Introduction This assignment will discuss and compare a communicable and non communicable disease and look at how

disease can impact upon the individual and their family. Disease is a condition of the body which causes illness or sickness, which is usually caused by one or more factors which include viruses, bacteria, inherited or acquired infection. Communicable diseases are acquired through infections caused by microbes or parasites, viruses, bacteria or worms which are transmitted by an infected host which could be either human or animal, to another human, either indirectly or directly in contact with an infected person. Generally, diseases are passed on through close contact with an infected person, because viruses or bacteria are airborne, excretions from the nose and mouth are expelled by the infected person which can then be inhaled by persons in close proximity, therefore infecting that person. A non communicable disease is not caused by infection; factors include genetic abnormalities either inherited or acquired, physical trauma or degeneration such as ageing or excessive use of drugs. For the purpose of this assignment, the diseases I have chosen to research and compare are Asthma and Meningitis. One of the main reasons I have chosen to research, learn and understand more about asthma, is that I work part time in a nursery environment and some of the children who attend the nursery have asthma, their care plan includes administrating prescribed inhalers to prevent or control their asthma symptoms. Whilst attending high school, one of the pupils in my year unfortunately contracted meningitis and sadly died from this disease, and this prompted me to research the disease.

Part A Meningitis is a communicable disease which is commonly transmitted through contact with an infected person. It is an infection of the meninges (protective membranes surrounding the spinal cord and brain), caused by either bacteria or a virus, and usually proceeded by a mild respiratory tract infection, in which some bacteria enter the blood stream, the bacteria is carried to the meninges where they may remain in the extradural or subdural space, if an abscess is formed this can rupture into the subarachnoid space spreading to the brain which can cause encephalitis and further abscesses can develop. This leads to inflammation of the meninges which can cause damage to the brain and nerves. Meningococcal disease is one of the main infectious diseases which causes death in children, mortality and morbidity rates are considerable, in less common forms of bacterial meningitis, the fatality rates are much higher. One in ten people carries the meningococcal bacteria in our nasal cavity and throat this is harmless for most people. Young children are not usually the main carriers; however the proportion of carrier is increased with age but peaks in young adults and adolescents, where twenty five percent of this age group carry the bacteria. The onset of meningitis it is usually unexpected and rapid, symptoms include severe headache, fever (high temperature of 38 degrees or over), stiff neck (not common in young children), vomiting, photophobia in adults and older children (sensitivity to light), which may be accompanied by a petechial rash but not everyone develops this. Babies can become floppy and unresponsive, irritable or stiff with jerky movements, they can refuse feeds, vomit, have blotchy skin and are reluctant to wake or other signs of meningitis. Also, some babies develop a swelling in the fontanelle (soft part of their head). Viral meningitis whilst serious rarely kills, but bacterial infections are classified as a medical emergency, if meningitis is suspected it is treated as urgent medical emergency, as bacterial meningitis could lead to septicaemia (blood poisoning) and death. Meningitis and septicaemia can present on their own, but usually appear together, these diseases can be fatal in a matter of hours, with septicaemia that does not have signs of meningitis being the more lifethreatening. Approximately one out of every ten children diagnosed with meningococcal disease will die; the more fatal cases will die in less than twenty four hours from onset of symptoms. Therefore, time is off the essence and there is a window of opportunity, however brief to assess and deliver effective treatment, as waiting to confirm a diagnosis can have consequences and resulting in fatalities. Patients who recover from meningitis can also be left with disabilities which can affect their everyday lives, which include tissue loss or severe skin scars, loss of sight or hearing, intellectual impairment, limb deformities and amputations, problems with coordination and motor skills, epilepsy and other psychological and cognitive disorders (Meningitis Research Foundation, 2010).

