Managing Asthma And Thunderstorm Asthma In Victoria: An Essay.

Prevalence of Asthma in Victoria

A common saying has it that "Health is gold." Health is indeed a universal right to all citizens and is inherently enshrined in the Australian Human Rights Commission. Be that as it may, there are a number of issues surrounding health and health care access ranging from access to information, socio-economic factors, distribution and access to medical facilities, demographic aspects among others that throw the spanner into the works in a bid to this inherent basic right (Harver & Kotses, 2010).

Nowhere more is this evident than in the case of general asthma and thunderstorm asthma in particular (Tennison, 2017). Though preventable, manageable, and curable to a larger extent, cases of asthma have taken their toll on the population the within the country, particularly in Victoria. According to Fraser et al. (2017), it is estimated that 2.5 million Australians have asthma and that roughly 450 deaths annually are directly attributed the same. So why is this preventable and even curable disease so manifest in Victoria?

According to D’Amato et al. (2013), a number of reasons are evident for the growth in asthma cases particularly thunderstorm asthma. To begin with, medical testing is yet to be embraced fully by the population especially men (Peat, Barton & Elliat, 2007). Environmental factors such as busts of pollen release exacerbated by weather conditions like thunderstorms also heighten the risk of asthma attacks (Talbot, 2017). In addition, public access to asthma information is limited in rural areas. Furthermore, social marketing on asthma programs is yet to take momentum and public education on asthma has been largely platonic given that government sponsorship only accounts for 0.9% of all public health expenditure (Fraser et al., 2017).

This report will inquire the salient issues predisposing the Victorian population to general asthma and thunderstorm asthma in specific. Moreover, it will explore ways to educate the population about asthma through public participation programs. In addition it will look at ways to reduce absenteeism in school among children, ways to reduce hospital admissions as a result of chronic asthma and asthma prevention through testing. The report will also examine ways to engage the government to avail more funds for asthma medication (Cloutier, 2016).

As alluded to above, asthma cases have been on the rise in Australia particularly in Victoria. According to Hester and Wilce (2013), in the year 2013, it was estimated that 9% of Australia population was affected by asthma. Currently, 10% of the Australian population is affected by this chronic disease (Fraser et al., 2017).

Factors Predisposing the Victorian Population to Asthma

According to Acton (2012), it is estimated that 10% of asthma cases result from occupational activities from the manufacturing sector. This affects people working in an environment that is predisposed to dust and other particulate matter that leads to high peak flow.

Thunderstorm Asthma is a growing concern since it creates an environment that favor s general asthma attacks to those already suffering from the disease and those yet to be diagnosed (Kanser 2008). The storm mostly happens in the month of November when pollen release from grass is at its peak in Victoria. The storm and the accompanying winds act as transport agents to this pollen which when breathed by people with asthma and those prone to asthma causes life-threatening asthma attacks (Hew et al., 2017).

The case of Thunderstorm asthma is a growing concern and has caused 6 deaths in 2016 in Victoria alone and 9 deaths elsewhere. In the last 35 years, there have been 9 cases of thunderstorm asthma in Victoria and has become very frequent in the recent past (Tennison, 2017)

In Victoria, it is estimated that 110,000 children suffer from acute asthma. This leads to discomfort. As a result, many of these children cannot attend schools which puts them at a disadvantage when compared to their peers who attend school throughout (Dozor & Kelly, 2014).

According to Fraser et al. (2017), there are 2.5 million cases of Asthma in Australia with most of the cases affecting women and indigenous population. While on one hand it is recommended that every person with asthma should have a well-documented action plan, only 20% of the population has the same which makes it difficult to manage the disease.

While asthma is obviously a formidable threat to 10% of the population, the government has only extended 0.9% of the public health budget to the management and prevention of this disease. The funds are simply not enough to cater for the lower socioeconomic groups particularly those living in the rural areas (Lavarack, 2007).

Asthma admissions to hospitals have been more prevalent when the predisposing factors such as thunderstorm asthma and aerosol particulate matter are prevalent in the air. This results from lack of education and awareness on the management of asthma on the part of the patients. In the extreme, it is a contributing factor to the deaths associated with thunderstorm asthma (Talbot 2017).

