School nursing is one of several traditional roles for community health nurse. Providing health care for schools placed for a number of reasons. In the first place, school environment it self may create hazards which students must be protect from. Beside, children need to be healthy to learn effectively .similarly vital reason is, maintaining the health of children today produce healthy adults in years to come. Subsequently, protect and promote the health of overall community. Jocelyn Elders a former U.S surgeon stated “you can not educate a child who isn’t healthy and you can’t keep a child healthy who isn’t educated” this common says teaches us the importance of keeping school child healthy as well as the necessity of school nurse (Clark, 2008).

An estimated 7 million U.S. kids under age 18 have been diagnosed with asthma and more than 13 million days of school are missed each year because of the condition, as indicated by the American Academy of Allergy, Asthma, and Immunology (KidsHealth,2011) .

According to my week rotation in Tareq Bin Ziad primary school, I have notice that asthma ranked the 2nd highest disease among the school children based on the statistic done by the school nurse. Therefore, I have chosen asthma as a topic of my written assignment.

This paper aims to identify literature review about asthma definition, pathophysiology, causes, risk factor and sign and symptoms, diagnosis and treatments. Secondly, it will clarify community health nurse strategies including comprehensive assessment, intervention and prevention.

Definition and statistics

Asthma is a disease that involves periodic episodes of severe but reversible bronchial obstruction in person with hypersensitive or hyperresponsive airway. Accordingly, a significant rise in episode of acute asthma requiring immediate hospitalization in children has occurred during the last 2 decades. On the contrary, frequent repeated attack of acute asthma may lead to irreversible disease in the lung and development of chronic asthma. It was proven that, in the age group 5 to17 years about 140 per 1000 persons have been diagnosed with asthma. However the number of attacks peaks in school children in September, often associated with increase in incidence of common cold (Gould,2006).

Although asthma is considering COPD group, likewise it is more common, more serious and more manageable than it is generally though. As asthma known to be chronic with some individuals so, it consider long live condition and might lead to death if not well managed in acute episodes . In UK, asthma kills about 1600 adults and 20 children annually (Hough, 2005).

Pathophysiology, Etiology and Risk factor

Asthma may be classified in different ways. It may be acute or chronic, acute referring to single episode where as chronic referring to long-term condition. A recently developed system rates a case of asthma on a clinical scale ranging from mild, intermittent, severe and persistent (Gould, 2006, P.393). Mater of fact there are three phases of response take place in asthmatic patient. Firstly, sensitization stage, which occurs in atopic people via exposure to allergens in fetal or early life, stimulates production of excess immunoglobulin -E (IgE) antibodies in the serum. IgE becomes fixed to mast cells, which then react to antigens by releasing bronchoconstrictor mediators such as histamine. Serum IgE is five times greater in people with asthma than in those without. Once allergic asthma has developed removal from the allergen does not always prevent continuing asthma, it might delay it only. Second stage called hyperreactive stage, what special about this stage it can occur with or without allergic component. Continued exposure to allergens or response to other stimuli leads to mast cell degranulation and release of inflammatory cytokines such as eosinophils . Also it releases bronchoconstrictor mediators such as histamine and extra mucus. Besides, chronic inflammation damages the surface of epithelial layer causing hyperreactivity of bronchial smooth muscle. Thirdly, bronchiconstrictors mediators and hyperreactive bronchial smooth muscle lead to exaggerated bronchoconstriction .These triggers might be food such as diary products, egg and acidic drink .pets, balloon, smoking, cold whether, indoor condition (dust) , some drugs, gastroesophageal reflux disorder and emotions such as depression and frustrated chest infection and exercise (Hough, 2005,P.366). Another facts associated with asthma pathophysiology are Impaired mucocilary function, edema formation, vascular congestion, increase vascular permeability, production of thick tenacious mucus, thikining of airway wall (McCance & Huether, 2006).

