The use of informatics in treating respiratory diseases - asthma

Introduction

The human body is a biological machine made of body systems without which the body will be nonfunctional. The body systems are groups of organs and tissues that work together to perform important jobs for the body. These organs might serve one or more purposes in one or more body systems (Katy McLaughlin, 2020).

There are eleven (11) major organ systems in the human body. They are the skeletal, muscular, lymphatic, urinary, digestive, reproductive, respiratory, nervous, endocrine, cardiovascular, and integumentary. Other studies show that there are 12 major organs in the human body. Hunter Business School (2017) showed that there are twelve (12) body systems. The study noted that the immune system is important and must be distinguished. The immune system according to this study includes the lymph nodes, the spleen, bone marrow, lymphocytes, the thymus gland, and the leukocytes. In another study, the immune system and lymphatic system were merged. 

The different organs that make up the body system work together to make a completely functional human body. The circulatory system is powered by the heart and responsible for the distribution of blood. The respiratory system enables air passage in the body. It helps every tissue within the body to get the oxygen required to function. The digestive system aids the intake and spread of nutrients in the body. It converts food through a chemical breakdown process. The skeletal system gives the body its basic framework, structure, protection, and enables movement. The nervous system allows humans to perceive, comprehend, and respond to the world around us. The productive system consists of a series of organs primarily for conceiving and bearing children. 

The human body and its systems are delicate and therefore are prone to diseases and infections. Just like every machine, these organs require frequent upkeep to keep them running effectively. In the world today, several diseases and infections affect the body systems. These diseases and infections include asthma (respiratory system), osteoporosis (skeletal system), epilepsy (nervous system), polymyositis (muscular system), diabetes (endocrine), allergic rhinitis (immune system), hypertension (circulatory system), kidney disease (urinary system), eczema (integumentary system), cervical cancer (reproductive system), and irritable bowel syndrome (digestive system). 

The centers for disease control and prevention (CDC), reports that infectious and parasitic diseases account for about 15.5 million doctor’s visits and 3.7 million emergency room visits each year. This is attributed to the fact that new causes of infection always emerge. Some examples are; severe acute respiratory syndrome (SARS) and the Zika virus. The treatment of virus infections and diseases is based on the symptoms experienced by the patient. Some virus or infectious diseases is known to stay with the patient for life once the patients have been infected. Bacterial infections are often treated with antibiotics. Fungal infections can be treated with antifungal medications. Parasite infections are treated with a type of anti-parasitic medications. 

This study further considers how informatics can help improve the treatment of a respiratory system disease called asthma. 

Summary of the topic

The respiratory system is a biological system consisting of specific organs and structures used for gas exchange in human beings. It is also called the gas exchange system. The respiratory system helps to get rid of carbon dioxide and take in oxygen. The system is made up of the nose, mouth, pharynx, larynx, trachea, bronchi, lungs, alveoli, and diaphragm. 

The respiratory system has built-in methods to keep harmful things in the air from entering the lungs. The hair in the nose plays a part in filtering out large particles. However, the hair cannot prevent harmful substances like smoke from entering the body through the nose. This and other hazardous substances lead to respiratory diseases such as asthma, lung cancer, pneumonia, tuberculosis, etc. 

Fuhbrigge et.al (2015) shows that the diagnostic modalities available for assessing the patient with suspected or known respiratory system disease include imaging studies and techniques for acquiring biologic specimens, some of which involve direct visualization of part of the respiratory system. 

Discussion

Asthma is a chronic condition that affects the airway. Researchers find it a serious disease that can kill if not treated the right way. Asthma makes breathing difficult as it causes the airways in the lungs to become inflamed and narrow. In some cases, patients might experience chest pain, cough, and wheezing. World Health Organization estimated that more than 339 million people had Asthma globally in 2016. 417,918 deaths were recorded due to asthma at the global level and 24.8 million were attributed to asthma in the same year (World Health Organisation, 2020). A study showed that in the children that died of asthma, one-third of them had mild disease. 