This research will be conducted in Melbourne. This is because cases of asthma in general and thunderstorm asthma have been found to be prevalent in within Victoria and Melbourne presents a homogeneous study area presented by cases of asthma there to draw the sample from (Grinnel, 2015).

Thunderstorm Asthma

To be able to address the problems identified above the grant will need to fulfill the following aims and objectives.

Aim 1: To develop an asthma action plan to reduce asthma admission cases especially those related to thunderstorm asthma to the hospitals at Melbourne in Victoria.

To be able to adequately respond to this aim the specific objectives will be

1. a)  To identify the participants of the program;
2. b)  To develop a program plan to reach out to the participants that will deliver preventive and management to people predisposed to asthma.

Aim 2: To reduce absenteeism from work and school from general asthma attacks and particularly thunderstorm asthma.

The objectives to fulfill this aim are;

1. a) Collaboration and partnership with at least three hospitals in Melbourne to identify and follow up on treatment and management asthma cases;
2. b) Liaison with schools and workplaces to ensure that asthma patients have a documented asthma management plan;

Aim 3: Educate and train the identified subjects on thunderstorm asthma, predisposing factors, and mechanisms to deal with asthma attacks.

The specific objectives

1. a) Development of an education and training curriculum program;
2. b) Identification and recruitment of staff who will deliver training to the subjects.

Aim 4: Community involvement and participation in asthma awareness.

The objectives will be

1. a) To develop an effective social marketing media to reach out to the population;
2. b) To come up with voluntary asthma testing program for the public.

Aim 5: Liaising with government for in the management of thunderstorm asthma and other asthma-related cases.

Objectives

1. a) To involve government authorities in the asthma testing and action plan for asthma cases;
2. b)  To enrich the early warning system to Thunderstorm asthma for better response;
3. b) To present an asthma tactical plan for funding by government.

1. Can an asthma action plan help in the reduction of asthma and thunderstorm asthma hospital admissions in Melbourne?
2. How effective is education and training in the alleviation of asthma in Melbourne?
3. To what extent can collaboration with hospitals and workplaces help in managing absenteeism as a result of asthma?
4. How does community involvement help in the management of asthma and thunderstorm asthma?
5. What is the degree to which the government can intercede in the management of asthma cases in Melbourne?

Asthma, in general, affects 10 % of the population in Australia. Even government funding to asthma and asthma-related programs have been dismal accounting for only 0.9% of all public funding (Fraser et al., 2017). This is due to this discrepancy in funding and presence of low-income groups especially the indigenous Australian population is 1.6 times more likely to develop asthma than any other group (Merkus, Roukema & Winjngaart, 2015).

While on one hand, it is advisable for people predisposed to asthma to have an action plan to manage the same, over 80% people with asthma do not have this plan. This makes treatment difficult for this group (Grinnel, 2015).

It has not been established the extent to which education, training, and public awareness programs can help alleviate cases of thunderstorm asthma in Australia. As a result, it is difficult to gauge what aspects of asthma the population does not understand and how they should deal with asthma attacks hence this study.

 

Figure 1: Conceptual Framework. Source: The author (2017)

This grant will focus on the Melbourne population on cases of asthma. The focus will be in hospitals around Melbourne where asthma cases have been referred to. The choice of Melbourne hospitals is because most asthma cases are witnessed in this city (Pielke, 2013).

There are 55 Hospitals in Melbourne where most of Victoria general asthma and thunderstorm asthma case are referred (Hew et al., 2017). From this population, the researcher will conduct random sampling and choose 3 hospitals from where 500 participants will be recruited.

The proposed action plan borrows from the 5 aims and the accompanying objectives. It is designed to show each aim the objectives, the key action areas from the objectives and the expected results. In addition, it shows the how the objectives will be measured and the responsible people to actualize each of the objectives. This is shown in the table below.

