Question:
Write an essay on The causes of asthmatic bronchitis.
Every time a person breathes in, the air enters through the nose and mouth. The air then flows down one’s throat into a series of passages of air called the bronchial tubes. These tubes are supposed to be open so as to allow for the air to reach the lungs where the oxygen gets passed into the blood plasma to be transported into one’s body tissues. If inflamed, the airways get complications with the air being blocked as the passage becomes impossible (Anon, 1975, 16). With the passage being blocked and less air getting in, there is a shortage of air in the lungs and as such, breathing difficulty becomes imminent. The individual becomes and feels short of breath. This may lead to an obvious case of wheezing and or coughing in an attempt draw in more oxygen via the tightened passageways.
Bronchitis and asthma are known to be two inflammatory airway disorders. Acute bronchitis refers to an inflammatory condition of the airway lining that normally recovers itself after going through its course. The causal agents for this condition are either viruses or bacteria. Chronic bronchitis, on the other hand, being the longest regarding its shelf-life is triggered by one being exposed to environmental agents of irritation like tobacco, dust, smoke and chemicals among other irritants (Springer, 2016, 33). Asthma, on the other hand, is an inflammatory disorder that causes the tightening of muscles surrounding the airways as well as their swelling which in most cases, causes the airways to narrow (Springer, 2016, 30).
The causes of asthmatic bronchitis
There are many triggers known to trigger the release of inflammatory elements. The common trigger of asthmatic bronchitis includes tobacco smoke, allergens like pollens, dust, mold, food additives, chemicals, some groups of medications like aspirin and beta-blockers, weather changes and viral or bacterial infections.
The symptoms of asthmatic bronchitis include shortness of breath, wheezing, tightness in chest, coughing and mucus production in excess. It should be noted that asthmatic bronchitis is not contagious (Springer, 2016, 30).
DRG refers to a system of patient classification based primarily on their related diagnosis and co-morbidities, complications and procedures that form the basis for calculating the public hospital funding in Australia. In full, AR-DRGs is Australian Refined Diagnosis Related Groups, which in this brief, Asthma and Bronchitis is given attention. The DRG consists of 670 patient classes and which are allocated classes that are used to determine their weighted inlier equivalent separation (WIES) value for a given patient admission which ultimately, is assigned a dollar value (Hosford-Dunn, et al., 2008, 12). Essentially, a DRG program is put in place to help determine the kind of DRG is suitably assigned for a given patient based on the coded ICD analysis, additional diagnoses as well as other procedural codes (Hosford-Dunn, et al., 2008, 12).
DRG standards in Australia
The National Case-mix and Classification Centre formed part of the Australian Health Services Research Institute and was formed in March 2010 after efforts by the University of Wollongong in its move to develop international Statistical Classification of Diseases and Related Health Problems among other major health concerns (Mackay, B., 1995, 9).The Australian Health facilities have thus adopted a DRG coding system at which point 23 major categories of diagnoses are based. For any patient admission, a DRG Grouper analysis is carried out which then allocated individual patient based on age, sex, their clinical edits and consequently, assign them an MDC, performs a pre-MDC processing on them, assigns adjacent DRG and then compile and comorbid the level and determines the level of the complexity of the PCCL assignment. After determining the above, it then becomes clear for the DRG Grouper to assign a patient a DRG (Mackay, B., 1995, 9).
The common notable DRG codes for admissions without catastrophic co-morbidities with this respect in UTS Hospital is E69B.
By definition, Asthma is a chronic inflammatory condition of the airways. Among susceptible individuals, the inflammatory processes cause some recurrent episodes of collagen deposition, breathlessness, cough, chest tightness and wheezing. These episodes are normally accompanied by variable obstructions of air which are sometimes reversible by treatment or just a spontaneous process (Moore, G., 1890, 11).It should be noted that asthma inflammations are characterized by hyper-reactivity of the bronchial. The inflammation, therefore, becomes the result of the vasodilation as well as the increase of the vaso-permeability and endothelial adhesiveness to the leukocyitic cells from circulation to the body tissues and fluid (Moore, G., 1890, 11).
Close to 22 million Australians have asthma, and it is among the common chronic diseases among children whose numbers are capped at 6 million. The weight of the disease affects not only the patients but also the families and society as a whole regarding schooling and other costs that are directly related to production (Anon, 2009, 10). An improved scientific concept of understanding the asthma conditions has seen remarkable interventions that have posed significant improvements on how to handle cases of asthma. There are no exact causes of asthma, and it is believed to be as a result of the combination of several factors even though the two main factors are thought to include environmental and genetic factors (Anon, 1973, 143-144).