There is no single cause of asthma, but certain factors may increase the likelihood of developing it. These factor can be categorized as genetic and environmental factors including: A family history of asthma or other related allergic conditions (known as atopic conditions), such as eczema, food allergy or hay fever. Having bronchiolitis as a child (a common lung infection among children) and being born prematurely (especially if you needed a ventilator). Developing another atopic condition such as a food allergy and being exposed to tobacco smoke as a child particularly if your mother smoked during pregnancy. As well as being born with a low birth weight less than 2kg or 4.5 pounds (Asthma, 2010).

Additionally causes are viral upper respiratory infection, sedentary life style, poor ventilation and increased air pollution (Gould, 2006). Few risk factors related to asthma including gender, obesity, smoking and population differences. Before puberty asthma occurs more often in males while after adolescence, it appears to be more common in females. Some experts argue that excess weight pressing on the lungs may trigger the hyperreactive response in the airways typical of asthma. Others believe that asthma leads to obesity by inhibiting physical activity, although several studies have found no difference in activity levels between people with or without asthma (health central, 2011).

Sign and symptoms and Diagnoses

The sign and symptoms of asthma vary from person to person and in any individual from time to time. Some of theses are Shortness of breath (especially with exertion or at night), Wheezing sounds, coughing may be chronic (worse at night and early morning) , sweating , bluish color to the lips and face , anxiety and chest tightness (Medicine Net, 2011). Similarly important symptoms including : Pulling in of the skin between the ribs when breathing (intercostal retractions), Abnormal breathing pattern, tachycardia, hypoxia, tick tenacious or sticky mucus ,chronic dry cough in some and others have productive cough (Copstead & Banasik, 2010)

Actually, there is no simple test to diagnose asthma. Nevertheless, general partitions normally diagnose asthma by asking about the symptoms, what trigger it, how often and what settle it down. Coupled with some questions about medications patient use, life style, occupational and home and work environment. Other test are spirometry, to assess how well your lungs work and Peak expiratory flow rate test which defined as a small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath (Medicine Net, 2011).

Further more, asthma can be diagnosed based on physical finding, sputum examination, pulmonary function test, and blood gases analysis and chest radiography. Complete blood count can show an elevate number of white blood cells with increased eosinophils. Equally important test is skin testing and inhalation test to determine type of allergens. Conversely, skin testing is usually more helpful in young patient who have extrinsic asthma. Arterial blood gases may be normal in mild condition but as long as it become severe respiratory alkalosis and hypoxia will be shown (Copstead & Banasik, 2010).

As it is mentioned previously, asthma classified as mild, intermittent, severe and persistent. Other classifications are status asthmaticus and it characterized by prolonged attack more that 24 hours, leading to dehydration. Asphyxia asthma, this attack leads to arrest within hours or minute. Another one is nocturnal asthma, related to asthma at night and it considers symptoms free in the day. Besides, occupational asthma, usually seen in adults and attribute to substance in work place. in addition to drug induced asthma , aspirin intolerance occurs in about 10% of asthmatic people because it reacts with in hours after ingesting it .one more is premenstrual asthma, it present as particularly severe monthly asthma attack during the 5- 10 days leading up to menstruation. As well as, exercise induced asthma; this is common in children and adolescents. Bronchospasm often occur within three minute after the end of exercise and resolve in 60 minute (Hough, 2005).