Issues Surrounding Asthma Education and Awareness

Table 1: Proposed Action Plan

Aim 1: To develop an asthma Patient Action Plan to reduce asthma admissions in hospital
Objective	Key Action Areas	Expected Results	Measurements	Responsible party
a) Identify program participants	· Locate Hospitals to find program participants · Recruitment of program participants	· Program participants for the project · Program Participants	· Locations identified for partnering with Hospitals · Number of program participants	· Researcher · Technical Assistant · Hospital staff
b) Develop patient asthma action plan	· Identify the hospital and doctor to manage the patient	· Reduced asthma admissions in hospital	· Number of patient action plans developed	· Technical assistants · Doctors
Aim 2: To reduce absenteeism by asthma patients from work and schools
Objective	Key Action Areas	Expected Results	Measurements	Responsible party
a) Liaison with Schools and Workplaces	· Identify schools and workplaces to liaise with	· Agreement with schools and workplaces · Reduced absenteeism cases	· Number of school and workplaces agreements · Number of days absent from work and schools	· School staff · Workplace managers · Researcher · Technical assistants
Aim 3: Educate and train the identified subjects
Objective	Key Action	Expected Result	Measurement	Responsible party
a) Identify and recruit trainers	· Identify the trainers · Recruit the trainers · Train the subject	· Recruited trainers · High awareness levels	· Number of recruited trainers · Number of people conversant with asthma after training	· Trainers · Technical Assistants · Researcher
b) Develop a training program	· Identify areas for training · Develop a training program	· Responsive training program	· Number of participants trained	· Researcher · Trainers · Assistant Researcher
Aim 4: Community Participation in Asthma alleviation and Management
Objective	Key Action	Expected result	Measurement	Responsible Parties
a) Social marketing, advertisement	· Identify the media to reach the greatest number of people	· Informed population	· Number of people aware of asthma management	· Researcher · Media stations/social marketers · Technical assistants
b) Facilitation of Asthma testing programs	· Identify appropriate testing program · Test the subjects	· Appropriate testing program · Tested subjects	· Number of tests performed	· Researcher · Testers
Aim 5: Government Involvement
Objective	Key Action	Expected result	Measurement	Responsible Party
a) To enhance government participation in the asthma prevention program	· Identify relevant government authorities · Identify gaps in early warning system	· Government funding in asthma programs · Responsive early warning system	· Funds submitted	· Government authorities

 Strategies to evaluate the impact

For proper evaluation of the impacts, the logic model will be developed the planned and achieved aims. This logic model will have inputs such as resources, star to be used, and the activities that will be undertaken. On the other hand, it will have outputs such and the outcomes expected. This is as shown in the table below.

Table 2: Logic Model for program evaluation

Resources (Inputs)	Activities done	Outputs	Outcomes	Aims (Goals)
· Staff	· Delivery of the asthma management program · Education and training	· 40-50 hours of education and training	· Improved self-awareness among the subjects	· Education and training
· Funds/Money	· Transport · Asthma program facilitation	· 500 persons to receive Asthma management and testing kits · 500 asthma management plans development	· Improved testing in undiagnosed cases · Asthma action plans	· Development of asthma management/action plan for each subject
· Social marketing	· Asthma awareness	· Over 5000 persons to receive asthma education	· Increased number of people encouraged for testing	· Community participation
· Partnerships with institutions and workplaces	· Support for asthma patients	· Over 240 man-hours saved from asthmatic  absenteeism	· Decrease in absenteeism hours	· Reduction in cases of admissions and absenteeism

A PERT (Project Evaluation Review Technique) tool will also be utilized to show the activities that will be undertaken and the duration that will be required to accomplish those activities. It will also be used to gauge the success or lack thereof on the activities undertaken to fulfill the aims (Mogasale & Vos, 2013).

It is anticipated that with the accomplishment of the aims developed for the research grant in asthma the resulting outcomes will be first to reduce hospital admissions in as a result of lack of asthma action plan. It is also expected that there will be a change in health behavioral patterns regarding asthma due to training and public participation (Brown, 2007). Lastly, it is expected that the government will fund more asthma programs in future.

In the short term, it is expected that more individuals will embrace testing. This will lead to a long way in preventing undiagnosed thunderstorm asthma attacks. It is also expected that absenteeism cases will reduce both at schools and workplaces (Bernstein & Levy, 2014).