If the patient is in their home then it is essential to summon urgent medical assistance, usually this is a call to the ambulance service, if in a health centre or doctors surgery a doctor will ensure appropriate antibiotics are given, the patient is then transferred to hospital by ambulance. The doctor has a legal duty to report and notify a suspected case of meningococcal septicaemia or meningitis to Communicable Disease Control ( CCDC). Meningitis can be difficult to diagnose as the onset is rapid, which could easily be confused with influenza, as many of the symptoms are alike. In suspected cases of meningitis, treatment is started before confirmation of diagnosis, because the tests carried out may take several hours for the results to be obtained, therefore delaying treatment could be dangerous for the patient. Doctors and paediatricians work in accordance with clinical guidelines and procedures to deliver the best quality care to patients and families. Therefore, following these guidelines the Doctor will make a full assessment of the patient presenting with symptoms of meningococcal disease. A physical examination is carried out by a doctor who will make a thorough examination of the patient for signs of infection, septicaemia or meningitis and check for a rash to decide whether it is non- blanching rash, if this patient also has a fever, immediate action is required by informing a senior paediatrician. A full history is taken such as when the symptoms started history of fever and other presenting symptoms. Making an assessment of a baby can be difficult because when babies are ill they are usually uncooperative, therefore it is often difficult to find where the infection is located. If a baby is quiet and lethargic and irritable when moved this could be a sign of meningitis. Any children who present with fever and haemorrhagic rashes have to be taken seriously by the medical staff; all must receive a thorough examination and measurements taken of their vital signs. Initial assessment of airway, breathing and circulation should be carried out on the patient to ascertain if the patient you are dealing with is seriously ill and clinical guidelines should be followed when dealing with this patient. Clinical signs such as temperature, respiratory rate, heart rate, capillary refill time and blood pressure are measured and recorded in order to complete the full assessment. A measurement is taken of oxygen saturation, where the normal value is above ninety five percent on room air, the size of the patients pupil and their reaction. Conscious level is assessed this includes how the patient responds to pain, voice, or if they are unresponsive then this is a medical emergency. If the patient is suspected of having meningococcal disease, the aim form the initial assessment is to identify whether raised intracranial pressure or shock is present and how severe the illness is. A patient with clinical signs of septicaemia leads to shock and multi-organ failure, because of circulatory failure. To diagnose meningitis a number of diagnostic tests will be carried out, firstly a number of blood tests are carried out which include to see if bacteria or viruses are present which cause meningitis, blood culture, a full blood count and blood gas. A lumbar puncture checks to see if bacteria or viruses are present, by taking a sample of

cerebrospinal fluid (CSF) at the base of the spine, however this test should only be undertaken if the patients condition is stable and no risk has been identified of raised intracranial pressure. If a clinical diagnosis is doubtful, a lumbar puncture is important for treatment, for children in particular those who are febrile and do not have a focus. Children who have obvious symptoms of meningitis, microbiological confirmation is valued to make decisions about prophylaxis (medication), duration of treatment, disease surveillance, after care of children recovering with neurological sequelae and managing public health. Asthma is a non communicable disease, which is a chronic inflammatory disease, causing a variable obstruction of the lung airways. The bronchi carry air in and out of the lungs, if a person has asthma the bronchi will become inflamed and become more sensitive than normal. The airways become narrower and the muscle layers become thickened and tightened, production of sticky mucus (phlegm) reducing the airway even further, making it difficult to breathe, which causes coughing, wheezing, chest tightness and shortness of breath (Waugh & Grant, 2001). Exacerbations of asthma can be gradual, rapid or severe which can be potentially life threatening. Inspiration is normal however partial expiration is achievable making the lungs hyperinflated and there is severe wheezing and shortness of breath. The characteristics of asthma include airflow limitation, inflammation and the airway hyperresponsiveness to a broad range of stimuli (Frew and Holgate, 2009). It is an increasingly common condition, where narrowing of the airways in the lungs is present, which changes over a limited period of time, recovery occurs either spontaneously or with treatment (Moore and Dalley 1999). Asthma is associated with acquired allergy, in addition to trigger factors, for example allergens, respiratory infections, pollutants, irritants (paint fumes and household sprays) and exercise and weather changes. Asthma can be triggered by exposure to specific allergens, especially house dust mite, pets and pollen (which may be severe in the spring and summer months), which stimulate an asthma attack where inflammation of the bronchioles, secretion of mucous and the submucosa becomes oedematous, bronchoconstruction occurs and smooth muscle hypertrophy (Frew and Holgate, 2009). Pathophysiology leads to asthma symptoms such as wheezing (the person makes a whistling sound when breathing), caused by obstruction to the airways, breathlessness (gasp for breath), chest tightness causing the individual to cough in an effort to clear the airway, with the cough particularly worse early morning and at night (Holgate and Douglas, 2006). The character of symptoms in asthma tends to vary in patients from mild to more severe and intermittent where symptoms come and go, as this is the characteristics of the spasmodic nature of asthma. Asthma is often worse at night although an explanation as to why this happens is uncertain. Asthma symptoms which get significantly worse are known as an exacerbation of asthma. This can develop slowly or become worse quickly, the person becomes wheezier, particularly on expiration,