Prevention and treatment

Minimizing the number and severity of acute attacks is crucial to prevent permanent lung damage, reduce risk of infection and to prevent chronic lung disease such as asthma. General measures to reduce asthma include avoidance of common triggering factors, doing skin test to determinate the stimuli casing allergy and avoid it. Good ventilation at home and school area, regular swimming sessions are of great benefit for school age children to strengthen chest muscle. Administer prophylactic medication as children go back to schools and at first sign of cold. During acute attack many individuals carry inhalers so they can self administer bronchodilator, usually beta adrenergic agent such as (ventolin). This medication can be also used prior to exercise or known stimuli to avoid attack happening. Controlled breathing techniques and a reduction of anxiety often decrease the severity of attack. When chronic inflammation develops it is recommended to use glucocorticoids such as (Beclovent) because this medication is more effective in reducing the second stage of inflammation in the airway. In cases like status asthmaticus hospital care is essential because patients do not respond to bronchodilators. In chronic condition prophylaxis is given to the patients such as Cromolyn sodium; a prophylatic medication administer by inhaler on a regular daily basis. The drug inhibits the release of chemical mediators from sensitized mast cell and decreases the number of esenophils, thus reduce hyperresponsiveness (Gould, 2006).

Assessment

Physical assessment for asthma patient includes examine nose, mouth, throat, sinuses, ears, chest and skin. Community health nurse is responsible for this assessment by examine patient nose for signs of increased nasal drainage, swelling inside the nose, check throat for signs of drainage, indicating inflammation and infection in the sinuses .Listen to child chest for wheezing, indicating blockage of airflow in the airways. Observe chest muscle for breathing and examine patient skin for signs of an allergy (Essig, 2011) Moreover, asthma can cause tiredness and weakness therefore child lacks energy and unable to perform simple tasks ( Haines & Clarke, 2009).

Asthma can be affected by psychological aspect such as stress, anxiety, sadness and can be provoke by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders (Lehter,Feldman, Giardino, Song & Schmaling, 2011). Regarding social assessment nurse can found that asthmatic child tend to stay alone always because of feeling embarrassed about their condition and medication taking in school or in public area( Essig, 2007) . Due to asthma some children lose their self -esteam ; others may fear oh having asthma attack if they are at school or around friends ( Roberts , 2010).

Children with asthma who live in economically deprived urban areas tend to have more-severe asthma and poorer outcomes over the course of the illness. Frankly there is evidence that in some low-income children with asthma, parents have problems with treatment compliance and adhering to home management guidelines factors that clearly affect the course of the illness in children (Nelson , Awad, Alexander & Clark , 2009).

To perform environmental assessment nurse need to collect information about patient area of living, home environment, work environment and school environment. Importance of this assessment is to reduce irritant and allergens in the sittings where asthmatic patient spends more time. Tobacco smoke and air pollution are the mainly two respiratory irritant that asthma patient suffer from ( NHLBI , 2011)

Prevention and Intervention

Primary prevention asthma patient are mainly education and awareness about the condition. It is recommended to avoid smoking and exposure to environmental tobacco smoke, particularly during pregnancy and early childhood. About infant regular and exclusive breast feeding reduce risk for asthma. Let the patient be aware about all risk factor associated with developing asthma such as allergen from food, animal, infection and bad life style (Arshad , 2005).

Secondary prevention of asthma defined as intervention for child or patients who are at high risk for the development of asthma but who have not yet developed asthma symptoms or signs. Beside those who are at initial development of the disease. Theses patients have family history of allergic disease or atopic conditions. Secondary prevention of asthma falls in to three phases: pharmacological treatment, control of environmental allergy and allergen -specific immunotherapy which reduced the progression of asthma and prevented an associated increase in bronchial hyperreactivity.( Canadian medical association, 2005)

Tertiary prevention is the stage where patient already have the disease however community health nurse role is to decrease attacks and reduce complications. Patient with allergic asthma , ezema and atopic dermatitis must reduce exposure dust and animal such as dogs and cats. Thus, improve system control and prevent excecerpation. Also pharmotherapy is very important in this stage (WHO, 2002).