The study will help open doors into more knowledge so that people can understand the development of asthma, thunderstorm asthma, and ways of preventing it. The research will also explore a possibility of future research besides adding to the body of knowledge research.

The proposed timeline for executing the program will be 2 years. This time will be utilized in the recruitment of new staff to help in the program administration. In addition, it will be utilized to identify and recruit participants who will be in the program. More than two months will be used in training the trainers who will educate the subject. Additional 4 months will be used to foster partnerships with government authorities as well as schools and workplaces. Furthermore, additional time of around 4 months will be required to market the asthma program. This is as depicted in the table below.

Table 3: Proposed timelines

Specific Aims

Year 1

Year 2

Qtr 1

Qtr 2

Qtr 3

Qtr 1

Qtr 2

Qtr 3

Identify Subjects

XXXX

Recruit participants  and staff

XX

XXXX

Collaboration and partnership with institutions

XX

XXXX

X

Develop study instruments

XX

Pilot Study

XX

Liaising with the government

X

XXXX

XXXX

Education and Training of the subjects

XXXX

XXXX

XX

Asthma patients action/management plan

XXX

XXXX

XXXX

XXXX

Monitoring and evaluation

XX

XXXX

XXXX

XXXX

Data entry

XXXX

XXXX

XXXX

Data analysis and preparation of scientific paper

XXXX

Where X represents 1 Month

The proposed budget for the study to be able to adequately cover all the needs has been set at $120, 000 Australian dollars. This is as broken down below.

Proposed Solutions

Table 4: Proposed budget

Item	Particular	Amount (A$)
1.	Staff Salaries	60,000
2.	Transport expenses	12,000
3.	Communication Expenses	3,000
4.	Hiring of trainers	20,000
5.	Program Marketing	10,000
6.	Materials and consumables	15,000
	Total	120,000

To make the program successful, the budget above-indicated will be used to run the affairs of the study in such matters as personnel, equipment to be used, aiding in communication, consultation, and marketing.

On personnel and staff salaries, the researcher will be in charge of all affairs of the study including pilot testing, recruitment of participants and trainers. The researcher will draw a stipend of A$ 20,000 to run the operations smoothly. Other personnel to assist the researcher will include a technical assistant who will be responsible for day to day implementation of the program activities and a research analyst consultant who will collect and collate the data. The study will also use 4 trainers to educate the subjects. Cumulatively the staff will spend A$ 80,000.

Transport and communication expenses will be utilized in collaborating with the hospitals to ensure that the participants get referrals. Moreover, the subjects will require close supervision and transportation, as well as constant communication to ensure that the study proceeds smoothly.

The material and consumables include equipment such as asthma test kits which will be required at a cost of A$ 10,000. The study will also require stationery and computers at a cost of A$ 5,000.

The study will also require reaching out to participants and randomly encourage people to get asthma tests at the hospitals through media marketing. This may involve print media, radio, social media, or a combination of these. The marketing media of choice will be constrained to fit into the budget allocated of A$ 10,000.

Conclusion

In conclusion, this study aims to find out the ways in which asthma can be managed to reduce the adverse impacts it exerts on the population. The researcher has stated the problems that exist with the asthma disease. The study observes problems such as lack of asthma management plan among 80% of all diagnosed people. It also observes the threat of death such as in emergency cases of thunderstorm asthma. Moreover, it is revealed that government funding for asthma cases is abysmal. To be able to handle the problems stated, the researcher proposes to study 500 people drawn from 3 hospitals within Melbourne.

The study aims to find out how education and training on asthma can affect asthma management. It also seeks to find out the effects of public participation and government involvement in asthma management. Lastly, the study seeks to find out ways of reducing hospital admissions and absenteeism from work as a result of asthma attacks.

Research Design and Methodology

The significance of the study is that besides adding to the body of research and revealing the most effective ways to manage asthma, it will also reveal other areas of interest in asthma that need to be explored. The study will be undertaken for a period of 2 years and will command a budget of approximately $120,000 Australian Dollars.

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