breathlessness, and children in particular will flare their nostrils during inspiration, interrupted talking where a person cannot complete their sentences, this requires immediate medical treatment. Asthma is a life- threatening and serious respiratory disease; its severity may vary from intermittent, mild to severe and persistent. It impacts upon an individuals life physically, psychologically and socially, therefore taking a holistic approach to manage the condition is needed. Asthma can occur at any stage in life; however it appears to be more common during infancy and childhood where it firstly develops, where the condition varies depending on the age of onset and the possible causative factors. In infancy, asthma can develop, however it can be difficult to diagnose at an early age, until the child is older. However, correct diagnosis of asthma and treatment means most patients will lead a normal life, although this will involve taking regular medication in the form of inhalers to prevent and control asthma symptoms. The diagnosis of asthma requires an initial consultation with the Doctor and then other health care practitioners, such as a practice nurse who specialises in asthma, who will make a full assessment of the patient; clinically diagnosis is based on the presenting signs and symptoms such as wheezing, breathlessness, coughing and chest tightness, which are particularly worse early morning and at night. A full history of symptoms is taken and any possible risk factors to be considered such as family history and known allergies. Taking a family history from the patient would identify any close relatives, mother or father, brothers or sisters, who may have asthma or related conditions such as eczema or allergic rhinitis, this information can be helpful in making a diagnostic decision. The diagnosis of asthma can be confirmed by objective measures of lung function. Taking a measurement of lung function will provide an assessment of airflow limitation, variability and reversibility which are essential for the diagnosis and management of asthma. There are two methods to measure lung function; one is Peak expiratory Flow (PEF) monitoring, which is a tool commonly used in asthma management, which is easy to perform, quick and inexpensive. Patients are asked to blow a short concentrated manoeuvre into a PEF meter, which measures the maximum flow rate through the medium airways (bronchi), three times and the best reading is recorded and assessed against the predicted normal values for their age, sex and height, these tests are carried out when the patient is well. The meter has a pointer which travels along a scale and stops at the maximum flow rate; these readings are then read and recorded, the meter is easy to use and some patients have their own meter at home so they are able to monitor peak flow readings themselves. To confirm the diagnosis of asthma using PEF measurements patients are provided with a peak flow meter and diary to monitor and record their peak flow readings at home, usually over a two to three week period. From these readings the health professional is then able to assess the measurements and confirm the diagnosis.

The other diagnostic tool available to measure lung function is spirometry which has to be carried out by a health professional who has received appropriate training, this method is referred to as the gold standard of testing lung function , although spirometry is more often used to test patients for airway obstruction, it can be difficult for the patient to perform, therefore it is not often used, for instance with children. Patients are instructed to breathe in then exhale as hard as possible into the meter, until they feel that they can breathe out no further, in spirometry the lungs must be empted as far as possible with the test has to be repeated several times. Some people find it difficult to perform this test and therefore are not often used with children. The aim of spirometry is to distinguish normality from either obstructive and or restrictive airways disease and to confirm a diagnosis; and is helpful in the diagnosis of asthma. If diagnosis is still in doubt the health care professional will discuss and explain to the patient the option of starting whats called a trial of therapy, normal treatment reliever therapy (inhalers) to see if the asthma symptoms improve over a certain length of time, including an acute attack, the diagnosis can then be confirmed. If no improvement is made, then the patient needs to be further assessed and an alternative explanation has to be sought, there could be underlying health problems such as heart disease. In infants and small children it may not be possible to measure lung function, the diagnosis then depends much more on obtaining a detailed history and careful examination. Health care professionals work in accordance with clinical guidelines and there is a suspicion in anyone who complains of asthma symptoms, which could indicate asthma, it is important to make the diagnosis because treatment is now highly effective. In order to manage asthma the health care professional will use the measurements from the lung function tests in addition to the symptoms the patient has described and is experiencing to grade the asthma by using guidelines from the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) (2008) ranging from trivial to severe asthma, this then determines which treatment is recommended using the stepwise approach (treatment guidelines BTS and SIGN 2008) to treat the symptoms, the aim is to prevent the asthma attacks happening and improve and relieve the symptoms. Having made the diagnosis of asthma, at the initial assessment the patients current situation is assessed and planned for the future, during which a management plan is prepared, which includes avoiding any obvious trigger factors which have been identified; this includes avoiding smoking atmospheres and fumes caused by air pollution which can trigger an asthma attack. Parents of babies or children are asked is there is anyone in the household who smokes, because passive smoking is harmful and causes damage not only to those who smoke, but to anyone who lives in the same house who are then put at risk of harm and can trigger an asthma attack (ref.....). Peak flow measurements will have been taken, prior to any treatment given. Health promotion and education is given together with literature to support learning. A personal asthma action plan will give the patient information on treatment

