a modified nursing program













Table of Contents

Abstract and introduction. 3

Search method/Strategy. 4

Table of evidence. 6

Critical appraisal of two case studies. 11

References. 13




Abstract and introduction

Aim: This paper aims to explore asthma and the available treatments. It has been observed that “a modified nursing program” can help in enhancing the outcomes of asthma which have rarely been studied in older adults with asthma and self-care management services.

Search strategy: This literature review has been conducted with the help of secondary research and there has been an in-depth analysis carried out on this topic where all the journals and articles have been segregated, interpreted, and reviewed critically in the table. Google scholar has been used immensely in browsing the journals and eventually, the researcher came up with diversified ideas and notions regarding the research topic that revolves around chronic asthma management.

Results: It has been observed that both the journals have been effective in delivering their aims and objectives. However, both the journals have involved professional support and intervention in the treatment of this particular disease. It has been globally found that asthma is a common chronic disease that has “affected 300 million people” and by the year 2025, it can be estimated that “100 million people will be affected”. However, it can be drawn that this disease can be cured with self-management to a greater extent.

Discussion/Recommendations: Asthma is a chronic condition that narrows the airways and swells while producing “extra mucus”. This disease is observed among many people and is one of the most common diseases that take place. It makes breathing difficult and restricts smooth breathing. The literature review focuses on several journals and articles centered around asthma and its treatment by parents, caregivers, and nurses. The symptoms of asthma can be understood by coughing and wheezing. The research papers that have been used for this literature review have been effective in determining the need for self-management and preventing the disease from spreading. It can be analysed that asthma can be treated with professional support and intervention. It can also be evaluated that lasting and chronic asthma cannot be cured even with professional intervention, however, it can be managed or controlled to some extent.

The PRISMA Flow Diagram has also been developed to get an idea of the screening and the studies involved in this research. In the critical appraisal of two case studies, there has been detailed conduct of two research papers that talks about the treatment of asthma through parental and nurse intervention.

Keywords: Asthma, Intensive Care Unit, Caregivers, Parents, Nursing Intervention, professional support.

Search method/Strategy

The search method or the strategy that has been used for this study is purely focused on secondary research. Hence, this means that the entire literature review has been conducted with the help of the internet, journals, articles, and books. For this research, the researcher has browsed several journals and books and tried to find some relevant topics and arguments in these journals. After 555 screened records, the six journals have been finalised for systematic literature. This secondary research uses existing data and this literature has been reviewed with the collated and summarised in order to increase the entire effectiveness and potentiality of this particular research. The existing data is collated and summarised to maximise the overall strategy of the research. This secondary research also involves research material that is published in similar documents.

The journals and articles that have been found during the secondary research where both the quantitative and qualitative data analysis have been found to have been used by the researchers in those research papers.

Database searched Google Scholar
Other sources NHS based evidence websites

Manual search in Extensive care unit and nursing management for taking care of old-age people with chronic asthma”

Terms used Asthma, treatment for asthma, asthma exacerbations, extensive care for asthma, and chronic asthma
Inclusion Criteria Published between 2017- 2022

English Language

Exclusion Criteria Respiratory issues, tuberculosis, and types of asthma

Table 1: Search strategy

(Source: Self-created)


Figure 1: PRISMA Flow Diagram

(Source: Self-developed)

Table of evidence

Author and date Focused topic and question Paradigm and method Context/setting/sample Findings/outcome
Hassan et al. (2020) This study has focused on evaluating the nursing program that was developed to improve the health conditions among the older patients who had asthma The study has followed a quasi-experimental method including a group (preset and post-set) was used in this study. The study was conducted in three clinics and 97 older patients with asthma and breathing issues. The study estimates that the results were satisfactory after the patients and the healthcare workers were introduced to the program. The statistical results show that there were significant improvements in the older patients after the implementation and conduction of the program.
Agusala et al. (2018) The study was conducted to see the impact of asthma education on the rural areas of Texas. An education intervention among the patients was conducted in the study 102 patients were selected for the study and visits to emergency units and hospitals were made as well.  It has been found from the study that Asthma education among the caregivers and children is related to “better symptoms management and lesser acute exacerbations” which can be pointed to the importance of the asthma education among the “pediatric patients in the rural areas”.
 Mohamed et al. (2019)  The study is aimed to investigate the effect of practicing the “Buteyko breathing” method on asthma of patients along with bronchial symptoms.





 The study was conducted with the help of the “Quasi-experimental research design”.   This study took place in “Chest Medicine Ward and Clinic Ain Shams University Hospital”. However, this study was conducted with the help of the “purposive sampling” which included 100 patients with bronchial asthma and there were also 50 respondents registered for the experimental group and other 50 patients in the control group. From the entire study, it has been found that there is a positive effect of practicing the “Buteyko breathing exercise” that helps in the reduction of the asthma symptoms. It has also been found that this practice can improve controlling the asthma patients.
Alagamy et al. 2019 The research was conducted in order to investigate the impact of “bronchial asthma self-care management” on older people which can help in coping with regular activities.





