Monday, 21 November 2016

Asthma and Immigration


  • Asthma affects 10% of all Australians (Reddel et al., 2015).
  • The Australian Institute of Health and Welfare revealed that asthma was responsible for the death of 416 people in Australia in 2014 due to incorrect control, which includes lack of knowledge about emotional and physical triggers, use of inhalers and necessary medication (Asthma Foundation, 2015).
  • A recent study from Canberra's Australian Centre for Asthma (Australian Centre for Asthma Monitoring, 2007) found that people with asthma have a higher percentage of anxiety and depression (Goldney, Ruffin, Fisher, & Wilson, 2003) and are more susceptible to report other chronic illnesses and experience a low quality of life (Adams, Wilson, Taylor, Daly, D’Espaignet, & Dal Grande, 2006).
  • The inappropriate control and treatment increase the amount of co-morbidity associated with asthma, hence, increasing complex care and financial costs (Steppuhn, 2014).
  • The government's health costs for asthma in 2009 were $655 million (Australian Centre for Asthma Monitoring & Woolcock Institute of Medical Research, 2007).
  • Recent studies presented at the 2015 Annual Scientific Meeting of the Thoracic Society of Australia and New Zealand highlighted that asthma and allergic diseases are increasing in Australia, which has one of the highest percentages of occurrences in the world (Asthma Foundation, 2015). The studies stated that something in the Australian environment is changing people's DNA, how their bodies work, and increasing susceptibility to respiratory diseases (Asthma Foundation, 2015). 
  • Therefore, it is crucial to raise awareness and provide culturally appropriate informationto
     educate the community in asthma prevention and management (Reddel et al.,2015).

Psychosocial Needs of People who Face a Health Challenge

  • Chang and Johnson (2014) argue that each individual is different and faces health and capacity challenges with different attitudes depending on their developmental history, cultural background, beliefs and social-economic and educational status (Chang & Johnson, 2014). In addition, how each individual responds to the illness varies according to the unique experience of the illness, the prognosis, biological aspects that affect body functioning such as age, type of symptoms, co-morbidities, type of treatment required and social support (Chang & Johnson, 2014). Moreover, the person's psychological behaviour, which includes personality type, level of self-esteem, negative or positive thoughts and emotions applied also play a role (Chang & Johnson, 2014). Chronic and long-term illnesses cause a great impact on patients and their families, bringing changes in their life style, work and relationships (Cukor, 2007).
  • Definition: Asthma is defined by The World Health Organisation as a chronic inflammation of air passages in the lung’s, and causes swelling and obstruction of airflow, as well as
          hypersensitivity of airway nerves, attacks of               breathlessness with noisy cough symptoms
          (Bousquet, 2010).
  • Symptoms: Symptoms worsen at night and can be caused by a number of triggers such as viral infections, changes in weather, allergies to some types of foods, medication, environmental chemicals, dust, pollens, and smoke (Bousquet, 2010).
  • Onset: The onset of the illness is influenced by a number of biopsychosocial life events such as stress due to a decreased immune system, therefore, increasing susceptibility to infections and allergy (Wright, 2011). Maternal stress also increases cord blood, altering the child's immune and respiratory system which is developed and regulated in utero and favour future development of asthma (Wright, 2011).
  • Symptom Control: Symptoms can be controlled by daily consumption of fruit and vegetables and avoiding triggers (except for viral infections) such as food preservatives, smoking, pollutants, dust, and excessive exercise (Australian Bureau of Statistics, 2006).
  • Treatment: Symptoms can be prevented, controlled or alleviated by inhaled corticosteroid medication, elimination of triggers, a mentally and physically healthy life style with a healthy diet and regular moderate exercise (Australian Bureau of Statistics, 2006).

Immigrants Diagnosed with Asthma

  • The Australian Bureau of Statistics states that Australia is one of the most multicultural countries in the world (Tam, Kraayenbrink & Australian Bureau of Statistics, 2006) with 45% of the population being first or second generation of immigrants (Australian Bureau of Statistics, 2009). Only in Queensland, 18% of the population was born overseas (Australian Bureau of Statistics, 2012).
  • It is expected that for every one million immigrants, 25% experience mental illness in their first year (Commonwealth Department of Health and Aged Care, 2004) due to high levels migration stressors (Khawaja, McCarthy, Braddock, & Dunne, 2013).
  • Some of the psychosocial problems that accompany the immigration process include language barriers and difficulties in qualification recognition leading to under-employment, low economic status and housing insecurity (Bhugra & Minas, 2007).
  • Exposure to racism and/or discrimination generate shame, stress and fear, increasing cortisol levels and leading to stress, mental illness and chronic respiratory conditions such asthma (Chung & Shibusawa, 2013).
  • Culture shock, grief and loss of roles, identity and relationships, which cause homesickness, anxiety, depression and a number of somatisations are also experienced by immigrants (Bhugra, 2007). Refugees also come with war traumas and post-traumatic stress disorder symptoms (Pumariega, Rothe, & Pumariega, 2005).
  • Social, cultural and language barriers, income constraints and lack of information about how to access medical and psychological services prevent immigrants receiving assistance at the onset of symptoms (Leu, Yen, Gansky, Walton, Adler, & Takeuchi, 2008). A systematic review of 65 articles from 1980 to 2006 showed that the information provided about asthma in several Western countries is not appropriated for people from CALD backgrounds, which contribute to increased rates of mortality due to asthma (Poureslami et al., 2007).
  • When help is finally sought, emotional issues are not appropriately addressed as general practitioners are not trained to identify somatisations as a consequence of the process of immigration (Multicultural Mental Health Australia, 2010).

