GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A A)

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1 GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1 Pre-release Article for Examination in January 2010 JD*(A A)

2 2 BLANK PAGE

3 3 Information for Teachers The attached article on asthma is based on some information downloaded from the internet. The asthma charter, quoted in the article, is published by Asthma UK. The article is intended as stimulus material in order to generate discussion and an understanding of the issue concerned. Questions will be set on the examination paper based on the information in the article and related aspects from the specification. No recall or terminology is required over and above that in the specification. It is anticipated that the material will be given to and discussed with students beforehand, in order to develop their understanding and interpretation of the techniques mentioned in the article along with the applications and surrounding issues. Students will be expected to have studied the article and relevant specification content prior to the examination. However, they will not be expected to memorise any part of it as a copy will be provided in the examination paper. Turn over.

4 4 What is asthma? Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a person is exposed to certain triggers: The lining of the airways become swollen and inflamed; The muscles that surround the airways tighten; The production of mucus is increased, leading to mucus plugs. All of these factors will cause the airways to narrow, thus making it difficult for air to go in and out of your lungs, causing the symptoms of asthma. Causes of Asthma There are a wide variety of triggers for asthma which are summarised in the table below. Allergens Allergens include: pollen; mould; animal protein (dander, urine, oil from skin); house dust/dust mites; cockroaches; certain foods. Irritants Irritants include: strong odours and sprays, such as perfumes, household cleaners, cooking fumes, paints, and varnishes; chemicals such as coal, chalk dust, or talcum powder; air pollutants; changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds; chemical-exposure on the job, such as occupational vapours, dust, gases, or fumes. Exercise Exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Longterm strenuous activities such as long distance running, are most likely to induce asthma, and swimming is the least likely. Smoke Tobacco smoke, whether directly or passively inhaled, has been shown to worsen asthma. Wood smoke from wood-burning heating stoves and fireplaces can release irritating chemicals such as sulfur dioxide. Respiratory Infections and Sinusitis Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma. Sensitivity to Medications Medications cause up to 20 percent of adult asthmatic attacks as a result of sensitivities or allergies to them. These medications often include: aspirin; other non-steroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen. Gastroesophageal reflux GERD, a condition characterized by persistent reflux of stomach acids, is common in individuals with asthma. Symptoms may include heartburn, belching, or spitting up in infants. Emotional Anxiety and Nervous Stress Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack. ( A)

5 5 Symptoms Of Asthma Asthma symptoms begin when the body's immune system detects an infection in the airways and releases white blood cells to the area. These white blood cells cause the airways to become inflamed and fill with mucus. This process in asthma sufferers is overly sensitive and the swelling reaches a point where breathing becomes difficult. Typically, asthma symptoms include tight chest, gasping, wheezing and coughing. Severe asthma attacks can cause the pulse to increase, the lips and finger nails to turn blue, skin around the chest and neck to tighten and the nostrils to flare. Asthma symptoms vary and can develop quickly or over a longer period (6-48 hours in some cases). Asthma can be worse during or after exercise or at night. If untreated, airways can become completely blocked and breathing stops resulting in death. Diagnosing Asthma Asthma symptoms are usually only present at the time of an asthma attack and so diagnosis should be undertaken by a GP. A GP will ask about family history, allergies, medications and working environment to determine a history of the condition and identify a common trigger of the asthma attack. Breathing rate and the presence of wheezing are also good indicators to asthma. A GP may also employ tests to assist in the diagnosis of asthma. These may include peak flow monitoring and spirometry. These two tests are outlined below. Peak flow monitoring (PFM) - a peak flow meter is used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled. Turn over.

6 6 Spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons: to determine how well the lungs receive, hold, and utilize air; to monitor a lung disease; to monitor the effectiveness of treatment; to determine the severity of a lung disease; to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow); to determine FVC values; to determine FEV 1 values. What is the cost of asthma? 5.4 million people in the UK are currently receiving treatment for asthma: 1.1 million children (1 in 11) and 4.3 million adults (1 in 12). There were 1,200 deaths from asthma in the UK in 2006 (40 were children aged 14 years or under). On average, 3 people per day or 1 person every 7 hours dies from asthma. An estimated 75% of hospital admissions for asthma are avoidable and as many as 90% of the deaths from asthma are preventable. Asthma costs the NHS nearly 1 billion pounds per year. Pet allergens affect 56% of asthma sufferers. One in ten children has asthma. Nearly 13 million working days are lost each year to asthma. Mortality rate from asthma The mortality rate from asthma in 2006, according to age range, is summarised in the following table. Sex Male Female Total Mortality per million of age group in 2006 All ages

7 7 Where do we stand? It is not known what causes the majority of people s asthma. At present, we do not know how to prevent it and we are unlikely to be able to cure it. Consequently, quality of life depends on the care, treatment and support that people with asthma receive from the NHS. In 2003 Asthma UK launched The Asthma Charter. This outlines what people with asthma have a right to expect from the NHS. The charter was developed using the British Guidelines on the Management of Asthma and by asking people with asthma about their top priorities for NHS care. The Asthma Charter As a person with asthma I have a right to: 1 High-quality treatment, care and information from asthma-trained healthcare professionals who know about best practice and the latest evidence. 2 Access to a doctor or nurse who has had specific asthma training, at either my own GP practice or in my local area. 3 Have my asthma quickly and accurately diagnosed, with referral to a respiratory specialist if necessary. 4 A full and open discussion with my doctor or nurse about the best asthma treatments for me, including side effects, regardless of the cost of the treatment. 5 Be shown how to use the devices needed to keep my asthma under control (e.g. inhalers and spacers). 6 Discuss and agree my own personal asthma action plan with my doctor or nurse so that I can keep my asthma under control. 7 Have my asthma reviewed at least once a year (more frequently if I have severe asthma symptoms) at a time convenient to me, or in the case of my children, every six months. 8 Be referred to a respiratory specialist if my asthma is becoming unmanageable and to be admitted to a specialist respiratory unit if I need to go to hospital. 9 Have follow-up appointments made with my doctor and my specialist before I am discharged from hospital or leave A&E. 10 Expect any people working in the NHS that I need to contact to be aware of the serious risks I face if my asthma symptoms are deteriorating (e.g. practice receptionists, ambulance personnel, and staff working for NHS Direct, NHS24 and HPSS 24).

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