There are many nursing intervention for asthmatic patient like Maintain respiratory function and relieve bronchoconstriction while allowing mucus plug discharge. Let the patient have enough rest and relaxation. As ordered, administer oxygen by nasal cannula breathing and to increase arterial oxygen saturation during an acute asthma attack. Place the patient in semi-fowler position and encourage diaphragmatic breathing. Reassure the patient during an asthma attack and stay with him .Encourage the patient to express his fears and concerns about his illness. Encourage regulate exercise as a part of asthma treatment; promote good nutrition and good hygiene. Demonstrate the proper use of metered dose inhaler properly. Educate client (recognize triggers: smoke, dust, mold, weather changes, and animals). Administer drugs and I.V. fluids as ordered (Nursing file, 2009).

Conclusion

Asthma is a chronic condition characterized by obstructing the bronchial airway. Usually it developed in childhood and symptoms decrease while grow up. Number of asthmatic children is increasing yearly due to the environmental factors. Simply asthma happened when inflammation of airway occurs, bronchospasm of airway muscle, edema of air way and increase mucus secretion. Many factors can cause asthma like environmental factor, family history, infection and allergy. Main sign and symptoms are wheezing sounds, coughing, more secretions and chest tightness. It can be diagnosed by asking patient about the symptoms, pulmonary function test, sputum examination, blood gasses analysis and chest X-ray. In treating asthma ventolin , beclovent and prophylaxis like cromolyn sodium are common . Physical, phychological, economical, environmental and social assessment is needed to done for asthmatic patient. Prevention of asthma categorized in to primary, secondary and tertiary. Nursing intervention for asthmatic patient vary. Some of these interventions are maintain respiratory rate, let patient complete rest and administer medications and oxygen.

Idiopathic Pulmonary Fibrosis

Sally Sanchez

Philadelphia College of Osteopathic Medicine

Abstract

Idiopathic pulmonary fibrosis (IPF) is a respiratory disease that is rare and, effects 13 to 20 per 100,000 people.  Researchers noted that prevalence and incidence rates have risen over the last decades.  IPF is considered to be a chronic condition that impacts lung tissue and respiratory abilities.  The disease is known to be more prevalent amongst the elderly, as it typically effects people ages 50 and older.  The process of fibrosis causes irreversible damage, and physical changes to the structure of the lungs.  Patients with IPF generally present with increase dyspnea, persistent and uncontrollable dry cough, fatigue, and finger clubbing.  There are significant risk factors that increase the risk to develop IPF including smoking, exposure to environmental toxins, genetic factors, viral infections, and more.  Pirfenidone and nintedanib contain anti-fibrotic qualities that assist in the preservation of healthy lung tissue.  Quality of life is severely impacted by IPF and, many IPF patients present with signs of depression and/or anxiety.  Future research studies should focus extensively on identifying any epigenetic considerations that may lead to the production of fibrosis in the lungs.

Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a respiratory disease that is rare and, effects 13 to 20 per 100,000 people (U.S. Department of Health & Human Services, 2019).  The National Institute of Health (NIH) (2019), estimated that in the United States, there are approximately 100,000 people affected by IPF.  Additionally, the NIH (2019), determined that there are between 30,000 and 40,000 new cases of IPF diagnosed each year.  Although researchers have considered IPF to be a rare disease, they noted that prevalence and incidence rates have risen over the last decades (Sauleda, Nuñez, Sala, & Soriano, 2018).  Lipsi et al., (2018) reported similar findings regarding prevalence rates; however, they mentioned that incidence rates remained constant.  Researchers indicated that prevalence and incidence rates are higher amongst males (Sauleda et el., 2018).  Moreover, IPF is known to be a disease that is more prevalent amongst the elderly, as it typically effects people ages 50 and above (Sauleda et al., 2018; U.S. Department of Health & Human Services, 2019).

