Transcript Respiratory Health and Homeless people

Respiratory health and
homeless people
Briege Casey
OVERVIEW OF THE RESPIRATORY
SYSTEM
Respiratory system
WHY ARE HOMELESS PEOPLE MORE
VULNERABLE TO RESPIRATORY
ILLNESS THAN THE REST OF THE
POPULATION?
Factors contributing to
respiratory ill health and early
mortality
Behavior
40%
Medical Care
10%
Genetics
30%
Environment
20%
McGinnis, et al., Health Affairs; 21(2), 2002
Environmental living conditions and
urban pollution
Poverty
Health damaging behaviours
Immuno -suppression
Barriers to health care
Lack of health provision
Ignorance, apathy and low self esteem
Common respiratory conditions
experienced by homeless people
Flu
Exposure
• Seasonal human influenza viruses spread from
person to person primarily through large-particle
respiratory droplet transmission (e.g., when an
infected person coughs or sneezes near a
susceptible person).
• Transmission via large-particle droplets requires
close contact between source and recipient
persons because droplets do not remain
suspended in the air and generally travel only a
short distance (< 6 feet).
• Contact with contaminated surfaces is another
possible source of transmission as is
transmission via droplet nuclei (also called
“airborne” transmission).
Flu virus and cilia
Get the vaccine – not the flu
Pneumonia
Inflammation of one or both lungs caused by
bacteria, virus, or fungi
Treatment
Antibiotics (usually bacterial cause)
Rest
Encourage deep breathing
Fluids
Possibly oxygen therapy depending on
severity
Bronchitis
• A respiratory disease in which the mucous
membranes of the bronchial passages in the
lungs become inflamed.
• As the irritated membrane swells and grows
thicker, it narrows or shuts off the airways in the
lungs, resulting in coughing spells accompanied
by thick phlegm and breathlessness.
• The disease occurs in two forms: acute (lasting
less than 6 weeks) and chronic (reoccurring
frequently for more than two years).
Symptoms of bronchitis
• A cough that is frequent and produces
mucus
• Lack of energy
• Wheezing sound when breathing, (may or
may not be present)
• Fever may or may not be present
Smoking and bronchitis
Even one puff on a cigarette is enough to cause
temporary paralysis of the tiny hair-like
structures in the lungs, called cilia that are
responsible for brushing out debris, irritants, and
excess mucus. Continued smoking, may do
sufficient damage to these cilia to prevent them
from functioning properly, thus increasing the
chances of developing chronic bronchitis. In
some heavy smokers, the membrane stays
inflamed, and the cilia eventually stop
functioning altogether. Clogged with mucus, the
lungs are then vulnerable to viral and bacterial
infections, which over time distort and
permanently damage the airways. This
permanent condition is called COPD (chronic
obstructive pulmonary disease).
Treatment of bronchitis
•
•
•
•
If bacterial in origin – antibiotics
Rest and fluids
Avoid smoking, pollutants and fumes
In more chronic cases – bronchodilators
and steroids, physiotherapy and oxygen
therapy
Asthma
Chronic inflammation of the bronchioles
causing
• Swelling and constriction – difficulty in
moving air in and out
• Sensitivity to allergens which causes
further irritation and inflammation
• Symptoms include shortness of breath,
wheezing, cough, and chest tightness.
Asthma
Treatment
• Avoiding precipitating factors is important
in the management of asthma.
• Medications can be used to reverse or
prevent bronchospasm i.e bronchodilators
and steroids (usually inhaled)
• Education and support in managing
triggers and medication
Chronic obstructive pulmonary
disease (COPD)
• Debilitating lung disease
• Progressive and is irreversible
• Linked to smoking in most cases and affecting over
110,000 Irish people.
• People with C.O.P.D. including those with Chronic
Bronchitis and Emphysema are estimated to account for
almost a quarter of deaths in Ireland.
• In Ireland about 7,000 people die each year from
smoking-related diseases. This is 10 times more than
the number killed each year in road incidents.