and what to do in an emergency. With asthma being such a variable disease, patients are regularly monitored and reviewed by the practice nurse, normally annually for adults; more frequently in children, especially if there have been any problems. The treatments for asthma are called preventers and reliever; these inhalers are fully explained and discussed with the patient and are discussed fully in part B of this assignment.

Part B According to Meningitis UK (2009) whilst septicaemia and bacterial meningitis are rare, the meningococcal bacteria that causes the disease is considerably common, of which ten per cent of people and a higher figure of ten to thirty per cent of young people (adults) carry the bacteria and the pneumococcal bacteria is carried by up to sixty per cent of either children, young adults or people at any time. Normally, these bacteria live harmlessly in the back of the throat or nose and are only passed between people by oral or nasal droplets, such as sneezing of kissing (Meningitis UK 2009). Students living on university campuses are thought to have a greater risk, as carriage rates are higher because they live in close proximity. Although these bacteria can be passed person to person, in most people it is unlikely to cause concern or problems because most peoples body will be naturally resistant to the bacteria (ref....). As these bacteria are only able to survive for a short length of time outside the body and are not able to live long in the atmosphere or on objects in the home, such as furniture or clothing (Meningitis UK, 2009). Apparently, Meningitis UK (2009) suggest scientist are not able to fully understand how and why bacteria is harmless to most people, enters into the bloodstream which then turns fatal. According to figures, in summer viral meningitis is more common, where as in winter bacterial meningitis is common. In wintertime, cases of meningococcal and bacterial meningitis dramatically rise, with the number of cases peaking in February, in recent years figures show around two hundred and fifty people within England and Wales are diagnosed with meningitis in the first month of January alone. Although, those who have had contact with a case of meningococcal disease, the highest risk to others is within the first week, people who live in the same household with the primary case of meningitis, have the highest risk of infection and secondary cases, after this period the risk falls (Health Protection Agency, 2011). Research and medical knowledge suggests a case of meningococcal disease is most likely acquired through an invasive strain from an asymptomatic carrier with close contact, usually in the same household, this could pose a risk of infection being transmitted to other members of the household (Beckett, 2010). In untreated households, medical research suggest from observations made that the risk is at its highest for the first two days after the onset of the disease from the case of meningitis, as source of

infection is most likely to come from the same carrier or someone else, but not from the primary case of meningitis (ref....). Any transient contact with the case of meningitis before the onset of acute illness is viewed by the Health Protection Agency (2011) as an unlikely important risk factor, so anyone who was in the same proximity as the case, such as travelling by car, bus or plane will perhaps not justify prophylaxis (treatment). However, there is some guidance and research which suggests anyone who was seated in a plane for over eight hours, next to a person with a confirmed case of Meningitis should be offered prophylaxis (ref....). If a patient is suspected of having meningococcal infection, then immediate treatment with benzylpenicillin is the recommended intervention, all GP surgeries carry benzylpenicillin which is administered whilst arrangements are made to transfer the patient to hospital. The Health Protection Agency (HPA) who have local based teams who take a lead role in managing public health in cases of meningococcal disease and meningitis, who then immediately respond by undertaking surveillance, managing contacts and outbreak control. Meningitis is a notifiable disease; the Doctor who suspects a case of meningitis or meningococcal disease, or a diagnosis of meningitis is made, the Doctor has a legally responsible to notify any case of meningitis to the local consultant for communicable disease control (CCDC), even if the results from microbiology have not been confirmed (Health Protection Agency, 2011). This is usually carried out by telephone consultation to ensure a quick public health response. The Health Protection Agency will carry out a risk assessment of the meningitis case to identify the probable cause of bacteria or virus, begin contact tracing (whether the case is probable, possible or confirmed meningococcal disease), ensure appropriate prophylaxis (treatment) is arranged and any contacts of the patient are vaccinated. The HPA will provide further information for people involved in the case including contacts liaise with nurseries, schools, colleges, education authorities, primary care, national health service help lines, meningitis charities and employers and collect information for prevention and surveillance purposes (Beckett, 2010). The role of public health when managing a case of meningococcal disease or meningitis is to ensure early referral of the patient to hospital, thorough investigation of each case, contacts are traced and appropriate prophylaxis (medication) is arranged, information is collected and support media communication (Health Protection Agency, 2011). In the United Kingdom vaccinations are given against three main causes of meningitis, which are the meningitis C, Haemophilus influenzae type b (Hib) vaccine and pneumococcal, these vaccinations are offered and given as part of the childhood immunisation schedule for babies and small children. Immunisation is given to children to protect them against meningitis; however at present there is no vaccine available to prevent infection from group B meningococcal disease, which is

