Asthma


Overview


Asthma is a condition of chronic respiratory illness typically characterized by bouts of difficulty breathing due to inflamed and constricted airways coupled with further obstruction by increased mucosal secretions. Coughing, wheezing and shortness of breath are typical symptoms. Asthma “attacks” - reversible exacerbations of the illness – can be triggered in some persons by different factors present in the environment.


Health Impact


Asthma is an important disease for clinical medicine because of its chronic nature.
Illustration of mechanism of asthma
Illustration of mechanism of asthma

Medical systems in the United States and many countries are challenged to provide quality care for asthma patients because there is no cure for the disease and in many cases it requires treatment with consistent medical maintenance through regular examination, testing and medications[1] .

The disease has tremendous significance for public health as well because its frequency has increased rapidly among many populations within the United States and across nations. Approximately 24 million Americans have asthma including an estimated 7 million children. Globally, an estimated 235 million people suffer from asthma. It is the most common chronic affliction among children worldwide[2] .

Asthma affects some groups more often than others. African-American and Latino children are more likely to suffer asthma than white children in the United States. Persons, especially children, residing in low-income communities also suffer disproportionately higher rates of asthma. While asthma occurs across industrialized and low-income nations, most of the morbidity attributable to the disease occurs in developing countries[3] .

During an asthma attack, a person’s bronchioles become inflamed, constricted and blocked with mucus so that breathing becomes difficult. People suffering regular asthma attacks often have less energy, lower productivity and may, as a result, be constrained from participating in some many activities like physical work, exercise and athletics.

Despite the great significance of the disease and large amounts of funding dedicated to researching it, asthma remains an at-best imprecisely defined illness. No single precise definition for the disease exists. There is debate among some medical researchers, clinicians and other scientists about how to best conceptualize asthma in relation to other chronic respiratory illnesses that have also increased in prevalence in recent decades[4] .

One perspective calls recategorization of asthma, along with chronic obstructive pulmonary disease (COPD) and chronic bronchitis, as components of a single common airway disease. Another critical perspective proposes that the term “Asthma” be abolished entirely because its descriptive utility has not kept pace with the evolution of understanding about the suite of similar syndromes to which it has been (mis)applied[5] .

Medical Anthropology Research


Medical anthropology has contributed to understanding of asthma and other chronic respiratory illnesses in significant ways. Anthropologists have used ethnographic inquiry to elucidate the lived experience of children and their families in communities where disproportionately high rates of the disease occur among marginalized social, ethnic and economic groups. In Childhood Asthma on the Northern Mexico Border Norah Anita Schwartz describes how confusingly imprecise asthma definitions and diagnoses add additional burden from children’s asthma onto households in Tijuana, Mexico[6] .

In their study, Childhood Asthma, Air Quality, and Social Suffering Among Mexican Americans in California’s San Joaquin Valley: “Nobody Talks to Us Here,” Schwartz and David Pepper apply ethnographic inquiry to explore the contradiction between reportedly low rates of pediatric asthma among migrant farm working families and the reality of high rates among that community residing in central California’s produce-producing region. They offer a comparison between lived realities of communities experiencing asthma on both northern and southern sides of the international border and stress that macro-scale population studies of the illness are likely to overlook these communities[7] .

Another significant medical anthropology contribution to understanding asthma is Janice Harper’s Breathless in Houston: A Political Ecology Approach to Understanding Environmental Health Concerns. The study employs a less often utilized methodological approach in that it integrates political analysis of social relationships of power and health policy-formation and an ecological analysis of interactions between environmental determinants and human health[8] .

Applied Work


An example of how applied medical anthropology has investigated asthma is found in Rich, Patashnick and Chalfen’s work, Visual Illness Narratives of Asthma: Explanatory Models and Health-Related Behavior. For their study, the authors elicited visual illness narratives to understand the relative significance of education and other sources of explanatory modeling like cultural beliefs and personal experience for more effective behavior change and respiratory health treatment interventions[9] .

Online Resources


The following links describe the work done by a social activist on behalf of a socioeconomically challenged community where the mostly African American and Latino residents suffer high burdens of asthma and other illnesses because of their exposures to air pollutants produced by a nearby Shell Petroleum Company processing station.






The following link opens a video clip about a form of nonpharmaceutical asthma treatment used by some asthma sufferers in India.
http://youtu.be/4CGr6z954Og

The American Lung Association’s Asthma website offers additional information about the problem.
http://www.lungusa.org/lung-disease/asthma/



Further Reading


Jackson, M. 2009 Asthma: the biography. New York: Oxford University Press.

Lehrer, P. M. 1998 Emotionally Triggered Asthma: A Review of Research Literature and Some Hypotheses for Self-Regulation Therapies. Applied Psychophysiological

Matricardi, P. M., G. R. Bouygue, and S. Tripodi 2002 Inner-city Asthma and the Hygiene Hypothesis. Annals of Allergy, Asthma, and Immunology 89(6, Suppl 1):69–74.
Biofeedback 23(1):13–41.

Scadding, J.G. 1983 Definition and clinical categories of asthma. In: TJH Clark and S Godfrey, Editors, Asthma, Chapman and Hall, London, pp. 1–11.

Wenzel, S. 2006 Asthma: Defining of the Persistent Adult Phenotypes. The Lancet, Volume 368, Issue 9537, 26 August 2006-1 September 2006, Pages 804-813.

Whitmarsh, I. 2010 Asthma and the Value of Contradictions. The Lancet, Volume 376, Issue 9743, Pages 764 - 765, 4.

Whitmarsh I. 2008 Biomedical ambiguity: race, asthma, and the contested meaning of genetic research in the Caribbean. Ithaca: Cornell University Press.

References


  1. ^ Asthma and Allergy Foundation of America: website: Asthma Facts and Figures Accessed May 02, 2011.
  2. ^ Asthma and Allergy Foundation of America: website: Asthma Facts and Figures Accessed May 02, 2011.
  3. ^ World Health Organization website: Health Topics: Asthma http://www.who.int/topics/asthma/en/ Accessed on May 02, 2011
  4. ^ Hargreave, F.E. and Parameswaran, K. (2006). Asthma, COPD and bronchitis are just components of airway disease, Eur Respir J 2, pp. 264–267.
  5. ^ Anonymous 2006, A Plea to Abandon Asthma as a Disease Concept The Lancet, 368.
  6. ^ Schwarz, A. 2004 Childhood Asthma on the Northern Mexico Border Medical Anthropology Quarterly, 18:2, 214-229.
  7. ^ Schwarz, A. Pepper, D. 2009 Childhood Asthma, Air Quality, and Social Suffering Among Mexican Americans in California's San Joaquin Valley: "Nobody Talks to Us Here", Medical Anthropology, 28: 4, 336-367.
  8. ^ Harper, J. 2004 Breathless in Houston: A Political Ecology of Health Approach to Understanding Environmental Health Concerns. Medical Anthropology 23(4): 295–326.
  9. ^ Rich, M. Chalfen, R. 2002 Visual Illness Narratives of Asthma: Explanatory Models and Health-related Behavior American Journal of Health Behavior.