 This study was conducted with the help of a pre-experimental design where a group pre-test along with a post-test study has been conducted in order to structure the study.






 The research study took place in “three outpatient clinics in Al Mahalla Hospital for allergy and pulmonary diseases as well as Tanta. This study was conducted with the sample that consisted of a sample size of 104 older people with “bronchial asthma”.









 The outcome of the study lies in the fact that the application of the “proposed asthma self-care management model” has been an influential model in enhancing the regular day-to-day activities. 
 Hui et al. 2020 This study has the aim of exploring assessing whether the “asthma apps” are able to support self-management and enable users to survive with asthma. The study was successful with the help of the mixed a method that includes whether users’ feedback on the “prototype app” questionnaire surveys about preferences along with qualitative interviews that assess professional and patients’ perspectives on self-management features. The study was mainly based on qualitative analysis. However, the research also considered interviews as well to support the aim and objectives. Purposive sampling has been done in order to derive opinions and information. The the sample has been done on the basis of age (16-25 years/young adults), adults (26-60), and older adults (above 60 years). The interview has taken place with the healthcare professionals involved in the asthma case. 







 The research concluded that “an evidence-based taxonomy of self-management components is able to instigate “the dialogue between app developers and both the users and developers along with the healthcare providers that underpin technological solutions that identifies the requirements and supports for people who are diagnosed with asthma.
 Busse et al. 2021 The study is aimed at curing asthma as it is a disease that is incurable and uncontrollable for many patients. This study sheds light on the patient characteristics and asthma control, along with exacerbations. This study is also using HCRU using GINA treatment as a treatment support for asthma.  The study was supported by the descriptive statistics, however, a large US health-claims, database, four database longitudinal cohorts of 517738 patients in GS2-5 involving a patient subgroup.





 The study was conducted by “a retrospective longitudinal cohort data analysis including a proportion of the patients on Medicare Advantage”.





 The outcome of this research paper reflects that the large database allows real-world evidence of the “low degree of uncontrolled asthma in the US Clinical practice across GS” supporting calls for better asthma management. 






 Table 2: Table of evidence

(Source: Self-created)


Critical appraisal of two case studies

The two case studies have been used in order to highlight the content and differences of both the research papers. “Modified Nursing Program to Improve Health Condition Asthmatics Older Adults. Egyptian Journal of Health Care” and “A study in rural Texas. Journal of International Medical Research”  can be considered in order to get insights into both the research papers. In the former journal, it has been observed that the study has conducted a “quasi-experimental method including a group (preset and post-set)” in order to support this study. There has been a survey, conducted with “97 older patients with asthma and breathing issues”. According to Hassan et al. (2020), asthma is a “complex chronic condition” that is generally ignored and not given attention in old adults. This journal has introduced the “Nursing intervention program” as a promising role that helps in bringing changes and transformations in the life of an asthma survivor. It has been observed in this journal that changes and transformations can be achievable through an effective nursing intervention program. While this particular journal is based on nursing and medical intervention to control asthma. The latter journal emphasizes the role and intervention of parents along with the steps taken to cure asthma or take them under control.

The “A study in rural Texas. Journal of International Medical Research”  relies upon the aim of exploring the magnitude of parents’ education in assisting to reduce the burden in cities. This paper studied the need for being literate and acquiring education in order to grasp knowledge about the disease along with the ways to cure them. As stated by Agusala et al. (2018), in 2013, children diagnosed with asthma abruptly “missed 13.8 million school days”. However, these absences have been observed to have negative impacts on children, including a decrease in academic performance along with social and mental hindrances. This journal has focused on the role of the parents that control chronic childhood asthma. Besides caregivers and nurses, this journal has showcased the importance of parents in dealing with children’s asthma. In an urban setting, it is quite evident that the parents are quite educated due to which they can easily identify the problems in children and seek better treatment for asthma. There is no doubt that the “Nursing intervention program” acts as a controlling method for controlling asthma and preventing the exacerbations that are required to manage oneself and this warns people with  asthma  from cigarette smoke and allergens (Agusala et al. 2018).

The latter journal is focused on interventions that revolve around knowledge and education in managing the disease for patients and parents have been described with different success rates. However, in a rural setting, it becomes quite difficult for the parents to identify and understand the ways to cure and control this particular disease. According to Sunjaya et al. (2022), it can be suggested that people with Asthma are at a higher risk of COVID-19. Hence, this particular author has a different view on the spread of asthma. As per Sunjaya et al. (2022), it can be understood that risk of the pandemic among the asthmatic patients globally is vital as countries lifted lockdown. From the view of Calmes et al. (2021), patients with asthmatics and patients with chronic obstructive pulmonary disease (COPD) are more at the “risk of severe outcomes with common cold virus infections”. As opined by Inselman et al. (2021), multi-center has suggested that there are severe asthma cases yet not mild asthma, is associated with the pandemic that is related to the mortality rate in the UK and Korea. Hence, this author has pointed out that there is a direct relationship of Covid-19 with asthma.


