CHAPTER 2

Review of related literature and studies

This chapter present conceptual literatures, researches,

synthesis and the significance of the review of the related materials in

the research. This would embody all the information gathered through

acquainting them into the various articles and studies conducted in

various fields in health. By finding this correlation, we can expect to

magnify a clearer vision of the study and founded a ground for relating

the study to the results.

Local and Foreign literature

According to Cawaling (1994), although there is a nationwide

study on respiratory ailments in the Philippines, the data acquired to

indicates that these conditions is quite high as much as 16.7 percent.

Through the initiative of asthma specialists who recognize that the task

of controlling and prevent these diseases is vested in the hands of the

many than few as the national asthma movement also stated. Tan

(1996) also dictated the national and international guidelines are

unanimous in their agreement of the aims of the successful respiratory

ailment management. To achieve this goal, drugs should be used at an

early stage of any respiratory disease in all but the mildest cases.

Current accepted practice uniformly endorses that the use of inhaled

steroids, decongestants and oral drug intake as the primary

maintenance therapy for respiratory ailments in adults. In children, the

initial preventive agent is of choice maybe either inhaled

corticosteroids or similar drugs. However, inhaled steroid

administration cannot be regarded as curative therapy and their

regular, long-term use is necessary to most bronchitis asthmatic

patients for good asthma control. In his statement, Juan (1999) says

that it sound contradictive that something good for you can also be

bad. Say example you have asthma, exercise is beneficial because it

makes it easier for you to do normal daily activities with loss shortness

of breath. However, exercises can also bring on an asthma attack. The

exercise induced asthma includes results showing chest tightness,

wheezes and breathless. In a related statement Dr. Alvarez (2000)

cited that you couldn’t completely block the effect of respiratory

induced responses. But you can lessen it still by actually aiming the

positive benefits rather than the negative ones. It is also advised that

whatever positions you may held with treating these respiratory

conditions recommends the guiding knowledge of the physician before

starting any. The department of health (2006) to obtain nebulizers,

you need the prescription of a physician. Home nebulizers vary in cost

approximately P2000-5000 in the local market and are usually covered

under the durable medical equipment portion of the health insurance

policies. However, most insurance companies will require you to work

with the specified durable medical equipment suppliers. The health

provider is also the one responsible in having the assistance you need

for these services.

Foreign Literature

According to Medical Progress (2000), another fact for

asthma condition is having seizure like properties that was triggered

by the blockage of the bronchial tubes. It was recorded in history that

a person named Galen of ancient Greece initially observed these

characteristics when the roman emperor consulted him for an asthma

attack. It was later then proved that the findings made by numerous

physicians way back history diversified the diagnoses made to asthma

conditions and related them into the symptoms that differed asthma

from all other lung conditions thus, making asthma a phenomena

needing an interest and attention. At a statement made the following

year by Medical Progress (2001), described that the asthma

conditions can be differentiated to be chronic or acute in nature. This

can cause such reactions either severe or mild that both come quickly

at a short time. It is also further related that asthma was experienced

by some individuals at a point in their lives wherein a sudden attack

was only experienced once or a few during a certain event.

Respiratory Management (2009) suggested that reasons to avoid

treatment of asthma and respiratory conditions considers factors such

as increased blood pressure, pulse and history of adverse drug

reaction to medications to accepting a certainty in treating the

ailment. The following equipments though primarily were suggested

during a need for respiratory treatment included a nebulizer,

compressor oxygen tank, oxygen tubing, respiratory medication and

normal saline solution. There was also a statement mentioned that in

preparing these equipments, clean technique should be practiced upon

maintaining the asepsis transmission of the procedures. Standards

were also set years ago in order to uniformly organize practice of these

services to achieve a level of competency amongst health practitioners

and distributors. Louis (2001) cited that the United States has 11% of

its population experiencing COPD, a term that refers to a group of lung

diseases that interferes with the functional ability to breath normally.

