Asthma is a chronic lung disease caused by inflammation of the lower airways and episodes
of airflow obstruction. Asthma episodes or attacks can vary from mild to life-threatening.
In 2007, about 7% percent of the U.S. population was diagnosed with asthma and there has
been a growing number of new cases since that time. There are several known risk factors
identified as triggers of asthma symptoms and episodes, including inhalation of allergens or
pollutants, infection, cold air, vigorous exercise, and emotional upsets. There is also
growing evidence relating body-mass index to asthma in both children and adults. Design a
study to investigate whether there is such an association.
Choose a study design and justify the reasons you chose the design over others.
Select a statistical measure you would use to describe the association (if there is one)
between body mass index and asthma.
In addition, address:

  1. Subject selection
  2. Issues relating to the measurement of both the exposure and the outcome
  3. Potential biases that the study might be prone to, and how they might be handled
  4. Possible confounding factors and effect modifiers and how to overcome their effect
    Present the information in a report, using section headings where each requirement is
    described and justified under each of the following headings: Study Design, Statistical
    Measures, Subject Selection, and Measurement Issues


This paper is a review of a man with COPD (chronic obstructive pulmonary disease) aged
above 40 years but also a smoker. Furthermore, it will appraise features, pros and cons of the
three databases used. At the onset, nursing research in this domain offer novel insights into
practice that enhance and advance methods of caring and the efficacy of care for persons with
COPD. However, there is no single prognosis experiment for COPD; hence carrying out the
analysis is anchored on clinical review that base on history, age, physical structure and

Epidemiology 2

determining airflow obstraction by spirometry. For smokers cough is closely monitored.
Prolonged oxygen treatment, regular screening of pulmonary and treatment are commonly
recommended. Despite the public consciousness regarding the negative impacts of smoking,
COPD remains a health predicament and leading cause of death around the globe (Hoyt, 2006).

Clinical Scenario Analysis
The COPD patient in this case should undergo respiratory analysis so as to determine the
seriousness and also gather informed consent of the condition. This helps establish heart beat,
pulse rate and wannabe inconsistencies. For healthy persons, the rate should be roughly 14-20
breaths in a minute. This also ensures that the patient does not alter breath patterns. Respiratory
analysis was also done to determine the volume of oxygen that is inhaled and exhaled. Here the
diaphragm, sternomastoid and intercostals morphology are check for healthy persons (Crossley,
et, al. 2010). Certified nurses are required to observe closely, this helps determine if it generates
a musical resonance which is rather well-known on cessation. A keen observation on clatter is
necessary to establish if it generates a fizzy sound emanating from fluid in the upper airway. The
patient is also checked for air shortage. Because the patient is a smoker, cough is also closely
monitored especially with a deep stimulation that follows a volatile expiration. This helps
determine the presence of sputum (Saint, et al.2005).. Analysis of the physical condition by a
professional nurse accelerates the use of collaborator muscles. Exhaustion, confusion, anxiety
and insensitivity should also be checked by the medical expert. An evaluation of non-verbal
expression of pain related to breathing, especially when breathing in or out. This occurs when air
is expelled through a narrowed brochi and bronchioles. In most cases a hiss is noticed.

Epidemiology 3

A prelude scoping was conducted to establish any implemented structure to analyse
guidelines on COPD. Data was sought from three databases including Medline, CINAHL and
PubMed Central published from 2007-2010. Key words employed include; COPD and Smoking,
chronic obstructive pulmonary disease, health promotion and public health, although suggestions
were integrated by way Boolean operators, truncation and the use of OR and AND so as to
establish accurate articles.  A methodical search from sites was used to determine the other rules
and recommendations not indexed in the reference database. Among the many sources used
include; Science Direct, Blackwell Synergy, National Institute of Clinical Excellence (NICE),
Health development Agency (HAD). Management and treatment, features, pros and cons of the
three databases were some of the key words. To ascertain that searches specifications, PICO
(population, intervention, counter-invention and outcome was applied precisely. The target
demographics was 40 years and above. All theories were analysed, incorporated UK
recommendations were reviewed by way a standard system. The review of COPD proposed
periodicals are summed up accordance to this system. The basis of this analysis was to establish
the legitimacy of affirmations made by COPD researchers (Hoyt, 2006).

