Asthma in Philadelphia, Pennsylvania
Demographics
Asthma affects a vast number of people, with each population group being nearly as vulnerable to it as the others are. According to the World Health Organization (2016), there are 235,000,000 asthma patients. Therefore, it is crucial to create strategies that could help not only manage the issue but also prevent it successfully.
Pathophysiology
Starting with the inflammation of airways, asthma causes people to experience severe difficulties breathing. After an antigen enters a dendritic cell, airways become hypersensitive, which leads to their obstruction and the threat of suffocation (Mims, 2015). Since asthma impedes breathing, it may lead to fatal outcomes, which makes it especially dangerous in child patients.
Transmission
Asthma is typically transmitted maternally during pregnancy (Gregory, Kobzik, Yang, McGuire, & Fedulov, 2017). After a mother inhales an allergen, her fetus shows allergic sensitization and, as a result, becomes susceptible to a particular allergen (Gregory et al., 2017). Transmitting asthma from one patient to another is impossible.
Screening Recommendations
Whenever a patient suffers from regular coughing, has wheezing sounds when breathing, and experiences chest tightness, there is a high probability that one has developed asthma (National Heart, Lung, and Blood Institute, 2018). Thus, additional tests are required to determine the presence of the disease.
Current Screening Tests Available
As a rule, two types of tests are typically advised when suspecting asthma. Spirometry allows determining the inhaling and exhaling capacity of a patient’s lungs (Yadav et al., 2015). X-ray, in turn, is used to locate possible internal causes of asthma (Yadav et al., 2015).
Asthma Testing
Test Specificity and Sensitivity
According to the existing evidence, the specificity of spirometry as the means of diagnosing asthma currently makes 90%, whereas the sensitivity rates reach only 29% (Francisco, Ner, Ge, Hewett, & König, 2015). Therefore, spirometry cannot be deemed as the perfect asthma test.
Positive Predictive Value
At present, the positive predictive value (PPV) of spirometry as the means of detecting asthma makes 22 % (Meneghini, Paulino, Pereira, & Vianna, 2017). The specified level of PPV is also comparatively low.
Problems with the Testing
When considering the issues associated with testing asthma, one must mention that a number of its symptoms coincide with the symptoms of other respiratory diseases (National Heart, Lung, and Blood Institute, 2018). As a result, diagnosing the issue may become problematic.
How the Tests Are Performed
Spirometry is carried out by calculating the number of times a patient inhales and exhales per minute (Turner & Bothamley, 2016). X-ray, in turn, requires the use of specific equipment. Nowadays, the devices used for radiology can be digital for greater precision.
CLIA Waiver Information
Apart from the specified tests, two new approaches have been designed by CLIA. A molecular test based on locating the Group A Streptococcus and the Cobas Influenza A/B test is viewed as credible (Krinsky, 2015).
What the Results Mean
The results indicate that the process of detecting asthma is rather intricate and complicated. Therefore, caution and care in locating the problem are required. However, when combined, the tests present a rather decent opportunity at determining the presence of asthma.
Occurrence and Implications of False Positives and False Negatives
False positives and false negatives occur in spirometry more often than when using X-rays due to the lack of direct indications of the disease (Li, Qin, Li, Wu, & Wang, 2015). Therefore, additional tests may be necessary.
Limitations of the Test
Due to reversibility in some patients, responses to spirometry may be negative even in the presence of asthma (Chhabra, 2015). X-rays, in turn, may hurt patients’ health.
Final Recommendation: Usage in Clinical Practice
It is strongly recommended to use spirometry along with additional tests in determining asthma (Li et al., 2015). Thus, the outcomes of the assessment will be accurate.
Influence on the Clinical Decision
The tests should have a direct impact on clinical decisions. In case the outcomes of either of the tests allow suspecting the disease, a more accurate evaluation will be necessary.
References
Chhabra, S. K. (2015). Clinical application of spirometry in asthma: Why, when, and how often? Lung India: Official Organ of Indian Chest Society, 32(6), 635-637. Web.
Francisco, B., Ner, Z., Ge, B., Hewett, J., & König, P. (2015). Sensitivity of different spirometric tests for detecting airway obstruction in childhood asthma. Journal of Asthma, 52(5), 505-511. Web.
Gregory, D. J., Kobzik, L., Yang, Z., McGuire, C. C., & Fedulov, A. V. (2017). Transgenerational transmission of asthma risk after exposure to environmental particles during pregnancy. American Journal of Physiology-Lung Cellular and Molecular Physiology, 313(2), 395-405. Web.
Krinsky, D. L. (2015). Soy for asthma? And other ‘respiratory’ musings. Pharmacy Today, 21(11), 16.
Li, Z., Qin, W., Li, L., Wu, Q., & Wang, Y. (2015). Diagnostic accuracy of exhaled nitric oxide in asthma: a meta-analysis of 4,691 participants. International Journal of Clinical and Experimental Medicine, 8(6), 8516.
Meneghini, A. C., Paulino, A. C. B., Pereira, L. P., & Vianna, E. O. (2017). Accuracy of spirometry for detection of asthma: A cross-sectional study. Sao Paulo Medical Journal, 135(5), 428-433. Web.
Mims, J. W. (2015, September). Asthma: Definitions and pathophysiology. In International Forum of Allergy & Rhinology, 5(1), 2-6. Web.
National Heart, Lung, and Blood Institute. (2018). Asthma. Web.
Turner, R. D., & Bothamley, G. H. (2016). Chronic cough and a normal chest X-ray-a simple systematic approach to exclude common causes before referral to secondary care: A retrospective cohort study. NPJ Primary Care Respiratory Medicine, 26, 15081. Web.
World Health Organization. (2016). Asthma.
Yadav, A., Corrales-Medina, F. F., Stark, J. M., Hashmi, S. S., Carroll, M. P., Smith, K. G.,… Mosquera, R. A. (2015). Application of an asthma screening questionnaire in children with sickle cell disease. Pediatric Allergy, Immunology, and Pulmonology, 28(3), 177-182. Web.