthma-nursing-management/

Weiner, J. (2011) Allergynet Australia. Pollens. Received from: http://www.allergynet.com.au/pollens/

What is a spacer?. (2016). Coping with Asthma. Retrieved 24 March 2016, from http://asthmanagement.weebly.com/spacer.html

Zaitlin, P. D. (2013). Mistaken beliefs and the facts about milk and dairy foods. Nutrition Today, 48(3), 135-143.

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After much research, we, as a team, have arrived at the conclusion that diet is not the key factor in the management of asthma, and therefore does not alone increase the risk of asthma exacerbation. We firmly believe that some of the more vital factors associated with asthma exacerbation and mismanagement include viral infection, genetic abnormalities and environmental factors.

Though some evidence does indicate that diet may be a factor in asthma management and exacerbations, the evidence based research explored within this poster further indicates that factors unrelated to an individuals diet are in fact more significant.

Through our collective research and improved understanding, we have acquired a greater knowledge of the nursing implications associated with the management and exacerbations of asthma. Those nursing implications deemed to be most prominent are;

patient education in various forms,

the importance of continuity of care,

medication management,

early identification of risk factors and triggers

As nurses, we need to be thoroughly educated in relation to these nursing implications so that we are able to pass this knowledge onto our patients confidently and allow them to make informed decisions regarding their healthcare.

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According to a number of theories, the genetics of an individual play the greatest role in the pathogenesis of asthma, as appose to diet (Ober & Yao, 2011). These theorists suggest that ones own heterogenous make-up solicits differences in a number of immune response pathways, such as changes within T Helper Cells,  epithelial cell derived cytokines and interleukin-33, within individuals who suffer from asthma (Ober & Yao, 2011). Asthma is often said to occur within a number of members of a family, or within individuals who share a similar genetic make up, indicating the strong heterogenous aetiology of the disease (Ober & Yao, 2011). Ober and Yao (2011) further explain that the genetic contribution evident in a disease such as asthma can be between 35% to 95%, depending on the individual.

The nursing implications concerned with the heterogeneous aetiology of asthma particularly refer to methods that allow for more individualized health care delivery and interventions to improve disease management (Forno & Celedón, 2012; Siroux et al., 2011). Understanding ones genetic link to asthma can allow for the early identification of children at high risk of asthma attacks and exacerbations (Forno & Celedón, 2012). Such early identification can lead to more personalised and effective health care delivery, and thus, improved health outcomes for children of an early age (Forno & Celedón, 2012). Understanding such genetic links can too allow for the early identification of individual risk factors of asthma exacerbation, allowing the client to be adequately educated on appropriate disease management from a preventative aspect (Forno & Celedón, 2012).

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Vitamin D has long been found to be an important element in ones daily diet. It is well understood that low levels of Vitamin D have severe consequences on the musculoskeletal system, but Vitamin D, when not in sufficient quantities, has increasingly been linked to exacerbation of asthma symptoms and lower lung function due to its role in the immune system  (Korn, Hübner, Jung, Blettner & Buhl, 2013). Though this is a relatively new connection and evidence is limited, research has found that there is a strong relationship between Vitamin D deficiency and the severity of asthma symptoms. Brehm et al., (2010) supports the idea that Vitamin D has local effects in response to respiratory infection and can aid in the reduction of inflammation as a consequence. Rance, (2013) states that Vitamin D acts to block inflammation in the airways by increasing a factor known as interleukin-10, which is an anti-inflammatory cytokine. Man, et al (2015) further support Vitamin D’s role in the immune system by confirming that Vitamin D has effects on epithelial cell, T-cell, B-cell and dendritic cell functions, which are significant for innate and adaptive immunity. They also conclude the importance of Vitamin D in increasing the response of steroids in the body as a treatment for asthma.

As previously stated, evidence in this area is limited, and so this impacts nursing implications. As a nurse, it is vital to understand the connection that has been established through evidence based practice and educate the client so they can make an informed decision regarding their healthcare. By explaining that Vitamin D can be linked with decreased asthma exacerbation, the patient is informed and can make a decision as to whether or not they wish to include it in their diet (Poon, Mahboub & Hamid, 2013; McCarthy et al., 2002). Referral of a patient to a nutritionist and other members of the multidisciplinary team is also an important implication. In summary, diet, namely Vitamin D, is somewhat essential to reducing asthma exacerbations and it is the nurse’s role to have an understanding of this to be able to educate the patient.

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Obesity is a leading cause of Asthma exacerbation within Australia, although many would argue differently. A study conducted by Robert, W in 2011 showed that in an obese adult shallow breathing is normal, due to the fat tissue making less space for the lungs to expand during inspiration. Within this study it was also argued that a full stomach can put extra pressure on the diaphragm further restricting the ability of the lungs to expand. Due to shortening of breath there is an increased chance of inflammation of the airway causing them to become narrowed. Due inflammation of the airway the individual can and will become short of breath (Koutoukidis, G., Stainton, K., Hughson, J, 2013). Chronic inflammation of the airway caused by the excessive amount of fat tissue can also make the airway oversensitive to asthma triggers such as pollen which is discussed by the opposing team. Studies discuss that the hormone Leptin which is released from the fat tissue is evident in assisting the airway to become inflamed. Leptin is present in all asthmatics but is often elevated in the obese asthmatic population (Robert, W., 2011).

