Table of Contents
PICOT Questions
- In asthma patients who are 25 or younger, how does tobacco exposure as compared to no tobacco exposure influence the patient’s morbidity over 6 months?
- What is the length of recovery for patients with asthma who developed exacerbations compared to those who did not within the first six months of recovery?
- In adult patients with asthma, how effective is smoking cessation compared to smoking in controlling asthma symptoms over a period of 6 months?
Description of Topic and Background Information
Tobacco is the most prominent cause of premature mortality on the globe. Furthermore, quitting can lower the risk of illness significantly, for cancer, stroke, and chronic lung disease (Polosa & Thomson, 2013). Many asthma smokers persist in smoking, due to their tobacco addiction. A study explores the asthma smoking phenotype, which affects disease mechanisms and management. Epidemiological evidence has not validated the link between active smoking and asthma (Polosa & Thomson, 2013). However, according to the Canadian National Population Health Survey, smokers have a 70% greater chance of asthma, compared to nonsmokers (Polosa & Thomson, 2013).
Most studies have identified a temporal link between smoking and asthma. Asthma patients begin smoking around the age of non-asthmatic smokers. The 2014 US Surgeon General Report on Health Effects of Smoking determined a relationship between new onset asthma and active smoking (Chatkin & Dullius, 2016). It also predicts new asthma cases for adults. Parental smoking is also associated with asthma in children. Morbidity and mortality rates increase in smokers with asthma, compared to non-asthmatic smokers (Polosa & Thomson, 2013). Asthmatic smokers have higher rates of asthma, asthma attacks, and exacerbations. Smoking also predicts new incidents of asthma in those with allergies, and experience a lower quality of life (Polosa & Thomson, 2013). Smoking status and smoking severity is associated with asthma severity. Smoking also lowers asthma control, and accelerates lung decline.
Significance of the Topic
Asthma is a major public health issue in most countries in the world. It affects 300 million individuals worldwide and accounts for 250,000 deaths per year (Chatkin & Dullius, 2016). Asthma also impact public health budgets. It is vital to develop health strategies to control this illness. Therefore, this topic is significant, as new strategies must include predisposing factors (Chatkin & Dullius, 2016). Smoking is a substantial factor for a large segment of asthmatic smokers. Clinical trials are being developed to implement new therapeutic methods for asthma (Chatkin & Dullius, 2016). However, many such strategies exclude smokers. No specific treatment information exists for asthmatic smokers. Asthmatic smokers are considered a unique phenotype with specific therapeutic needs, and health outcomes (Chatkin & Dullius, 2016). Cigarette smoke, and all tobacco use, plays a role in the negative health outcomes.
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Smoking cessation can improve pulmonary function and symptoms. A combination of counseling and first-line alternatives can increase rates of quitting (Chatkin & Dullius, 2016). Electronic cigarettes may also play a role in this disease, however, studies have yet to examine this topic (Chatkin & Dullius, 2016). Clinicians require a better understanding of smoking for asthmatic patients. These patients tend to respond poorly to corticosteroids. This is not a universal condition and doctors often include asthma patients in treatment for pulmonary issues. Inhaled corticosteroids, and a long acting beta2 adrenergic by asthmatic smokers, can increase asthma outcomes, as compared to corticosteroid use alone (Chatkin & Dullius, 2016). Therefore, this topic requires research because present treatments for asthma do not address asthmatic smokers. Asthmatic smokers have special characteristics, such as more frequent exacerbations, low quality of life, more life threatening attacks, and higher mortality and morbidity rates (Chatkin & Dullius, 2016). Smoking increases the risk of airflow obstruction by three.
The Significance of the Topic to Nursing Practice
Resident nurses, trained in asthma and COPD, spend .5h per week per 1,000 inhabitants caring for asthmatic and COPD patients (Efraimsson et al., 2015). Nurses play a role in motivational interviewing (MI) (Efraimsson et al., 2015). This is a clinical communication method designed motivate change by mitigating uncertainty. This also further engages the patient in the treatment. Motivational interviewing supports patient autonomy and collaborates with their efforts (Efraimsson et al., 2015). It also reinforces a patient’s capacity to change. This tool is based on four tenets, understanding the patient’s motivations and empathizing, encouraging hope and optimism, empowering the patients, and resisting the “righting reflex” (Efraimsson et al., 2015).
The more motivated patients are, the more they participate in behavioral change. They are more likely to engage in self-disclosure, and take responsibility for their actions and their desire to change (Efraimsson et al., 2015). Motivation encourages patients to identify a problem and a way to change, while maintaining that change. Nurses can use this method for asthmatic smokers. Motivating them to change this behavior will reduce symptoms, complications, and morbidity/mortality rates (Efraimsson et al., 2015). Nurses can engage in joint decision making with patients and instigate change.
References
- Chatkin, J. M., & Dullius, C. R. (2016). The management of asthmatic smokers. Asthma research and practice, 2, 10. doi:10.1186/s40733-016-0025-7
- Efraimsson, E. Ö., Klang, B., Ehrenberg, A., Larsson, K., Fossum, B., & Olai, L. (2015). Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care. European clinical respiratory journal, 2, 27915. doi:10.3402/ecrj.v2.27915
- Polosa, R., & Thomson, N. C. (2013). Smoking and asthma: dangerous liaisons. European respiratory journal, 41(3), 716-726.