    Community Needs regarding immigrants diagnosed with asthma

  • Many Australians and immigrant parents do not have clear information in how to prevent and control their children's and their own asthma symptoms. A cross-sectional web-based survey conducted in 2012 with 2686 Australian participants with asthma showed that there is currently very poor control of the disease with 90% of people unaware of how to utilise the inhaler correctly (Reddel, Sawyer, Everett, Flood, & Peters, 2015).
  • Due to their low English proficiency, immigrants find difficulty communicating with health professionals. This was identified in a qualitative study from 2011 to 2012, where immigrants reported overwhelming anxiety due to their inability to communicate with clinicians and follow the instructions in order to manage their children's medication, which, in turn, increased the children's stress and worsened their symptoms (Riera, Ocasio, Tiyyagura, Krumeich, Ragins, Thomas, & Vaca, 2015).
  • A great number of immigrants and refugees develop asthma as a result of the overwhelming stress experienced, not only during the immigration and settlement process, but also as they age in Australia. A longitudinal study about nativity, duration of residence and chronic health conditions in Australia, conducted by the Alfred Deakin Research Institute revealed that newly arrived immigrants from both English and non-English speaking countries report having less chronic conditions than native-born Australians (Jatrana, Pasupuleti, & Richardson, 2014). However, both groups report the same percentage of a chronic disease, such as asthma, after 20 years of living in Australia (Jatrana et al., 2014). The study suggested that some of the reasons why immigrants' health deteriorates is the embracing of the Australian diet and habits along with the stress caused by immigration and acculturation process (Jatrana et al., 2014).
  • Asthma symptoms seem to be cross-generational. Research shows that, as a result of the exposure to their parents’ migration difficulties, the second generation develops chronic stress, experience conflicts regarding culture, values and identity and are more at risk of developing mental and physical illness in adulthood (Ek, Koiranen, Raatikka, Järvelin, & Taanila, 2008). In addition, many elderly immigrants feel isolated, lonely and depressed (Gerst, Al-Ghatrif, Beard, Samper-Ternent, & Markides, 2010).

Physical and Psycho-social Aspects of People with Asthma

  • Elderly people: Data from the Cooperative Research Centre for Asthma and Airways     indicated that asthma in elderly people causes physical and cognitive impairment, and worsening of symptoms as they are often confused with the usual elderly breathlessness or as a result of other age related illnesses (Jenkins, Douglass, Cousens, & Goeman, 2007). They also underestimate the severity of the asthma and have low medication adherence and self management, leading to undesirable outcomes (Jenkins et al., 2007).
  • Children: A qualitative study of 20 children diagnosed with asthma and 35 parents showed that they require ongoing monitoring and assistance to receive correct medication (Stewart,Masuda, Letourneau, Anderson, & McGhan, 2011). Children fear asthma attacks, death and the future, suffer frustration because of restrictions regarding food and pets, anxiety and isolation as they are not allowed to participate in normal social activities (Stewart et al., 2011). They also do not receive explanations about their condition from anyone but their parents (Rand & Butz, 2008) and they would like to see their friends being educated by their teaches about the asthma and the associated restrictions (Stewart et al., 2011).
  • Adults: Warren-Findlow's (2010) studies demonstrated that psychosocial aspects of asthma vary according to gender (Warren-Findlow, 2010). Women have higher rates of asthma severity, life activity limitations, psychological distress, anxiety, insomnia, low energy levels, hospitalisation, low quality of life and mortality than men (Warren-Findlow, 2010). These rates are attributed to women's hormonal levels, changes related to puberty, menstrual cycles, use of contraceptives, pregnancy and menopause (Warren-Findlow, 2010). Women are also more sensible regarding symptoms and changes in their body than men, resulting in more regular accessing of to health care systems (Warren-Findlow, 2010).

Natural tips to prevent asthma

1. Avoid asthma triggers
2. Practice relaxation techniques
4. Exercise regularly
5. Have a good night sleep
6. Drink healthy water (with no fluoride)
7. Avoid sugar, soft drinks, aspartame and junk food
8. Have a healthy diet rich in vegetables, fruits and omega-3
9. Avoid stressful people and activities
10. Vitamin D supplement taken in addition to asthma management, lower the risk of severe asthma attacks, and reduced the need for medication with no side effects (Jensen, M., 2016).
11. Understand the causes and how to manage emotions such as anxiety, anger, fear, and stress as these emotions change heart-rate and breathing patterns causing constriction of airways and can consequently lead to asthma attack.

Mrs Glaucia Barbosa,
PACFA Reg. Provisional 25212 
MCouns, MQCA(Clinical)  

                                                               ABN: 19 476 932 954

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