Week 6 Assignment Pathophysiological Mechanisms

Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. To Prepare 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 different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders.  Week 6 Assignment Pathophysiological Mechanisms .Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. 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. To Complete 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. Week 6 Assignment Pathophysiological Mechanisms

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In both acute and chronic asthma, the main physiological events that lead to clinical symptoms include narrowing of the airway and airflow interference. In acute asthma exacerbations, contraction of the bronchial smooth muscles occurs rapidly which causes narrowing of the airways after being exposed to various stimuli such as irritants and allergens (Castillo et al, 2017). Acute bronchoconstriction that is stimulated by allergens occurs after mast cells releases IgE-dependent mediators such as tryptase, prostaglandins, histamine and leukotriene; this leads to contraction of the airway smooth muscles. For the chronic asthma, the disease increasingly persists, inflammation progresses while other factors continue limiting the airflow (Bonsignore et al, 2015). These factors consist of mucus hypersecretion, edema, inspissated mucus plugs, inflammation and structural changes like hyperplasia and hypertrophy of the smooth muscles of the airway.  In both acute and chronic asthma, the bronchial airways are compromised and this causes resistance within the airway. However, in acute asthma exacerbations there are numerous cells that cause airway hypersensitivity. Cells involved in acute asthma response consist of eosinophils, mast cells, basophils, dendritic, B lymphocytes, neutrophils, as well as T helper 2 lymphocytes. There are different reactions and responses from these cells during acute exacerbation as well as latent release of inflammatory cells; this causes edema, increased secretions as well as bronchospasm (Castillo et al, 2017). Week 6 Assignment Pathophysiological Mechanisms .

Acute asthma exacerbations tend to be more prominent when compared to chronic asthma attracts because in chronic asthma there is late asthmatic response to the inflammatory cells. In chronic asthma, the exacerbations affect the arterial blood gas and there are both short inspirations and long expirations and this affects the oxygenation process which eventually leads to airway remodeling.  On the other hand, in acute asthma exacerbations individuals trap air and this causes respiratory disadvantage which lead to a reduction in tidal volume as well as an elevation in carbon dioxide causing respiratory acidosis (Sullivan et al, 2016).

In chronic asthma, airway remodeling leads to permanent structural changes in the airway. The structural changes include loss of lung function, stimulation of numerous structural cells, and increased blockade of the airflow, as well airway obstruction of the airway responsiveness. The structural changes in the airway consist of subepithelial fibrosis, thickening of the sub-basement membrane, atrophying of the smooth muscle of the airway, as well as dilation of blood vessels (Bonsignore et al, 2015).

Impact of Age Factor on Pathophysiology of Asthma

Asthma is a pulmonary disease affecting both children and adults. Nonetheless, the prevalence of asthma is higher in children. There are numerous factors that contribute to this. In children, there are various respiratory viruses that contribute to the start or development of asthma (Dunn et al, 2015). For instance, parainfluenza virus and respiratory syncytial virus (RSV) cause bronchiolitis which is dominant feature of asthma in children. Similarly, symptomatic rhinovirus infections are risk factors to recurrent wheezing which is associated with asthma. In addition, the age and the onset of asthma have an effect of decline of the lung function. For example, in children where symptoms of asthma start before the age of 3, there are lung deficits that lead development of asthma later on (Puranik et al, 2017).

In addition, the elderly also have a high risk to asthma. This can be attributed to the age-related changes such as reduced elastic recoil of lungs, reduced vital capacity, reduced diaphragm’s motion, limited rib and chest, as well as reduced rib and chest wall motion.  Moreover, the elderly people have reduced lung function, longer period of asthma as well as earlier asthma onset. In addition, there is reduced responsiveness to treatment with age increase and this can be attributed to the airway remodeling that may play a role in elevated risk of treatment failure among the older people with asthma. Variations in the form of airway inflammation among the elderly can also contribute to poor response to treatment.  According to Dunn et al (2015) eosinophilic inflammation that is Th2-driven has better response to corticosteroids when compared to the Th1-driven phenotype inflammation. Evidence shows that older people have lower levels of Th2 cytokine when compared to young people. Therefore, age not only impacts the pathophysiology of asthma but also influences the treatment response (Castillo et al, 2017).

As a healthcare provider, it is important to ensure that the patient assessment of a patient presenting with a respiratory problem a comprehensive evaluation of the history, physical, as well as immunization records are performed. Week 6 Assignment Pathophysiological Mechanisms .This will facilitate investigation of symptoms and signs in order to prevent specific infections, particularly among the elderly and the children (Puranik et al, 2017).  When prescribing treatment, it is important to take age factor into considerations because asthma management requires different types of medications for different age groups, especially for the young children aged below 12 years. Stepwise approach management to asthma should be used in diagnosis, treatment and management of asthma (Puranik et al, 2017). It is also important to educate the patients about the possible triggers of the asthma attacks and asthma exacerbations and recommend the implementation of the appropriate environmental controls.Week 6 Assignment Pathophysiological Mechanisms .

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Mind Map for Chronic Asthma Exacerbation

Mind Map for Chronic Asthma Exacerbation

References

Bonsignore M, Profita M, Pace E, Mark G, Riccobono L & Chiappara G. (2015). Advances in asthma pathophysiology: stepping forward from the Maurizio Vignola experience. European Respiratory Review. 1(24), 30-39.

Castillo J, Peters S & Busse W. (2017). Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. Journal of Allergy and Clinical Immunology. 5(4), 918–927.

Dunn R, Lehman E, Martin R, Homer B, Elliot I, Kraft M, Lugogo N & Peters S et al. (2015). Impact of Age and Sex on Response to Asthma Therapy. American Journal of Respiratory and Critical Care Medicine. 192(5).

Puranik S, Forno E, Bush A & Juan C. (2017). Predicting Severe Asthma Exacerbations in Children. Am J Respir Crit Care Med. 195(7), 854–859.

Sullivan A, Hunt E, John M & Murphy D. (2016). The Microbiome and the Pathophysiology of Asthma’. Respir Res. 17(63).   Week 6 Assignment Pathophysiological Mechanisms.