This report includes a multi-scenario forecast for asthma therapeutics in Australia. The current asthma treatment guidelines and choices, a detailed pipeline analyses, a clinical trial result, the main drivers and barriers, the promising pipeline molecules and the strategic as well as co-development deals among the key players in therapeutic asthma markets.
Treatment of asthma can be classified as either long term meditation or a quick relief meditation that are aimed at relieving the exacerbations as well as the acute symptoms. The long term control meditations are known to include Inhaled Corticosteroids, immunomodulators, cromolyn sodium, nedocromil, methylxanthines and leukotriene modifiers (Tulchinsky et al. 23). Additionally, the long acting beta-adrenoceptor Agonists also abbreviated as LABAs can be made use of when combined with inhaled corticosteroids. This should however not be used a monotherapy for the severe or mild asthma. To date, only one biologic omalizumab is recognized and approved as an add-on treatment of therapy for allergic asthma in Australia. Nonetheless, there is an unfulfilled need that is yet to be met, and that is the treatment of acute eosinophilic asthma (Tuberculosis, 1969, 21).
The contemporary asthma market in Australia contains novel products that include Xolair, which is a recombinant humanized monoclonal anti-IgE antibody, seretide/ Adoair, an ICS-LABA among others. Having over 274 molecules, some late stage investigational f=drug candidates are under evaluation with improved dosing administration and regime routes being compared to the contemporary market products (Einf, 1970, 24-26). The analyses of the clinical trials carried out since the year 2006 has brought about the identification of failure rates when it comes to asthma molecules. These were capped at the highest rate being in Phase III representing a percentage of 46, an overall attrition rate of the development of asthma being capped at 78 percent (Lorig, K. 2012, 17). In the forecast period of between 2017 and 2021, the asthma therapeutics in the Australian continent is expected to rise in value at a compound annual growth rate of 7.2 percent that ranges from $3.5 billion to close to $5.6 billion (Maddock, A.,1855, 18).
The rising prevalence and the uptake of newer biologists are projected to have a significant market growth in the course of the forecast period despite the affordability issues.
This report will help the UTS hospital governing council in-
Notably, there are comparatively a trivial number of patients having chronic medical conditions, and this accounts for the larger percentage of the inpatient costs. There is some considerable evidence asserting that case management can help in improving the quality of life health wise as well as reducing the number of time a patient can get readmitted. To establish whether or not a statistical algorithm can be employed in identifying patients risks of readmission and whoever will derive benefits from the case management (Understanding bronchitis and asthma, 1965, 296).
The UTS database for the hospital patients who had at any time secured an emergency admission for the chronic medical disorders like the congestive heart failure, the chronic obstructive pulmonary disease, and dementia among others. The multivariate logistic regression was employed in developing an algorithm for the prediction of readmission within a given period of time. The performance of this algorithm was piloted against recoded readmissions with such considerations done on sensitivity, likelihood ratios and specificity (Russell, H., 1934, 231-231).
There were several factors that were identified to serve as sure predictors of readmission, that is, age, economic disadvantages, co-morbidities and previous cases of admissions among other factors. The power of discrimination model proved to be modest as was determined by the area under receiver operating characteristics known as the ROC curve denoted as c and caped at c= 0.65. At a score threshold that is capped at 50 and which is considered a risk zone, the algorithm was identified to be 44.7 percent of the patients who were admitted with a condition of admission being in the 12 months of 37.5 percent of the patients flagged incorrectly (Shayevitz, M., & Shayevitz, 1991, 31).
The statistical algorithm based on the UTS hospital data accomplished just some moderate identification of patients at risk of getting readmitted.
The data for the patients in the public sector came from the UTS hospital, meaning that the inter alia, the demographic traits of patients, the principal diagnosis, the other treated conditions, and other procedures performed to the effect. The UTSHAPDC is kind of similar to the routine databases of the inpatient in some states and territories within the Australian continent and is also more likely to differ substantially from the states in the United Kingdom (Simpson, A. 1857, 57).
In the survey, a list of 28 conditions was made use of. These included congestive heart failure, the chronic obstructive pulmonary disease, and dementia among others.
Below is the reference table used in defining cases for the predictive algorithm.
Patients were picked for inclusion in this study if they had any form of an emergency inpatient admission for the reference condition. The admissions represented a percentage of the inpatients identified to be using the AR-DRG codes as well as the emergency admissions of inpatients as defined in the treating physician’s opinion.
In case the patient had more multiple emergency admissions, the first admission is taken as the trigger for the admission for purposes of consistency with the precious studies. Sensitivity analyses carried out indicated that patients with multiple admissions made no difference concerning the results whether the first or the last admission was selected for purposes of triggering the admission (Watts, R. 1999, 249-252).
Patients were classified as either readmitted if within the first 12 months after discharge for purposes of initiating admission, they had witnessed at least an acute admission.