COPD Treatment/prevention
• Smoking cessation is single most effective intervention
• Try to prevent flare ups by avoiding triggers, cold, damp,
pollutants
• Keeping up fluid levels by drinking enough water and
using steam or a humidifier to help keep airways moist this can help reduce the thickness of mucus and phlegm
that are produced
• exercising to keep moving and eating a healthy diet to
help heart and lungs. Strengthen immune system
• having a flu vaccination each year, as COPD makes
person particularly vulnerable to the complications of flu,
such as pneumonia (bacterial infection of the lungs)
• having a vaccination for the Streptococcus pneumoniae
• In flare ups - drug treatment and oxygen therapy
Tuberculosis
Bacterial infection primarily affecting lungs
There are 2 types of TB:
• TB infection: The bacteria is present but is
not active or contagious. TB infection is
also called latent TB or inactive TB.
• Active TB: The bacteria is present, causing
symptoms and is contagious.
Pulmonary TB
A number of factors increase the risk of TB among homeless people. These
are:
• the increased number of undetected cases among homeless people
• delayed diagnosis caused by problems accessing health care and the
reluctance of some homeless people to consult health services
• generally poor nutrition and weakened immunity (HIV/AIDS) which
increases the risk of initial infection and progression to active disease
• high alcohol intake has a direct effect on immunity and can be linked with
poor nutrition
• hard drug use, especially smoking crack cocaine, can mask TB as it
produces similar symptoms
• overcrowding - crowded or poorly ventilated accommodation with little
natural light makes the spread infection more likely
• taking TB treatment for a minimum of six months is often very difficult for
homeless people due to other priorities, low self-esteem, lack of knowledge
about TB, alcohol misuse, mental illness or living on the streets or in
unsuitable accommodation
• the prevalence of drug resistant TB among homeless people. This form of
the disease is much harder to treat and is likely to be infectious for longer
periods of time.
Symptoms of TB
● A cough which seems to get worse over a period of two
to three weeks
● Persistent fever
● Heavy sweating at night
● Loss of appetite
● Unexplained weight loss
● General & unusual sense of tiredness and being unwell
● Coughing up blood – seek urgent medical advice
A person with 3 or more of these symptoms should seek
medical advice.
If people with TB are detected early the disease is easier to
treat and further spread is limited.
Treatment
• Long term antibiotic therapy – rifampicin
and izoniazid (6-24 months) for cases of
active TB
• Drug resistant TB becoming more
common
Am I at risk?
• There is no evidence to suggest that homeless sector
workers working with TB patients are more at risk of TB.
• Nevertheless, awareness of symptoms and treatment
regimens are crucial to ensure that TB cases are
detected early.
• You should be aware of symptoms, treatment and what
to do if you suspect that you, a client or other members
of staff have TB.
• If you have not had a BCG vaccination you should
consider a vaccination and discuss this with your GP.
• If you are especially susceptible to infection, for example
if you have an illness or have to take medicines that
reduce your immunity, then you may need to take further
precaution.
• Consistent use of infection control measures
Keyworker interventions to
promote/maximise respiratory health
• Promote positive respiratory health through encouraging
exercise, smoking cessation and adequate diet and fluids
• Awareness of at risk groups – older people and people
who are immuno-suppressed –protect as far as possible flu vaccines etc. Be aware of current circulating diseases
infectious respiratory illness in the environment
• Try to minimise risks/triggers in the environment – ensure
adequate ventilation, elimination of smoke and fumes,
protection for people in cold damp weather, infection
control, cough etiquette.
• Education and support for clients re diagnosis and
maintaining respiratory health - use of inhalers, medication
concordance, achieving maximum lung function,
• Observation and seek prompt treatment re changes in
person’s respiratory capacity- breathlessness, cough,
wheeze, change in skin colour, fever
Look after yourself
• Make sure your vaccinations are up to
date
• Infection control – gloves, handwashing
• Don’t over-expose yourself to known risk
of airborne infection
• Ensure that your workplace is not
overcrowded and is adequately ventilated
• Seek medical assessment early for any
respiratory illness