Respiratory Disease: Asthma
Acute asthma elicits an increased oxygen requirement and breathing work secondary to airway obstruction and bronchial constriction through inflammatory secretions. A plethora of research demonstrates that non-invasive ventilation has the latent of countering these processes more sufficiently compared to traditional asthma therapies. Conversely, there has been lack of large-scale prospective controlled discourses to interrogate this hypothesis. For that reason, this study aims at determining if the incorporation of non-invasive positive airway pressure for patientsadmitted with cases of acute asthma exacerbation alleviates their breathing work, shortens their length of hospital stay, and the requirement for adjunctive medications, in comparison to current standard therapy.
This section explores the background of the topic. Asthma is a prevalent chronic condition that is characterized by reversible airway obstruction due to airway inflammation, elevated airway secretions, and contraction of bronchial smooth muscle. Whereas there have been tremendous developments in controlling asthma, acute exacerbations remain a huge concern, especially during the viral season (Schauberger et al., 2018). As much as acute asthma has few cases of fatality, it imposes an overwhelming health burden on the affected population. Exacerbation of asthma is a leading cause of emergency room visits and hospitalization. According to Schwindt, Wu andDelfino (2018), asthma accounts for 3 to 7 % of all emergency department visits with a mortality rate of 3 per million adults in the united states. In this way, any therapy that has the ability to improve outcomes would be a significant development in this segment.
General Problem Statement
The general problem is the lack of large controlled studies to support the use of non-invasive ventilation in the treatment of asthma. Even though non-invasive ventilation has gained increased usage in asthma treatment in the emergencydepartment, little relevant research exists on the same (Asher& Pearce, 2014). Recent investigations, including a Cochrane review based on only 6 studies, all maintain that, while the therapy has a great potential, there is an urgent inclusion of large-controlled studies. According to these researches, non-invasive ventilation was safe and possibly effective, but lacked a key ingredient: controls.
Specific Problem Statement
The specific problem is ambiguity in clinical definitions that enable wheezing or coughing children to be distinguished from others. Clinical suspicion of bacterial pneumonia, including the presence of focal crackles and alterations in bronchial breathing may be used as an exclusion criterion (Schwindt, Wu&Delfino,2018). Even so, impending respiratory failure at the point of admission coupled with an altered mental status may complicate the entire elimination process. What augment this problem is the occurrence of unrelated illnesses bronchopulmonary dysplasia or congenital heart disease.
The aim of this research is to establish whether the use of non-invasive ventilation for children diagnosed with exacerbation of acute asthma, lowers the need for adjunctive medications, breathing work, and period of stay at the hospital. Investigating the use of mechanical ventilation and intubation, the study will include randomized and controlled procedures. In a way, tightly fitting face masks for non-invasive ventilation make it intricate to perform this as a blind study.
The research addresses the following research questions:
RQ1: Its non-invasive ventilation analogous to conventional ventilation in the absence of intubation?
RQ2: Does non-invasive pressure deliver minimize the side-effects in comparison with traditional ventilators?
Asher, I., & Pearce, N. (2014). Global burden of asthma among children. The International Journal of Tuberculosis and Lung Disease, 18(11), 1269-1278.
Schauberger, E. M., Hershey, G. K. K., Bernstein, D. I., Myers, J. M. B., He, H., Martin, L. J., … &LeMasters, G. K. (2018). Predicting Asthma Development in Children Using a New Personalized Asthma Risk Score. Journal of Allergy and Clinical Immunology, 141(2), AB106.
Schwindt, C. D., Wu, J., &Delfino, R. (2018). Risk of Asthma Among Children from In-Utero Exposure to Traffic-Related Air Pollutants. Journal of Allergy and Clinical Immunology, 141(2), AB3.
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