The “Nursing intervention program” has been able to create an idea that older adult patients need to participate in decision-making for creating a better environment along with programs that enhances the emotional and social health of patients with asthma. According to Hassan et al. (2020), asthma education for children and caregivers have associated with the disease and the statistical results have shown that the patients have gained improvements and this has been developed by the implementation of the Nursing intervention program”. In conclusion, it can be analysed that both the journals have been able to receive insights into the ways that both the scholars have been able to tackle the disease and cure it in an in-depth manner. It has also been studied that having knowledge and skills regarding self-care management needs to be a priority for programs that can take place in the future. This program can help in the promotion of behavioral strategies for preventing asthma.

Amaral-Machado et al. (2020), it can be understand that asthma can be caused by the pollen, dust and food products. As opined by Petsky et al. (2018), adjusting treatment that is based on the “airway eosinophilic markers” have been witnessed to reduce the proneness of asthma. As opined by Kaplan and Price (2020), communication is the best method to help the patients take their medications on time to reduce asthma among patients. According to Lycett et al. (2018), it is important to design “adherence interventions” for asthma patients and further research is required to understand the relationship between the adherence and perceptions. It has also been observed that the asthma has also prevailed among the children where 5% of the populations have been affected (Ahmed and Turner, 2019). According to Zervas et al. (2018), more than 5% of the patients are affected. Hence, it can be understood that both the authors have stressed on the same percentage of number of people who are affected by the menacing disease.




Agusala, V., Vij, P., Agusala, V., Dasari, V. and Kola, B., 2018. Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas. Journal of International Medical Research, 46(8), pp.3172-3182.

Ahmed, H. and Turner, S., 2019. Severe asthma in children—a review of definitions, epidemiology, and treatment options in 2019. Pediatric pulmonology54(6), pp.778-787.

Alagamy, Z.G.A., Hussein, H.A.E.S. and Hassanin, S.T., 2019. The Effect of Bronchial Asthma Self-Care Management Model on Older Adults’ Coping with their Daily Living Activities.

Amaral-Machado, L., Oliveira, W.N., Moreira-Oliveira, S.S., Pereira, D.T., Alencar, E.N., Tsapis, N. and Egito, E.S.T., 2020. Use of natural products in asthma treatment. Evidence-Based Complementary and Alternative Medicine2020.

Busse, W.W., Fang, J., Marvel, J., Tian, H., Altman, P. and Cao, H., 2021. Uncontrolled asthma across GINA treatment steps 2− 5 in a large US patient cohort. Journal of Asthma, pp.1-13.

Calmes, D., Graff, S., Maes, N., Frix, A.N., Thys, M., Bonhomme, O., Berg, J., Debruche, M., Gester, F., Henket, M. and Paulus, V., 2021. Asthma and COPD are not risk factors for ICU stay and death in case of SARS-CoV2 infection. The Journal of Allergy and Clinical Immunology: In Practice9(1), pp.160-169.

Hassan Abd El-fatah, S., Mostafa Abd Elzaher, O. and Mohamed Ebrahim Abd-Elraziek, E., 2020. Modified Nursing Program to Improve Health Condition Asthmatics Older Adult. Egyptian Journal of Health Care, 11(1), pp.329-353.

Hui, C.Y., Walton, R., McKinstry, B. and Pinnock, H., 2020. Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app. Health Informatics Journal, 26(2), pp.862-879.

Inselman, J.W., Rank, M.A., Zawada, S.K. and Jeffery, M.M., 2021. Which people with asthma are most likely to be hospitalized with COVID-19 in the United States?. The Journal of Allergy and Clinical Immunology: In Practice9(5), pp.2080-2082.

Kaplan, A. and Price, D., 2020. Treatment adherence in adolescents with asthma. Journal of asthma and allergy13, p.39.

Lycett, H., Wildman, E., Raebel, E.M., Sherlock, J.P., Kenny, T. and Chan, A.H.Y., 2018. Treatment perceptions in patients with asthma: synthesis of factors influencing adherence. Respiratory medicine141, pp.180-189.

Mohamed, Y., Elderiny, S. and Ibrahim, L., 2019. The effect of Buteyko breathing technique among patients with bronchial asthma: Comparative study. International Journal of Midwifery and Nursing Practice, 2(2), pp.01-10.

Petsky, H.L., Cates, C.J., Kew, K.M. and Chang, A.B., 2018. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax73(12), pp.1110-1119.

Sunjaya, A.P., Allida, S.M., Di Tanna, G.L. and Jenkins, C., 2022. Asthma and risk of infection, hospitalization, ICU admission and mortality from COVID-19: systematic review and meta-analysis. Journal of Asthma59(5), pp.866-879.

Sunjaya, A.P., Allida, S.M., Di Tanna, G.L. and Jenkins, C.R., 2022. Asthma and COVID-19 risk: a systematic review and meta-analysis. European Respiratory Journal59(3).

Zervas, E., Samitas, K., Papaioannou, A.I., Bakakos, P., Loukides, S. and Gaga, M., 2018. An algorithmic approach for the treatment of severe uncontrolled asthma. ERJ open research4(1).