The types most commonly occurring chronic conditions were bronchitis

and emphysema that in general, the understanding pertaining to these

diseases are relatively not fully defined. Causes such as pollution and

smoking are mentioned dealing with existence of these diseases. The

debut of Google library (2009) noted a topic about asthma

confirming symptoms and possible origins of developing this kind of

diseases usually have cough and sputum for many years that results to

congestion of airways leading to SOB or shortness of breath. While

certain conditions occur inversely such as emphysema in its latter

stages develop cough and shortness of breath, which are primarily

aided by supporter machines such as nebulizers.

B. Research and Thesis Studies

Studies made with asthma conditions showed exactly the same

primary interventions with the diseases affecting the airways. In a

research made by Mendoza, CEU graduate studies (1996)

mentioned the accepted specific treatments for asthma will be

determined by physicians based on an over all assessment on health

and medical history. This includes extent of the disease/s, medication

taken, procedures and therapies undergone and expected for the

course of illness intervention and opinions of preference. Though

asthma had not yet found a certain cure, this, however can still be

controlled by prescriptions and medications that relieve the symptoms

experienced. Garcia, UST College of Psychiatric medicine (1998)

also reviewed in his study that the people for example with diseases,

commonly such as ARI and asthma conditions constantly learn to

identify and avoid the things that trigger an episode, educate

themselves about medications, and other management strategies. He

mentioned that the natural coping reaction of man to a certain illness

motivates him to seek information and know the known intervention

for his condition that this pattern is commonly seen evident on all

other types of diseases occurring. The Department of Health (2008)

specified the four stages of asthma management includes

identification and minimization of contacts with asthma inducing

factors to understand and eventually medicate the conditions. The first

is information, which enables the individual to know about the nature

of the disease that will help him understand precautions and measures

he/she should take upon experiencing the condition. Then follows the

assessment of severity of asthma to monitor the course of treatment

applicable and the use of medication therapy to reserve and prevent

airway inflammation brought about the disease. Last stage would be

use of environmental control measures to avoid or eliminate factors

that induce or trigger asthma flare up that includes consideration of

immunotherapy and patient deduction that includes partnership

among family members and physician. These risk factors had given

attention and definition by Calderon; UP Epidemiological studies

Center, Diliman (1997) that these factors can increase a person’s

risk but do not necessarily cause the diseases. Risk factor variation

occurs on a case-to-case basis, not all person with risk factors develop

the disease interrelated to it. There are persons who develop the

disease without even having risk factors to cause them. So this means

that there are similarities amongst diseases that resemble the same

prototype with others such as in cases of asthma. Asthma may

resemble other respiratory problems such as emphysema, bronchitis

and lower respiratory distresses. So it is recommended to confirm your

risk factors so as to determine the cause of a disease occurrence in a

person. In a statement made by Durantes, De La Salle College of

St. Benilde graduate studies (2007) in his work on nature of stress

intervention, stressed that it is important also to know that in diagnosis

diseases, emotional factors should be considered to affect its

existence. Emotional anxiety and nervous stress can cause fatigues,

which compromises the immune system or brought about changes in

vital stability that can aggravate an acute attack of a certain disease.

However, these reactions are considered to be more of an affect than a

cause for the disease that which is considered possibilities only but not

the exact cause of it.

Foreign Research

Different treatments were also formulated by the foreign

researchers to aid in different health conditions. An interesting fact

according to the study conducted by Stockholt, University of West

Virginia (1989) in his research on interventions of diseases stated

that in the 1970’s, that a certain patient undergoing an asthma care

recommended an entire routine to eliminate attacks of asthma that

includes exercising, diet therapy and removing leather pillows as well

as the feathers from the bedroom that in a simple way, provided a

relief which made the strategy famous. At the same time Schwaer,

Columbia University (1999) differentiated and detailed the

treatment of acquiring nebulizer service in relation to convenience

relayed that the mechanism of nebulizers to blow a compressed air

over a liquid medication in creating a fine moist take a matter of 10-15

minutes which is long, compared to tow puffs on an inhaler. The fine

mist and length of time allowed to be inhaled in a facemask or a naso-

oral piece differed upon these factors compared to the latest models.