Nursing implications are an important factor in asthma management and even more important when assisting with a dual diagnosis, such as a poor diet leading to obesity and asthma. Patient education is an important implication as studies have shown, that the more the patient understands about their illness the more likely they are to be invested in the treatment that will be available to them (Victorian Department of Health, 2014). Education is the key nursing implication when discussing that diet is a key factor in asthma exacerbation, as it is important that the patient has an understanding about the importance of their diet as a risk factor to their underlying illness (Berman., Et, Al, 2012).

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(Vera, 2012)

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Pollen and Pollution's influence on Asthma

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Pollen and Pollution's influence on Asthma

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Pollen and pollution is one of the leading causes of asthma exacerbations in Australia today. Evidence has shown that in both children and adults major asthma exacerbations occur due to the air we are breathing in. A study conducted by D'Amato found that one major contributor to asthma was global warming. This is due to the higher levels of carbon that are present in the atmosphere and are therefore increasing the length of seasons such a spring and summer. Spring is the main season where the growth and spreading of pollens occur such as perennial rye grass (Lolium perenne), couch or Bermuda grass (Cynodon dactylon) and plantain (Plantago species) (Weiner, 2011). This increases the amount of triggers for asthma sufferers therefore increasing the amount of asthma attacks seen in our population (D'Amato, 2010). Other weather conditions that may also affect the airways of a person are rain or humidity as they induce hydration and fragmentation of pollen grains, which releases allergenic biological aerosols into the atmosphere (Britta, 2013).

Some vital nursing considerations surrounding asthma would include the education for patients about their condition. The more a patient understands about their condition the more they will get to know their triggers and what affects them the most. Education could also include the proper administration of medication through an inhaler or spacer if nursing a child. As well as ensuring they know the correct doses of medication to be given and continuation of care from the health care provider (Nursing File, 2010).

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(Marigolds, R. E. 2013)

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Milk and dairy products play an important role in the human diet especially for growth and development, despite some individuals believing that these products are harmful for those who suffer from Asthma (Zaitlin, 2013). Parents of those children who suffer from asthma are reluctant to give their children milk with the belief that it will worsen their child’s symptoms due to increased mucus secretion (Thiara, 2012). It has also been said that dairy foods are a common trigger for Asthma, but despite these beliefs by the public there is little scientific evidence to support this statement. This belief can be traced back to ancient traditional Chinese medicines, and instead it has been suggested by research that dairy may help and protect adults and children against becoming an asthmatic by reducing the incidence of asthma symptoms (Dairy Nutrional )
There are also beliefs among the population about milk and its effect on the respiratory tract and allergies. This is a false, milk does not cause increased mucus production, and it does not cause worsen allergies or asthma. It is also believed that the hormones in milk can affect the individuals who drink it, this evidence is not supported today (National Asthma Council Australia , 2015).
A study was conducted by researches in which over 3,000 pre-schoolers, they found that children who consumed dairy foods everyday had significantly fewer asthma symptoms against children who didn’t consume dairy foods everyday (Nutrion Australia , 2009).
Another study that has been conducted by researchers investigated food intake and asthma in adults, drinking milk was associated with a lower risk of asthma. These findings support earlier research showing that children who consumed more than three serves of milk every day were two-and-a-half times less likely to develop asthma than children with the lowest intake of milk.
Despite these beliefs being upheld still today among parents of children who suffer from asthma there is very little scientific evidence linking milk consumption and dairy products together (Thiara, 2012).
Education is critical for the success of asthma management and a long-term approach is needed, (Gupta, 2011) vital information that needs to be taught is that a balanced diet of dairy and milk needs to be consumed, not only for growth and development but asthmatics are at a higher risk of bone disease and osteoporosis due to the use of steroid medication such as salbutamol.

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(Busse, Lemanske Jr., & Gern, 2010)

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Viral Infections influence on Asthma                                                        

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Viral Infections influence on Asthma                                                        

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While diet may play a role in the severity of asthma exacerbations, asthma itself is primarily a result of an immune response (Murphy, & O’Byrne, 2010). Therefore, the exacerbations are caused by an innate or adaptive response to allergens and viruses, or a combination of the two.

Viral respiratory tract infections, particularly those caused by human rhinoviruses can cause serious asthma exacerbations, which can require acute care. The main explanation of why this may occur is that viral infections weaken the airway epithelium, reducing effectiveness of this non-specific immune barrier and therefore boosting absorption of allergens and irritants across the airway wall, leading to increased inflammation (Busse, Lemanske Jr., & Gern, 2010). This inflammation results in a narrowing of the airway, which when coupled with the innate or acquired immune response, exacerbates the typified asthmatic response (Murphy & O’Byrne, 2010).
Individuals with asthma already experience mucous hypersecretion (Trevor & Deshane, 2014), and this is further increased for the duration of the virus, leading to a further narrowing of the airway and the possibility of mucous plugs.

The previous points raise questions about prevention of exacerbations caused by viral infections, and the importance of inquiry-based practice is that the knowledge gained from such research enables the consideration of the nursing implications that arise. While there is no drug that cures or prevents the human rhinovirus, patients should be educated on the importance of hand washing to reduce the spread of the virus, bacteria and possible allergens. Patients should also be educated on the importance of vaccinations that help prevent influenza (Mandelcwajg et al., 2010) and pneumococcal disease, in order to allow them to make an informed decision about their health care.

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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. Discuss the nursing implications for your position utilising evidence based research.

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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. Discuss the nursing implications for your position utilising evidence based research.