IPF is considered to be a chronic condition that impacts lung tissue and respiratory abilities (U.S. Department of Health & Human Services, 2019).  Although there have been several risk factors identified as potential contributors to the development of IPF, it has not been attributed to a direct cause (Sauleda et al., 2018).  Moreover, IPF has been associated with a high mortality rate and, very poor prognosis (Lipsi et al., 2018; Swigris, Brown, Make, & Wambolt, 2008).  The progression of the disease involves limited abilities to deliver oxygen to parts of the body and, ultimately leads to death (Vega-Olivo & Criner, 2018).  Patients diagnosed with IPF live for an average of 2 to 5 years after being diagnosed with IPF (Lipsi et al., 2018; Sauleda et el., 2018; Swigris et al., 2008).  The poor prognosis and high mortality rate are not only attributed to a lack of cure, but also to a lack of effective pharmacological treatment options (Sauleda et al., 2018).

What is Idiopathic Pulmonary Fibrosis?

IPF is deemed to be the most prevalent subtype of idiopathic interstitial pneumonias (Lipsi et al., 2018; Sauleda et el., 2018; Swigris et al., 2008).  Interstitial pneumonias belong to a broader category of disease known as interstitial lung diseases (Swigris et al., 2008).  One of the essential features of interstitial lung disease is the scarring of lung tissue (Lipsi et al., 2018).  Throughout the development of IPF, lung tissue becomes thick and tough which often leads to the formation of scar tissue in the lungs (U.S. Department of Health & Human Services, 2019).  The scarring is considered to be the fibrosis (U.S. Department of Health & Human Services, 2019).

Fibrosis is defined as, “The overgrowth, hardening and/or scarring of various tissues and is attributed to excess deposition of extracellular matrix components including collagen” (Wynn, 2008, p. 199).  According to researchers, IPF is a byproduct of altered healing processes that occur during the cycle of cell damage and repair, specifically in the lungs (U.S. Department of Health & Human Services, 2019).  The result is, the formation of scar tissue that prevents the lungs from accomplishing its main function of delivering oxygen to other areas of the body (U.S. Department of Health & Human Services, 2019).  In essence, IPF makes it very difficult to breathe, as oxygen does not pass through the thick walls of the alveoli with ease (Kolahian, Fernandez, Eickelberg, & Hartl, 2016).  The fibrosis prevents the oxygen in the lungs from fluently passing through the cell walls and, into the thin blood vessels that surround the cells (Kolahian et al., 2016).

There are a number of events that must occur in order for IPF to develop.  There must be a presence of an abnormal tissue healing process in the lungs as well as, constant microinjuries to the alveoli (Todd, Luzina, & Atamas, 2012).  This leads to an excessive deposition of extracellular matrix components which include hyaluronan, fibronectin, and interstitial collagens which ultimately compromise gas exchange abilities at the cellular level (Todd, Luzina, & Atamas, 2012).  The process causes irreversible damage to the lungs as well as physical changes to the structure of the lungs (Kolahian et al., 2016).

Patients with IPF generally present with increase dyspnea or difficulty breathing (Ryu et al., 2014).  Other symptoms include dyspnoea or shortness of the breath and persistent and uncontrollable dry cough, and finger clubbing (Ryu et al., 2014; Swigris et al., 2008; U.S. Department of Health & Human Services, 2019).  Patients may also present with fatigue, fevers, and weight loss as a result of the progressive respiratory failure (Ryu et al., 2014).  It is also common to observe declines in walking distance when completing a 6-minute walk test (Vega-Olivo & Criner, 2018).  Furthermore, patients with IPF often complain about sleeping difficulties (as breathing may become difficult even at rest), gastrointestinal problems, anxiety, and depression (Vega-Olivo & Criner, 2018).  Researchers have noted that the presentation of IPF can be very similar to the presentation of other respiratory diseases and can be comorbid with other conditions such as emphysema, pulmonary hypertension, and lung cancer amongst others (Ryu et al., 2014).  Comparably, Vega-Olivo and Criner (2018) discussed the importance of ruling out other respiratory disorders before diagnosing IPF.