Asthma symptoms are different in individuals and start at different points in life. Sometimes it starts in infancy, other times it starts at childhood. A study shows that some children outgrow asthma, but it is clear that the disease never goes away. Asthma can also start in adulthood. Some people start having asthma after a bad cold or flu. Others develop asthma as a result of work-related exposure. 

The attack ‘episode’ can also be mild or severe. Most often asthmatic patients do not know when to expect an episode. Mild episodes can be treated without panic using the right medications. Sometimes, a mild episode seems to go away without the use of medication but often reoccur after few hours. In most cases, severe episodes would require the attention of medical personnel. During an episode, the lining of the airways tightens causing the lungs to swell. The muscles around the airways also tighten up to make the airways narrower; thus, causing a blockage in the usual flow of air which makes it hard to breathe. 

There are different types of asthma. The common type is bronchial asthma. Others are childhood asthma, adult-onset asthma, allergic asthma, non-allergic asthma, occupational asthma, exercise-induced bronchoconstriction, aspirin-induced asthma, nocturnal asthma, and cough-variant asthma. 

Several risk factors as identified by Mayo Clinic reveal possible chances of patients developing asthma. These factors are: being overweight, being a smoker, exposure to secondhand smoke, having a blood relative with asthma (such as parents or siblings), exposure to chemical substances, exposure to exhaust fumes or other pollution, and having another allergic condition. 

Treatments

The Asthma Initiative of Michigan has shown that there is no known cure for asthma at the moment. There are however treatments, asthma medications, that can help reduce the episodes or prevent asthma symptoms. These treatments ensure that the asthma patient stays alive, maintains normal functioning such as going to school or work, and has a normal or near-normal lung function. 

The treatment of asthma is both pharmacological, including immunotherapy, and non-pharmacological. Non-pharmacological treatment often involves environmental procedures such as elimination of allergens in the patients’ surroundings (Peter Gotzsche and Helle Johansen, 2008).  

Victor Ortega and Frank Genese (2019) also acknowledge that the therapy for asthma is based on two classes of drugs; anti-inflammatory drugs and bronchodilators. The anti-inflammatory drugs suppress the inflammation that narrows the airways. Examples of this drug are corticosteroids, leukotriene modifiers, and mast cell stabilizers. Bronchodilators help to relax and widen the airways. Bronchodilators include beta-adrenergic drugs, anticholinergics, and methylxanthines.

Controller medications such as corticosteroids, budesonide, mometasone, ciclesonide, flunisolide, beclomethasone are taken daily. Combination medications are often recommended in some cases. These include fluticasone and salmenterol, fluticasone and vilanterol, budesonide and formoterol, and mometasone and formoterol. Other inhaled medications that help clear the airways are anticholinergics and leukotriene modifiers. Anticholinergic such as tiotropium is used in maintenance therapy of asthma. Examples of leukotriene modifiers are montelukast, zafirlukast and zileuton. Mast cell stabilizers include cromolyn and nedocromil. These drugs are inhaled and are thought to inhibit the release of inflammatory chemicals from mast cells and make the airways less likely to narrow. It is often used by children and people who developed asthma due to exercise. 

There are also beta-adrenergic drugs. These drugs are grouped into three – short-acting beta-adrenergic drug, long-acting beta-adrenergic drug, and ultra-long-acting beta-adrenergic drug. The effect of ultra-long-acting beta-adrenergic drugs can last for 24 hours and requires only a dose daily. This drug is also used together with inhaled corticosteroids. Long-acting beta-adrenergic drugs are used to prevent rather than to treat asthma attacks. This medication cannot be used by all asthmatic patients as it may cause some risks to the patient. The drug is effective for 12 hours, so patients usually need to take two per day. It is also advised to be inhaled with corticosteroids. The short-acting beta-adrenergic drugs are considered the best drugs for relieving asthma attacks. These drugs are referred to as bronchodilators. 

In the case of an emergency, there are rescue medications that are used to immediately relax and open the airways and relieve symptoms during asthma attacks. These medications include; albuterol, levalbuterol and pirbuterol. However, it has been medically advised that the rescue medications cannot totally help relieve asthmatic patients and therefore cannot take the place of controller medications. 

