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Asthma Management Case Study

Introduction

Asthma is a chronic lung illness that influences millions in the world. During an asthma attack which is considered an asthma exacerbation, the airways tend to be inflamed and swollen. J.S. is a 42-year-old male patient who is extremely allergic to pollen and dust and has mild asthma history. J.S was driven to the emergency room after his wheezing failed to respond to his Advair inhaler. This paper will focus on the case study to investigate the condition of asthma and the manifestation of the disease and determine the symptoms that have supported the diagnosis. The paper will also examine the treatment that will mitigate asthma symptoms and ensure that J.S gains wellness. Treatment and management of asthma conditions require understanding the physiological processes linked to the diseases, the causes and origin, and clinical manifestations to display the symptoms and signs of the illness.

Pathophysiology

Asthma exacerbations are often triggered by viral respiratory infections, exposure to allergens or irritants, or emotional stress. During an exacerbation, the airways become more inflamed, and the smooth muscle cells in the airways contract more easily. This leads to increased bronchoconstriction and airflow obstruction. The pathophysiology of asthma is intricate and entails intermittent airflow obstruction, airway infection, and bronchial hyperresponsiveness (Gans and Gavrilova, 2020). Airflow obstruction is recurrent and caused by several airway changes, such as airway edema, hyperresponsiveness, bronchoconstriction, and airway remodeling. The infiltration of inflammatory cells characterizes airway inflammation into the airway wall and the release of mediators that lead to asthma symptoms. The four main types of cells involved in airway inflammation are mast cells, eosinophils, neutrophils, and T-lymphocytes. Bronchial hyperresponsiveness (BHR) is an exaggerated bronchoconstrictor response to various stimuli such as cold air, exercise, or exposure to allergens or irritants. BHR is thought to be caused by a combination of airway inflammation and smooth muscle dysfunction. Asthma can also lead to airway remodeling, a structural change in the airway that can lead to permanent airflow obstruction. Airway remodeling is caused by airway inflammation and smooth muscle cell proliferation.

Etiology

The disease is characterized by events of wheezing, chest tightness, shortness of breath, and coughing. Asthma can be triggered by various environmental and other factors, including dust mites, pollution, cigarette smoke, cold air, exercise, and stress. When an asthma attack occurs, the airways become inflamed and constricted, making breathing difficult. Asthma triggers include cold air, flu, respiratory infections, medications such as beta-blockers, and airborne allergens such as pollen, dust mite, mold spores, and pet dander. J.S asthmatic condition is triggered by wheezing and environmental factors that cause the allergic condition.

Clinical Manifestations

The clinical manifestations of asthma are recurrent shortness of breath, wheezing, cough, and chest stiffness (Van Bragt et al., 2018). Asthma symptoms worsen at night or in the morning after waking up from sleep. These symptoms may worsen after hours, leading to severe airflow blockage and exacerbations triggered by cold and dry air and traffic pollution. Since he is highly allergic, J.S’s asthma attack can be triggered by clinical manifestations such as pollen and dust. Some symptoms supporting asthma conditions in J.S are arriving at the emergency room wheezing, and a high allergy to pollen and dust. Wheezing occurs when the airways are narrow or swollen, which makes it hard to breathe, thus triggering the whistling sound when a patient breaths out or when there is shortness of breath. Another clinical manifestation is the high heart rate during an asthma attack. J.S. heart rate was 124 beats per minute. In severe asthma attacks, patients are likely to experience high heart rates of more than 120 beats per minute. J.S’s respiration rate was 42, while the normal respiration rate was 12 to 16, which means that J.S’s respiration rate was abnormal. The respiration rate increased naturally due to the fact that J.S was asthmatic. Most asthma patients have a respiration rate above 30. J.S partial pressure of carbon dioxide and oxygen is above the normal rate of 35-45mmHg. J.S has PaCO2 of 48, indicating respiratory acidosis, a common acid disorder based on acute severe asthma attacks. J.S has a PaO2 of 55, which is below the normal PaO2. Low PaO2 means low oxygen tension due to the inability of the lungs to oxygenate the blood, which may be caused by hypoventilation. J.S had a high temperature of 38 degrees, a symptom of asthma that might have resulted from high humidity and temperature that causes air not to move and trapping air pollutants that can irritate airways.

Treatment

Treatment for an asthma exacerbation usually includes bronchodilators (medications that open the airways) and corticosteroids (anti-inflammatory medications). Prevention of asthma exacerbations is important in managing the condition. Avoidance of triggers, taking prescribed medications as directed, and having a written asthma action plan can help prevent exacerbations (Chung, 2018). The orders made in the emergency room were adequate in developing an intervention to prevent an asthma attack. The treatment conditions for the asthmatic condition of J.S include lowering the high heart rate, increasing oxygen saturation, and lowering the temperature. Therefore, the treatment plan provided in the emergency would include medications for immediate asthma control, such as short-acting beta-agonists and mechanical ventilation. For instance, short-acting beta-agonists are quick-acting inhalers that can be inhaled to correct lung respiratory failure. Inhaled corticosteroids should also be utilized as additional therapies that will sustainably suppress the inflammation in asthmatic airways, thus returning J.S to wellness through lowering their heart rate and temperature and increasing oxygen saturation after opening the blocked airflow.

Conclusion

Asthma is a chronic condition that affects the airways, which leads to asthmatic patients having delicate airways that are exacerbated. The symptoms of asthma include wheezing, chest tightness, shortness of breath, and coughing. Asthma can be triggered by a variety of environmental and other factors, including dust mites, pollution, cigarette smoke, cold air, and exercise. Managing asthma attacks requires an understanding of the patient’s condition, the causes of the condition and signs, biological markers, and disease processes to facilitate treatment and control of the patient’s asthmatic condition.

References

Chung, K. F. (2018, February). Diagnosis and management of severe asthma. In Seminars in Respiratory and Critical Care Medicine (Vol. 39, No. 01, pp. 091-099). Thieme Medical Publishers.

Gans, M. D., & Gavrilova, T. (2020). Understanding the immunology of asthma: pathophysiology, biomarkers, and treatments for asthma endotypes. Pediatric Respiratory Reviews, 36, 118-127.

Van Bragt, J. J., Vijverberg, S. J., Weersink, E. J., Richards, L. B., Neerincx, A. H., Sterk, P. J., … & Maitland-van der Zee, A. H. (2018). Blood biomarkers in chronic airway diseases and their role in diagnosis and management. Expert Review of Respiratory Medicine, 12(5), 361-374.