The predictor variables
The demographic characteristics of the area of focus were obtained from the trigger entry and entailed such factors as sex, age, Indigenous statuses, socioeconomic status and marital status among other traits. The Indigenous status was collected from the UTSHAPDC and categorized as non-indigenous versus native. The use of SEIFA mainly characterized the socio-economic status, particularly noted as the social and economic indexes for the areas, the index of the disadvantages and advantages based on the Australian Bureau of Statistics. This is by all means a composite measure describing an area advantage or disadvantage based on the range of social as well as economic factors based on the census data (Weissflog, D. 2000, 333).
The presence of the co-morbidities recognized from the perspective of both primary and secondary diagnoses for the trigger of admission as well as the acute admissions before the trigger makes up the event. Having the decision to carry out an evaluation of the comorbidities throughout the admissions including the admission for trigger was meant to give an account of the potential lapses as used in the coding of the various diagnoses. The comorbid conditions in the question were synonymous to the reported study in the United Kingdom (Weissflog, D. 2000, 333).
The comorbidity conditions as evaluated in the development of risk algorithm
Statistical algorithm
The predictive algorithm as developed through the use of logistic regression. This regression was applied to the SAS version of 9.1. The predictor measures were given a further analysis within the natural groups and aimed at minimizing the co-linearity and the prevention of a vast number of the conceptually equal measures from doing anything close to saturating the archetype. For instance, the social demographic variables entered into the regression model as a group identifying the best subset for purposes of the proposed selection methods (Maddock, A., 1855, 24).
For the purpose of consistency, the previous admissions as enumerated preceded the trigger admissions for the number of years. These included such things as any forms of admission or the kind of emergency admission. The measures so displayed indicated the natural skewness of the hospital use of data which was seen to be resolved through the measure of the ordinal variable being categorized as 0, 1, and 2 and so on.
Works Cited
Anon, 1998. Clinical management of HIV and AIDS at district level, New Delhi: World Health Organization, Regional Office for South-East Asia.
Anon, 1975. Health and safety a survey of provisions in labor agreements in the federal service, October, 1975, Washington, D.C.: The Office.
Asthma. SpringerReference. https://doi.org/10.1007/springerreference_44133
Bronchitis, Chronic. SpringerReference. https://doi.org/10.1007/springerreference_110130
Hosford-Dunn, H., Roeser, R.J. & Valente, M., 2008. Audiology: practice management, New York: Thieme.
Mackay, B., 1995. Kaupapa Maori and responsiveness: management responsiveness to Maori health issues in the reformed health service of the 1990’s: a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Policy, Department of Social Policy and Social Work, Massey University, Aotearoa,
Moore, G., 1890. Bronchitis and asthma: their spray and pneumatic treatment, London: James Epps.
Anon, 2009. Personalized Data Service For Master Data Management. Proceedings of the International Conference on e-Business.
Anon, 1973. Foundations for Health Service Management. Public Health, 87(4), pp.143–144.
Tulchinsky, T.H. & Varavikova, E., The new public health,
Tuberculosis, Climate, Asthma and Chronic Bronchitis. (1969). https://doi.org/10.1159/isbn.978-3-318-00064-1
Lorig, K. (2012). Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, depression, asthma, bronchitis, emphysema, and other physical and mental health conditions. Boulder, CO: Bull Pub. Co.
Maddock, A. B. (1855). Pulmonary consumption, bronchitis, asthma, chronic cough and various diseases of the lungs, air-passages, throat, and larynx successfully treated by medicated inhalations; illustrated with cases. Philadelphia: Vanhorn.
Understanding bronchitis and asthma. (1965). Public Health, 79(5), 296. https://doi.org/10.1016/s0033-3506(65)80050-6
Russell, H. S. (1934). Asthma and Chronic Bronchitis. Bmj, 2(3839), 231–231. https://doi.org/10.1136/bmj.2.3839.231
Shayevitz, M. B., & Shayevitz, B. R. (1991). Living well with chronic asthma, bronchitis, and emphysema. Yonkers, NY: Consumer Reports Books.
Simpson, A. (1857). Compressed air as a therapeutic agent: in the treatment of consumption, asthma, chronic bronchitis and other diseases. Edinburgh: Sutherland and Knox.
Watts, R. W. (1999). Asthma Management In Rural Australia. Aust J Rural Health Australian Journal of Rural Health, 7(4), 249–252. https://doi.org/10.1046/j.1440-1584.1999.00235.x
Weissflog, D. (2000). Prs17: Epidemiology and Costs Of Bronchial Asthma And Chronic Bronchitis In Germany. Value in Health, 3(5), 333. https://doi.org/10.1016/s1098-
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