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Because asthma is a complex condition with a wide array of symptoms, Janson notes it is often difficult for health care practitioners without extensive experience in the field to accurately diagnose and treat the disease.

“Often, patients will also have allergic rhinitis or gastric esophygeal reflux, and if these conditions aren’t treated, they can exacerbate asthma,” Janson said. “Older patients are often misdiagnosed with chronic obstructive pulmonary disease when, in fact, they have asthma.”

Janson recommends that all nurses who work in primary and acute care take a CEU class on asthma management.

“Because so many people are being diagnosed with asthma, it benefits all nurses to learn about devices such as peak flow meters, and how to recognize the signs of an asthma attack, which can mimic the signs of a heart attack,” Janson said.

The hygiene hypothesis

Some nurses, including Gayle Traver, RN, MSN, a pulmonary clinical nurse specialist at the Arizona Respiratory Center and University Medical Center in Tucson, Ariz., cite the hygiene hypothesis as a possible explanation of why asthma is on the rise.

The hypothesis revolves around a theory originally developed by David Stratham, MD; the theory was further studied by health researcher Erika von Mutius, MD. She compared the rates of allergies and asthma in East and West Germany in the late 1990s. Her hypothesis was that children growing up in the poor, dirty, and generally less healthful cities of East Germany would suffer from more allergy and asthma symptoms than youngsters in West Germany, where it is typically cleaner and the environment is more modern.

When the two regions were unified in 1999, von Mutius compared the disease rates and found exactly the opposite. Children in the polluted areas of East Germany had lower allergic reactions and fewer cases of asthma than children in the West.

Those who support the hygiene hypothesis propose that children who are around other children and animals early in life are exposed to microbes, which help their immune systems to mature and develop, and their immune systems develop more tolerance for the irritants that cause asthma.

“While those who support this hypothesis don’t recommend letting our children become critically ill, it does raise the possibility that preventing early diseases through vaccinations and antibiotics may not allow our immune systems to mature properly,” Traver said.

“We are a society that definitely prides itself on being ultraclean and using antibacterial soaps, and maybe this isn’t always best.”

Looking back over the last 40 years of asthma management, Traver notes that dramatic improvements have been made in patient care.

“Years ago, we only saw asthma patients who were having acute severe exacerbations and there was little chronic management or emphasis on prevention,” she said. “When we did treat these exacerbations, the medications we used had many more side effects than those available today.”

Traver sees a growing need for nurses who are more knowledgeable in asthma care to better educate patients.“Working with asthma patients is a constant education process,” she said. “If we can help patients effectively manage their symptoms and recognize triggers, we can prevent them from progressing to the point of chronic airway obstruction.”

Lisa Nicoud, RN, director of critical care services at North Vista Hospital in Las Vegas, says that despite advances made in asthma care, many patients continue to be plagued by the stigma of being labeled asthmatic.

“Many patients don’t see having asthma as a lifelong condition that constantly needs to be monitored,” she said. “As nurses, I think we have a responsibility to impress the seriousness of the condition upon patients.”

Nicoud would also like to see programs that track noncompliant patients. “We have patients who come into the hospital for an asthma attack and then we don’t see them until their next flare-up,” she said. “I’d like to see us address the emotional aspects of asthma and offer more support groups and educational resources for patients.”

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Additional information and fact sheets on asthma are available on the American Lung Association website at www.lungusa.org. For more information on asthma education classes for nurses or volunteer opportunities within the American Lung Association, call (800) LUNG-USA.