responsible for ninety per cent of meningococcal infection here in the UK, research is being carried out into developing a Men B vaccine (Meningitis Trust, 20...). In the UK the Men C conjugate vaccine was first introduced between 1999 and 2000, providing excellent protection from meningitis and septicaemia, which is caused by Group C meningococcal bacteria, reducing the number of cases by ninety five per cent (Royal College of Nursing and Meningitis Research Foundation, 2009). These immunisations are given in primary care, either by practice nurses or by health visitors within a Doctors surgery. Therefore health promotion is essential to raise awareness to parents that the single most important measure when caring for a child, is to protect them from meningitis and other preventable diseases, by ensuring their child is up to date with routine immunisations. The vaccines to protect against bacterial meningitis are offered and given as part of the routine infant immunisation schedule, which offers vaccinations at two months, three months, four months, twelve and thirteen months. According to the Royal College of Nursing and the Meningitis Foundation (2009), the uptake of boosters at twelve and thirteen months has a tendency to be lower against those children who receive primary doses of vaccines, therefore it is essential that the health care professional in their role in health promotion, explains and discusses with parents that without boosters children are not fully protected. The aim of chemoprophylaxis (antibiotics) is to identify and assess those at highest risk who are close contacts of the case of meningococcal disease, those within the same household and to reduce the risk from the invasive disease of secondary cases, by treating the carriers of the disease who are at risk of affecting others and those with the newly acquired invasive strain, who could be at risk themselves (Health Protection Agency, 2011). The local health protection or communicable disease control teams contact general practice, the Doctors of those with identified close contact to the Meningococcal case to request a prescription for antibiotics is issued immediately (Beckett, 2010). Studies, trials and medical research carried out into chemoprophylaxis show that Ciprofloxacin, Ceftriaxone and Rifampicin (Rifampicin is licensed specifically for prophylaxis) these antibiotics are more effective in eliminating the carriage of the disease and significantly reduces the risk of secondary cases, such as those living within the same household. Ideally, antibiotics should be administered within the first twenty four hours after a diagnosis of Meningitis, although in cases of a delayed diagnosis it can be given up to four weeks (ref....). However, Beckett (2010) suggests no prophylaxis can be one hundred per cent effective, as contacts of the case of meningitis could be already incubating the disease. After a case of septicaemia or meningococcal meningitis, often raises public anxiety, however, the risk is considered low to those outside the immediate household. Therefore, recommendations suggest not issuing treatment (prophylaxis) to preschool settings following a single case (unless they are living in the same household), treatment is not indicated for co-workers, those who have attended the

