Assignment: Asthma Disease Essay
Asthma is a chronic illness that manifests with airway inflammation and reversible airflow obstruction with classic symptoms of cough, wheeze, and shortness of breath (Mims, 2015). Inflammation in asthma can be acute, subacute, or chronic. Airflow obstruction is caused by airway edema, secretion of mucus, and bronchial reactivity. This paper will aim to discuss the pathophysiology of chronic asthma and acute asthma exacerbation and how age influences pathophysiology, diagnosis, and treatment.
Chronic asthma is characterized by persistent inflammation of the airways, which results in remodeling of the airway and structural changes. The structural changes occur in untreated chronic asthma and include hypertrophy and hyperplasia of smooth muscles in the airway, angiogenesis, and subepithelial fibrosis (Mims, 2015). In chronic asthma, airflow limitation is partially reversible as a result of airway remodeling.
On the other hand, acute asthma exacerbation occurs when there is an exaggerated bronchial hyperreactivity or airway hyperresponsiveness in response to endogenous and exogenous stimuli (Bush, 2019). There is direct and indirect stimulation of the airway smooth muscle by pharmacologically active substances produced by mediator-secreting cells such as mast cells (Mims, 2015). Unlike in chronic asthma, airflow limitation is fully reversible in acute asthma. The pathophysiological mechanisms that occur in an asthma exacerbation include inflammation of the airway, contraction of smooth muscles, hypersecretion of mucus, bronchial hyperresponsiveness, and mucosal edema (Bush, 2019).
In an acute asthma exacerbation, arterial blood gas (ABG) analysis is essential in detecting dangerous levels of hypoxemia secondary to hypoventilation, which results in respiratory acidosis (Mims, 2015). In the early stages of an acute exacerbation, there is usually respiratory alkalosis due to hyperventilation, which is triggered by hypoxic drive (Bush, 2019). However, as the exacerbation worsens and there is increased ventilation-perfusion mismatch, carbon dioxide is retained in the blood, causing acidosis.
How Age Might Impact the Pathophysiology of Chronic Asthma and Acute Asthma Exacerbation
Older asthmatic adults have a higher sensitivity to allergens and decreased lung function, which results in high morbidity and mortality as compared to younger patient populations (Bush, 2019). On the other hand, a majority of children no longer have wheezing symptoms after the age of 6 years. This may result in the diagnosis of asthma as an upper respiratory tract infection (Mims, 2015). Besides, children often have an abnormal lung function but have no allergy, which is attributed to having small lungs.
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Diagnosis: To make a diagnosis of Asthma, I would assess for the presence of the typical symptoms of asthma which include,
wheezing, shortness of breath, cough, and chest tightness. I would also auscultate the lungs to assess for wheezing which is a frequent finding in asthmatic patients especially during forced expiration (Mims, 2015). Spirometry would be essential in confirming the diagnosis of asthma and ruling out the possibility of COPD, which presents with similar symptoms. In children, a normal FEV1/FVC ratio should be more than 0.85 compared to a ratio of 0.75-0.80 in adults. ABG analysis is necessary for assessing for hypoxemia and respiratory alkalosis in acute asthma exacerbation in both children and older adults (Bush, 2019).
Treatment: In children, I would prescribe Short-acting beta-agonists (SABA) such as Albuterol in the management of acute asthma exacerbation. In the elderly, I would also recommend a similar short-acting beta-antagonist to treat bronchospasm in asthma exacerbation (Jonathan, 2014).
In the treatment of chronic asthma in older patients, I would prescribe an inhaled corticosteroid as the maintenance therapy. The drug of choice would be inhaled Beclomethasone, which is available in an inhaled metered-dose aerosol (Falk, Hughes & Rodgers, 2016). In addition, for patients with known allergies, I would prescribe Omalizumab to lower hypersensitivity to allergens.
Review “Asthma” in Chapter 27 of the Huether and McCance text.
Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.
Select a patient factor: genetics, gender, ethnicity, age, or behavior.
Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.
Write a 2- to 3-page paper that addresses the following:
Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.
Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.
Explain how the factor you selected might impact the pathophysiology of both disorders.
Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.
Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation.
Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
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