A study by AAAAI shows that several newer medications are used for the treatment of asthma. These drugs are developed to treat severe or difficult-to-treat asthma on regular basis. The newer medications come in form of injections or infusions called biologics. Research also shows that biologics cannot be used for all types of asthma. Asthmatic patients will have to get their blood tested for suitability before biologics can be administered.

Challenges faced treating asthma

In managing asthma, healthcare providers and the patients are often faced with lots of challenges and these challenges of asthma management include challenges in diagnoses, challenges in the treatment, follow-up challenges, and other general challenges. Treatment challenges include a high-cost and unavailability of essential asthma medications. The unaffordability of inhaled corticosteroids is a potential barrier to the treatment of asthma in developing countries. The lack of essential devices like nebulizers, space devices, lack of blood gas analysis machines including pulse oximeters, which are used for severity assessment poses challenges to asthma management (CC. Onyedum et.al 2013). 

Current use of informatics in treating asthma

Chi Yan Huiet. al in research to promote the adoption and usage of application software to support asthma management shows that apps can potentially support asthma self-management. The study further reviews the use of Facebook and Twitter platforms of Asthma UK and the Asthma UK Centre for Applied Research (AUKCAR), giving that Asthma UK had 379,000 followers on Twitter and 66,665 followers on Facebook in August 2017, while the AUKCAR has 577 followers in Twitter in August 2017 but no Facebook account. The study also shows the development of an app that was made available on the Google play store or Apple app store. The adoption of the app shows that most patients were able to download, activate and use the app by themselves; however, some other patients needed assistance. Chi Yan Hui et.al concluded that using social media may provide a quick win in terms of initial downloads, but adherence to the app dropped rapidly over time.

David Sanders and Dominik Aronsky (2006) described computer-based programs used by asthmatic patients. Examples of these applications include a computer game for children, a presentation of instructional multimedia clinical scenarios designed to improve recognition of asthma symptoms, a system to teach the avoidance of triggers such as dust mites, and a program to assess patients’ knowledge of proper therapy for asthma exacerbations. The study further described applications that allow patients to use prescribed medications, or track the use of rescue medication. The implementation of these applications varies. There are home-based tools such as web pages and patient-centered data collection tools that were designed for the ambulatory care setting. 

The prospect of informatics in the treatment of asthma

Tech companies like iSonea, Asthmapolis, and Whoezometerare beginning to prove the impact of technology in the treatment of asthma. iSonea in a recent partnership with AsthmaSense developed an application that alerts the user when the risk of an asthma attack increases and lets the patient log medicine use. The company uses sensory technology to measure breathing vibrations with sound while Asthmapolis uses GPS. Whoezometer also available with a prescription; records the breathing rhythm once pressed against the throat and analyses it to give a percentage for wheezing. Kibkabe Araya (2012) explained that mobile-health apps are expected to reach 142 million downloads by 2016. 

The University of Manchester announced in new research the use of x-ray CT scanning to quantify the tiny microstructures of individual particles from the drug product at the nano-scale. Drug Discovery from Technology Networks (2020) disclosed that the new research has revealed new insights into common asthma aerosol treatments to aid the drug’s future improvements which could benefit hundreds of millions of global asthmatic patients.

Conclusion

In the past few years, asthma patients have seen technology make the disease more manageable. Companies now are unveiling devices that track inhaler usage with GPS, measure wheezing, compile data in a smartphone – mobile apps and share interactive online content.

Asthma is a critical disease that causes airway inflammation and recurrent episodes and has caused many patients to require high doses of inhaled corticosteroids. The regular treatments have proven to be effective in improving symptoms and lung function and in reducing the number of asthma exacerbations. 

Informatics is helping patients and physicians to monitor the use of medications and also protect against misuse and insistent exacerbations. Informatics has also been used in discovering reactions to certain medications which help to improve asthmatic treatment prescriptions. Furthermore, it has provided several platforms for patients to discuss and discover symptoms and other related issues.

While the use of social media and applications does not seem to be receiving the expected effectiveness among patients, there is a need for proper education on use. There is also a need for constant upgrading and remodeling of informatics tools to meet up with the growing trend of treatments and response to treatment by patients.