Diagnostic

Vega-Olivo and Criner (2018) encouraged the use of a multidisciplinary framework when working with a patient who is suspected to have IPF.  They highlighted the benefits of working collaboratively in order to reliably diagnose IPF.  Typically, high resolution computed tomography (HRCT) scans allow physicians to screen for recognizable patterns of usual interstitial pneumonia (UIP) (Vega-Olivo & Criner, 2018).  HRCT scans help physicians and diagnostic teams view distinguishable patterns that are similar to the pattern of a honeycomb (U.S. Department of Health & Human Services, 2019).  Whereas some researchers consider that a HRCT scan is sufficient to fulfill a diagnosis of IPF (Vega-Olivo & Criner, 2018), others consider that HRCT scans can conceal IPF (Lipsi et al., 2018).  It was noted that honeycombing may only be observed in the upper lungs although a majority of the damage may be in the periphery of the lungs (Lipsi et al., 2018).  Therefore, Lipsi et al., (2018) suggest that a lung biopsy is required to make a diagnosis of IPF.

Causes and Risk Factors

Researchers have not yet found a direct cause of IPF (Ryu et al., 2014).  Idiopathic is a term used to describe disease that do not have a direct cause.  Although researchers have not yet found a direct cause of IPF, many factors have been linked to the development of IPF (Ryu et al., 2014).  Researchers have found relationships between IPF and smoking, exposure to environmental toxins, pharmacological therapies, respiratory disease, medical conditions, viral infections, autoimmune disorders, genetic mutations, and more (Kolahian et al., 2016; Ryu et al., 2014; Vega-Olivo & Criner, 2018).  Amongst the most profound contributions are genetic factors and exposure to environmental pollutants (Li et al., 2019; Renzoni, Srihari, & Sestini, 2014; Ryu et al., 2014).

Multiple researchers have referenced the role of genetics in the development of IPF (Kolahian et al., 2016; Ryu et al., 2014; Vega-Olivo & Criner, 2018).  Kolhian et al., (2016) reported that the gene MUC5B is highly correlated with IPV.  Ryu et al., 2014 discussed that the MUC5B gene is present in almost 40% of patients with IPV.  Researchers believe that MUC5B is related to a higher chance of survival and, it is hypothesized that MUC5B may actually decrease the rate of advancement of IPF (Renzoni, Drihari, & Sestini, 2014; Ryu et al., 2018).  Additionally, researchers have noted that particular chromosomes suffer structural damage as they are observed to have shorter telomeres, specifically AEC1 and AEC2 (Richeldi, Collard, and Jones, 2017).  AEC1 and AEC2 are suspected to be instrumental in the development of fibrosis and restructuring of the lungs (Richeldi, Collard, and Jones, 2017).  Overall, researchers have proposed that IPF is a byproduct of an interplay between genetics and exposure to environmental toxins (Renzoni, Srihari, & Sestini, 2014).

Scientists have largely credited exposure to environmental toxins as a prime factor in the etiology of IPF (Li et al., 2019; Renzoni, Drihari, & Sestini, 2014;

Richeldi, Collard, and Jones, 2017; Ryu et al., 2018).  Exposure to metals, silica, and wood dust have been linked to IPF (Richeldi, Collard, and Jones, 2017).  Moreover, researchers examined the incidence of IPF in world trade center respondents who were exposed to high levels of environmental toxins that have been linked to IPF (Li et al., 2019).  The findings indicated that first respondents who were exposed to environmental toxins from 9/11, had a higher incidence rate than non-respondents (Li et al., 2019).  Additionally, older age groups, males, and smokers were more likely to develop IPF (Li et al., 2019).  Overall exposure to environmental toxins from 9/11 was a significant factor in the development of IPF.  Li et al., (2019) hypothesize that exposure to metals, alkaline, silica, and wood dust may have triggered inflammatory responses in the cell.  Scientists propose that the inflammatory responses may have triggered abnormal healing processes, which may have led to the development of IPF (Li et al., 2019).  Other studies should continue to investigate how exposure to environmental toxins may have influenced the development of IPF.