same social event or residents in a care home (Health Protection Agency, 2011). However, there is guidance and recommendations for specific circumstances, which include where clusters of cases from educational settings such as universities and colleges, when decisions are taken by the local Health Protection Agency or CCDC teams (Beckett, 2010 NICE....). The Health Protection Agency have an important role in providing information where appropriate, this includes informing the GP of the patients diagnosis of meningitis and other general practices within the local community and area, the aim is to raise awareness of the possibility of secondary cases. Individuals who are issued with prophylaxis are given information and advice on the symptoms and signs of meningitis and meningococcal disease, so that people can recognise signs and symptoms early. Meningitis charities and NHS help lines are notified of cases of meningococcal disease and meningitis cases, so that any contacts who are worried are able to contact them for advice and they can provide them with information and discuss any concerns they may have and give a national disease picture. Apparently, Meningitis UK (2009) suggest scientist are not able to fully understand how and why bacteria is harmless to most people, enters into the bloodstream which then turns fatal. According to figures, in summer viral meningitis is more common, where as in winter bacterial meningitis is common. In wintertime, cases of meningococcal and bacterial meningitis dramatically rise, with the number of cases peaking in February, in recent years figures show around two hundred and fifty people within England and Wales are diagnosed with meningitis in the first month of January alone. Asthma is a common disease and although it cannot be cured, asthma attacks can be prevented and treated. Whatever the prime cause of asthma, allergy or inheritance or from a secondary cause from a variety of triggers, the effects are still the same. Some people as it is suggested have a predisposition which they can be born with or develop asthma later, where they are liable to react to various substances which can trigger an attack. Allergy is a disorder of the bodys immune system, special structures to protect the body from infections (ref.....). The primary causes of asthma are not fully understood, however Holgate and Douglas (2006), classify risk to include predisposing factors such as being atopic (a person prone to allergies) some people appear to inherit a tendency to develop allergies, which is associated with allergic disease which include asthma, hay fever or eczema, developing atopy is influenced by both a genetic predisposition, specific genes that have been acquired from parents or environmental factors. If both parents are atopic, children or adults are much more likely to develop asthma, as some people appear to inherit from their parents a tendency for their bronchioles to over-react and become inflamed, the start of an asthma attack. This is not an allergic reaction this is due to the bronchioles being hyper-sensitive. People who inherit both atopic and a tendency to asthma are much more likely to suffer from asthma, as asthma appears to run in families. The other important risk factor for asthma appears to be acquired

allergy, although the role of developed allergy and its connection to atopy in predisposing (inherited) a person to asthma is not clear. When a person is at risk of asthma, whatever the primary cause, they need something else to cause an acute attack. These substances that can cause an acute attack are called triggers. All allergens are triggers; common triggers include smoke, cigarette smoke, animals with fur, domestic house dust mite, moulds, pollen, aerosol chemicals, drugs, stress, exercise and respiratory infections. House dust mite is the most common allergy in this country, as this small insect lives in peoples homes, often in fabric, bedding, carpets, furniture and soft toys, unfortunately this insect thrives on pieces of dead human skin, as we humans shed our skin all the time. Soft toys and carpets can cause asthma, as the character of housing has changed, where people have fashionable carpets in the home, powerful vacuum cleaners raise the dust and central heating are important factors. Hay fever is responsible for more frequent attacks especially in the spring and summer months. Outdoor and indoor fungi are potential allergens, pollen allergens are derived from trees especially in early spring, grasses and weeds are associated with asthma (Holgate and Douglass, 2006). The list of allergies is immense; domestic animals are often triggers, cats especially more often than dogs. Domestic animals secrete allergens in their dander (fur), saliva, urine and faeces, other pets particularly horses, guinea pigs, gerbils, rats, mice and rabbits are another source of allergens (Holgate and Douglass, 2006). As well as allergens food additives, drugs and occupational substances can make a persons airways sensitive and could play a causal role with up to twenty per cent of people with asthma. Occupational factors could be important as a trigger for asthma, as these could be allergic or irritant, allergic occupational factors include exposure to some chemicals and drugs. Irritant triggers include dusts (flour dust) and grain such as in a bakery, factory of warehouse, dyes in the textile trade, isocyanates which are used in glues and resins, poultry feathers and droppings and wood dust. When an adult present with asthma signs and symptoms past and present occupations are discussed to eliminate the possibility of occupational asthma, this could identify the patient has been exposed to substances that have the potential for a person developing an allergy to them (Romano-Woodward, 2009). Cigarette smoke is highly implicated as a trigger for asthma, as they contain a number of chemicals of which are potential allergens (causing allergy). People and especially babies and children in smoky environments (passive smoking) can be affected as well as the smokers themselves. In addition there is the irritant factor from the smoke, causing an attack when it passes through the over-active bronchi (ref....). The problem of passive smoking was well recognised by medical research and published statistics on the harm and damage caused, therefore to protect and prevent people from the harm and damage caused by passive smoking, laws were passed by government that in the United Kingdom, smoking is forbidden in public places and these areas were made smoke free from 2007 (.....). Mothers who smoke and expose their children to cigarette smoke, is associated with a high risk of