The latest models are bit quieter, compared to the old battery

operated portable nebulizers of noisy compressors or propellants.

Some smaller ones rely on ultrasonic technology to create a breathable

mist, which in some studies confirms some hazards on using them.

Usage of these devices relates their convenience and effectiveness to

the brand as well as the cost. The more popular the brand and the

studied effectiveness of the product, the higher the cost it will have.

Gotenbourg of German Economic Institute in Copenhagen

(1989) says that the effectiveness of a procedure or product doesn’t

determine much the cost of its value. It is should be according to the

law be given in an amount considered fair to the construction of the

device as well as for the affordability cost of it to the people. However,

the business industry contradicted the fact by establishing conditions

to depend the pricing of the product agreed with the distributors that

are not in the scope of the general agreement. In the same statement

Haitmaen, University of Philadelphia (1997) directed that the

balance between the demand and supply played a vital role in

determination of product consumption. The increase in the demand

leads to increase of supply that either result in sufficiency or shortage

of it. In the medical industry, the fate of these devices is guaranteed by

health practitioners who use them. When certain products experience

more referrals by many, it follows that the product may achieve its in-

demand potential. On the other hand, Tsunji Takashi of Japanese

Imperial Center of Medicine (1998) based his study of health

devices in contradiction of traditional known relief for the diseases. He

stated that the modern devices posed a risk of developing complex

type of side effects related to the incorporation of chemically

developed properties of materials used. He also affirmed that the

difference with effectiveness of traditional medicine is that it is assured

to give a relief more practical than the said methods.

C. Synthesis of the review

Among various studies made to the relation of nebulizers to the

stated find for the study, it is known that there are already beset

guidelines and recommendations for the management of it. Asthma

and other respiratory cases depend their relief to these given health

equipments that are bounded by the balance between the business

and health delivery. Maintaining this balance helps contribute to the

proper and effective delivery of these services though there are

interchangeable factors that also alters it. Primarily, the government

would be the one responsible in effort for alleviating health conditions

and services as well as distribution of funds and programs for health

(DOH 2008) but it is also acknowledge that there should also be an

effort on the part of all other sectors that is involved in delivery of

these services.

The masses are also responsible in according to the

implemented rules and guidelines by the authorities. The people

needed to cooperate discipline themselves and be educated with

different information they should know. Though it shouldn’t mean that

the rights for them would be compromised, it just dictates that the

factors interfering with the system of health managements needed a

vice versa relationship of people and the authorities.

D. Significance and Implications of the review

The great significance of nebulizers is embodied on the

researches made by the previous researchers. The results and reviews

made by them founded the argument as to whether there is really an

existing demand for nebulizers. It answered not only question for the

demand but also as to whether there is a problem rooting to this

statements and facts presented even before the study had

commenced. As to the study, it re-assures the stand of the need of

nebulizer service to the residents covered by Barangay 369,

Dimasalang Health Unit.

As mentioned, the price of nebulizers as well as the medication

entitles the distributor to rule out the cost of these equipments. So this

doesn’t care about how the specific consumer could afford it. It bases
its conditions to the general public that is expecting to be given fair

pricing. Its solution is implicated to the responsibility of the proper

authorities in providing sufficient low cost supplies or services for the

people. Also, the business empire to further formulate solutions to

lessen price of the units distributed in the market but at the same time

maintaining the quality service the devices offers. It is also expected

for the hospitals and private health practitioners to agree to offer

generous cost of service in delivering these health services with a

quality uncompromise despite of what is paid to them. The other

nebulizer issue expects to be given action by the specified area of the

government department of health with regards to implementation and

programs in relation with.