Treatment

Over the years, treatment options for IPF have been scarce and limited (Lipsi et al., 2018).  However, researchers have explored the use of pharmacological options such as pirfenidone and nintedanib (Lipsi et al., 2018; Vega-Olivo & Criner, 2018).  Although the medications that are currently available are not intended to cure IPF, they have been found to be effective at limiting the advancement of IPF (Lipsi et al., 2018).  Pirfenidone and nintedanib contain anti-fibrotic qualities that assist in the preservation of healthy lung tissue and ultimately prolong lung functioning (Lipsi et al., 2018).  Vega-Olivo and Criner (2018) noted that there are minimal differences between each drug’s effectiveness in treating IPF.  Vega-Olivo and Criner (2018), advise that treatment of IPF should be guided by the current stage of IPF.  Patients with severe IPF experiencing the last stages of the disease may resort to other treatment modalities such as oxygen therapy to increase oxygen levels, lung transplant, or palliative care (Lipsi et al., 2018).  Oxygen therapy alleviates dyspnea and increases quality of life (Vega-Olivo & Criner, 2018).  In relation to accessibility, oxygen therapy may be more accessible than lung transplants as lung transplants often involve waiting lists, require patients to complete multiple examinations, and can require patients to wait long periods of time (Akhtar, Ali, & Smith, 2013).

Impact on Quality of Life

Patients with IPF are very limited with the activities that they can engage in due to the symptoms presented in IPF (Swigris et al., 2008).  Patients with IPF often present with difficulty breathing upon exertion (Swigris et al., 2008).  Throughout the progression of the disease, breathing becomes difficult even at rest.  According to Swigris et al., (2008) patients with IPF reported having to pace themselves during physical activities, needing to rest more often, and required more time to recover after completing an activity that requires energy (Swigris et al., 2008).  Moreover, oxygen therapy can be a barrier to engaging in pleasurable activities and hobbies if the patient is confined to carrying a large oxygen tank along with him or her.

Swigris et al., (2008) noted that the limitations presented with IPF, can be accompanied with symptoms associated with depression and/or anxiety.  Investigators who examined the relationship between IPF and depression discovered that symptoms of depression were prevalent in almost 50% of the participants (Akhtar, Ali, & Smith, 2013).  Multiple researchers attribute the depression symptoms to the changes in daily living and, they noted that IPF has multiple social and psychological implications (Akhtar, Ali, & Smith, 2013).  Akhtar, Ali, and Smith (2013) recommend that patients with IPF be screened for depression.

Conclusion

IPF is a chronic respiratory condition that severely affects the elderly and is more common amongst males.  Researchers estimated that the prevalence and incidence rates of IPF has increased throughout the years (Sauleda et al., 2018).  IPF is characterized by fibrosis in the lungs, which prevent the lungs from carrying out their responsibilities.  Overtime, the respiratory disease leads to respiratory failure, and ultimately death.  Researchers have mentioned that several factors play a key role in the development of IPF.  Such factors include genetic factors, environmental factors, and comorbidity with other disorders (Li et al., 2019; Renzoni, Drihari, & Sestini, 2014; Richeldi, Collard, and Jones, 2017; Ryu et al., 2018).  Specific genes have been identified and, thought to be involved in the development of IPF (Li et al., 2019).

It has also been noted that exposure to metals, wood dust, silica, and other toxins plays a pivotal role in the development of IPF (Li et al., 2019).  Although there have been multiple studies exploring IPF, more research is needed to clearly understand the underlying markers of IPF.  Future research studies should focus extensively on identifying any epigenetic considerations that may lead to the production of fibrosis in the lungs, in attempts to identify the genesis of IPF.  Superior treatment modalities for IPF can significantly enhance the life of patients with IPF as currently, there is no cure for IPF (Ryu et al., 2014).   Systematic investigations evaluating the origin of IPF can lead to better treatment modalities and, essentially better treatment outcomes for patients with IPF.

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