asthma and asthma attacks, also it is an early risk factor for asthma, which can impair lung growth and function, which can also encourage allergic responses in infants and small children. Atmospheres that are heavily filled with smoke, causes problems with passive smoking but also climate change is responsible for triggering attacks, people vary where some reaction to colder weather and other to warmer weather, these are also irritant effectives. Certain drugs which have been prescribed for medical purposes can trigger an asthma attack through allergy, aspirin which is taken for pain relief and in preventing coronary heart disease is a common allergy, with about one in fifty people allergic to it (ref....). A group of drugs known as non-steroidal anti-inflammatory drugs, which are taken for arthritis and pain relief can cause an allergic reaction, such as Nurofen and Ibuprofen. A drug known as beta blockers, which are used to treat high blood pressure, angina and heart failure frequently trigger asthma attacks. Chest infections can be a trigger factor for asthma, either viral or bacterial infections as well as the person not responding to antibiotics, this is the commonest trigger factor for asthma in children (ref....). Physical activity and exercise can also trigger asthma attacks, because most physical activity causes shortness of breath, causing an irritant effect. It is recommended that for people with asthma, swimming is a good form of exercise, as inspiration from the warmed air close to the surface of the water and decreases dehydration of the lower airways. As some people find cold air is a trigger of their asthma symptoms, as cold air holds less water than warmed air, exercising in the cold for example skiing cold, dry air will have an irritant effect, producing exerciseinduced symptoms. In the field of athletics, there are a high percentage of elite athletes who suffer from exercise-induced asthma; bronchodilator treatment (inhalers) is determined by assessing and evaluating symptoms and lung functions, to control symptoms, controller (preventer) and reliever. Treatment may be required before exercise to prevent exercise-induced asthma. Athletes who have exerciseinduced asthma are recommended to warm up slowly. Depending upon the grade of asthma the patient has been assessed as having, will determine which inhaled drugs are used, in asthma these are called preventers and relievers and are only use in connection with asthma. The practice nurse will provide education on how these inhalers work and a demonstration on how to use them will be given to ensure the patient or parents are able to administer treatment correctly and effectively. Preventers are to stop something happening, but if it does relievers give relief. Bronchodilators these inhalers are highly effective at dilating restricted bronchioles, relaxing the smooth muscle of the airways, even though the constriction could have been caused by the airways response to a trigger and are available as aerosols, dry-powder, tablets and liquids, these are used when needed to give relief. Preventers of asthma works on the principle that asthma is an inflammatory condition, inflammation of the airways causes the airway wall to swell and the

secretion of phlegm into the airway causing obstruction. Preventer inhalers are normally used twice a day in varying doses, but can be used more often in severe cases and should always be taken on a regular basis. These are inhaled corticosteroids, based on a steroid hormone produced in the cortex of the adrenal gland; these suppress the inflammatory response within the airways, having an antiinflammatory effect. The dose of inhaled steroids is low, so general side effects are rare, however thrush infections and hoarseness are common, patient are advised to rinse their mouth after use to prevent possible side effects. There are some similarities between the communicable disease of Meningitis and the non-communicable disease of asthma, in comparison both of these diseases can occur and develop in babies, young children and adults. Another similarity between asthma and meningitis is that people with asthma or other respiratory diseases are offered immunisation against influenza or pneumococcal, as both illnesses are common and pneumococcal infections have a high mortality of between ten to twenty per cent and for someone with asthma these infections can prove fatal. Immunisations are also offered against meningitis as part of the childhood immunisation schedule and later in young adults. These immunisations are given to help protect babies, children, young adults and older adults from disease or illness. Asthma is life threatening as is meningococcal disease, both can prove fatal, acute exacerbations of asthma possibility caused by a trigger, such as a recent respiratory chest infection can be dangerous, severe and potentially life threatening for the person. Over five hundred young and middle aged people die as a result of asthma every year in the United Kingdom (Asthma, UK 2.....). Therefore, it is essential the person receives urgent medical help either at their Doctors surgery or in more severe cases taken by ambulance to the local accident and emergency hospital. Ambulances are equipped with oxygen and medication to treat the patient until they arrive at hospital. The person can be very distressed and will experience severe breathlessness, increase respiratory rate, increased pulse, have a widespread wheeze and their oxygen level when measured will be quite low, they may not be able to communicate in full sentences. This situation is requires prompt action and treatment as it is classed as a medical emergency, the patient is assessed by a Doctor and given urgent treatment either steroid tablets or injections, an oxygendriven machine called a nebuliser gives the patient a bronchodilator (medication to open up the airways) in liquid form is administered and repeated if necessary, they usually is an effective method of treatment, with patients who make a good recovery, the more serious cases will then go by ambulance to hospital. There are several differences in the signs and symptoms between meningitis and asthma. With meningitis the symptoms include a high temperature of a fever of thirty eight degrees or above, a stiff neck, headache, vomiting, sensitivity to light and a notable rash. Most of these symptoms are also similar to other diseases for example