Management of the Condition
This paper substantiates that in nursing, it is commonplace knowledge that hypoxemia patients
with COPD are treated by oxygen, antibiotic as well as corticosteroids. Nevertheless, in
circumstances where patients exhibit no response to bronchodilators, mythylxanthine
management is applied. Antibiotic is normally employed for prevalent microbes such as

Epidemiology 4

streptococcus, haemophilus influenzae and so forth. Clinical research shows that antibiotics such
as; doxycycline and amoxicillin-clavulanate potassium are applied to manage mild COPD (Saint,
et al.2005). Conversely, management of severe COPD requires oxygen treatment and the patient
to quit smoking. Caring for persons with COPD can be a nightmare owing to operation
challenges and anxiety of airflow. Subsequently, they undergo recurrent exacerbations which
commonly oblige care giver concern. Ultimately, medical practitioners may be faced with ethical
dilemmas when it comes to euthanasia. Since there’s no cure for COPD, management of patients
should gear toward alleviating symptoms and restoring the evidence based competence.

Oxygen saturation

Early management of patients with COPD should basically endeavor to manage oxygen
concentration at 90% or more. Oxygen condition can be managed either clinically or through
pulse oximetry. However, supplementation of oxygen through nasal cannula is regularly
required. With chronic exacerbations, intubation technique like CPAP or continuous positive
airway pressure is crucial to provide enough oxygen. These kinds of intervention measures are
necessary in cases where hypercapnia is there, frequent exacerbations or incidences of altered
psychological condition. Other than avert smoking, oxygen supplements is the only essay that
has been demonstrated to decrease deaths in COPD patients. As such oxygen supplements should
be administered to hypoxemia patients with a PaO2 of about 55mm hg, or oxygen diffusion of
above or below 88% wile asleep. In addition, LTOT or long term oxygen therapy should be
measured in patients with a PaO2 less than 55mm hg while awake and asleep, while in
polycythemia, hypercecapnia and primary hypertension; PaCO2 is over 45 mm hg, CPAP is
usually considered for people suffering from severe hypercapnia. Previous medical evidence

Epidemiology 5

show remarkable reductions of inpatients for severe exacerbations among patients managed with
both CPAP and LTOT (Caruana-Montaldo et, al. 2000).


In severe exacerbations of COPD, inhaled beta2 agonists has to be directed instantly. To
increase the flow of medicine in airways, nebulizer and similar agent containing saline and
oxygen should be used. Although, in case patients have the ability to use suitable approaches,
which may be complex throughout exacerbation Beta2 agonists can be delivered efficiently.
Actually, evidence, show that long term beta2 agonist can relieve warning signs in COPD
patients. Daily dosage is an additional advantage and is suitable to several patients. Whereas,
oral medication of beta2 agonists have additional negative effects compared to inhaled agonists.
Thus oral medicine, usually are not used in the management of exacerbations of COPD (Aubier,


Like beta2 agents, inhaled anticholinergics including ipratropium present similar or
effective bronchodilation. Consequently, these forms have indicated to be effective among
COPD patients. Anticholinergics can be offered through nebulizers or even inhalers. With
respect to inhaled anticholinergics agents have fewer side effects due to negligible efficient
absorption. Utilization of a combination product like ipratropium-albuterol has the ability of
reducing medicine routine, thus enhancing compliance (Saint, et al. 2005).

Epidemiology 6


Aubier M. (2008) Effects of the administration of O2 on ventilation and blood gases in patients
with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev
Respir Dis; 122:747-754.

Caruana-Montaldo B, Gleeson K, Zwillich GW (2000) The control of breathing in clinical
practice. Chest; 117:205-225.

Crossley DJ, McGuire GP, Barrow PM, Houston PL (2010) Influence of inspired oxygen
concentration on deadspace, respiratory drive, and PaCO2 in intubated patients with
chronic obstructive pulmonary disease. Critical Care Med; 25(9): 1522-1526.

Epidemiology 7

Hoyt JW (2006) Debunking myths of chronic obstructive pulmonary disease. Crit Care Med;
Saint S, Bent S, Vittinghoff E, Grady D. (2005) Antibiotics in chronic obstructive pulmonary
disease exacerbations: a meta-analysis. JAMA;273:957-960