influenza which is a viral disease, these include a fever with a temperature ranging from 38 to 40 degrees, headache, fatigue, weakness, aching muscles and joints and vomiting. Influenza is more prevalent between October to May, which can become more serious and severe, which can lead to pneumonia, brain and nerve damage, life threatening and can result in fatalities although such complications can be rare. Influenza is a viral infection and therefore is not treated with antibiotics; the disease is spread between people through the air (airborne) infecting the lungs, nose and throat. Whilst breathing, cells in the mucous membrane (cells lining the respiratory airways) are susceptible to viral attacks as they do not have a protective skin. Influenza epidemics can break out, which can quickly spread between towns, areas, and country to country for example the recent case of swine flu outbreaks. The symptoms of asthma will include wheezing, a high pitched sound caused by narrowing of the airways, impeding the normal flow of air into and out of the lungs. If the airways are obstructed they cannot provide the oxygen demands of the body and results in shortness of breath, if the muscle of the larger bronchi contract and narrow the person can experience a feeling of chest tightness, a cough when the airways become irritable and the body tries to clear the problem by coughing. The symptoms of asthma are similar to another respiratory disease, namely chronic obstructive pulmonary disease, this disease is usually caused by smoking or being in contact with smoke over a long period of time, smoking is also a trigger for asthma attacks. Chronic obstructive pulmonary disease is a combination of several things, which include chronic bronchitis, emphysema, bronchiolar disease and chronic asthma, the result is obstruction to air flow, it affects the respiratory system the same as asthma. The character of symptoms is similar to asthma although symptoms come and go, but in chronic obstructive pulmonary disease they are more severe and they remain constant, people still experience a wheeze, shortness of breath, chest tightness and chest pain and a productive cough, some people have more difficulty in breathing and have a productive cough which is often worse in the morning, they produce more phlegm. Other symptoms include weight loss, chest infections and ankle swelling people can get more depressed with this disease. Asthma and meningitis are diagnosed differently, using various tests and procedures to confirm a diagnosis. Firstly, with asthma the Doctor or practice nurse will use tools such as a peak flow meter or spirometry machine to test and measure the person for lung function, expiratory flow and to measure airway calibre. Peak flow readings are taken and recorded by the patient themselves at home over a two week period, these readings are then assessed, if there is variability of peak flow figures on three or more occasions in this time a diagnosis of asthma can be confirmed. A trial of therapy with inhalers over a two week period which showed the person has benefitted from treatment and reduced or improved their symptoms would indicate and confirm a diagnosis of asthma.

References Books Cross, S & Burns, D (2005) Vital Asthma London: Class Publishing Limited

Frew, A.J. & Holgate, S.T.(2009) Respiratory Disease eds. Prof.P.Kumar & Dr M Clark Kumar & Clarks Clinical Medicine 7th ed. London: Elsevier Limited

Holgate, S.T. & Douglas, J. (2006) Fast Facts: Asthma 2nd ed. Oxford: Health Press Limited.

Moore, L.M & Dalley, A.F. (1999) Clinically Orientated Anatomy 4th ed. Philadelphia: Lippincott Williams & Wilkins

Levy, M., Weller, T., &Hilton, S. (2006) getting asthma patients to take their therapy. Practice Nurse 31, pp.40-43

Waugh, A & Grant, A (2001) Anatomy & Physiology In Health And Illness 9th ed. pp240 London Elsevier Churchill Livingstone

Internet

Health Protection Agency (2011) Guidance for public health management of meningococcal disease in the uk London: Health Protection Agency Available from: http://www.hpa.org.uk

Meningitis Research Foundation (2010) Lessons from research for doctors in training London: Meningitis Research Foundation Available from: http://www.meningitis.org NHS choices your health your choices (2010) Meningitis London: direct gov Available from: http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx

Research Articles & Journals Becket, G (2010), Meningitis and septicaemia: diagnosis and prevention Practice Nursing 21 (8) pp 398- 402

Leaflets Getting to know the facts (2010) NHS Foundation Society