Case Study on Child and Adolescent Asthma Essay

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Case Study on Child and Adolescent Asthma Essay

When environmental triggers or allergens coexist with a hypothesized genetic predisposition to develop asthma symptoms, the result is respiratory distress. Asthma’s etiology is complex and includes both genetic and environmental components. It is one of the diseases in children marked by respiratory failure. It can be recognized by intermittent episodes of airway narrowing, a cough, and respiratory discomfort (Hammer & McPhee, 2018). It is typically identified by a characteristic narrowing of the airways and the generation of significant mucus secretions. These things typically happen as a consequence of a trigger. Infection, particular medications, and allergens are just a few of the identified causes of asthma episodes (Jameson et al., 2018). Asthma has a negative impact on two major body systems due to the pathophysiology of the aforementioned abnormalities. It is the breathing and circulatory systems that are affected. This paper is a case study of pediatric asthma. Case Study on Child and Adolescent Asthma Essay

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Pathophysiology of Childhood Asthma

When subjected to certain stressors, such as breathing in pollen or contracting a cold or another respiratory infection, the lungs and airways readily swell up with inflammation in children with asthma. Children with asthma may experience bothersome daily problems that disrupt sleep, playtime, recreation, and education (Hammer & McPhee, 2018). The respiratory airways of children are still developing and narrower than those of adults. That means processes such as mucociliary clearance are easily deranged when triggers exacerbate asthma. Case Study on Child and Adolescent Asthma Essay

The respiratory airways are more sensitive and receptive to environmental allergens and irritants, such as smoke, as a consequence of causative genes. Respiratory passages become inflamed and narrowed when inflammatory cells like eosinophils invade them. The lung epithelium becomes damaged as the smooth muscle enlarges (Licari et al., 2018). The mucus in the bronchi is over-secreted, and the airways become blocked. Respiratory discomfort from insufficient oxygenation of the body follows (Hammer & McPhee, 2018; Patel & Teach, 2019). As a consequence, wheezing, coughing, shortness of breath and tightness in the chest characterize the clinical presentation of asthma.

The overall result is less oxygen entering the lungs from the outside. This happens since the stimulus from the triggers causes the cholinergic receptors to start constricting the respiratory airways. As a result of the narrowing, there are bronchospasms, impaired mucociliary clearing, and an increase in blood carbon dioxide levels. The child’s body’s acid-base equilibrium is upset as a result (Maaks et al., 2019; Patel & Teach, 2019). As in the patient’s situation, wheezing is a blatant sign of bronchospasms and also denotes inflammation. Case Study on Child and Adolescent Asthma Essay

On the other hand, the cough is a reflex action that occurs as a result of attempting to clear the respiratory airways of the mucus that has blocked them. Along with the agitation, restlessness, and distress displayed by the patient in this case study, these are some of the classic symptoms of asthma in kids (Gupta et al., 2018; Patel & Teach, 2019). If the acidosis is acute and serious, the kidneys are unable to maintain the retention of bicarbonate necessary to correct it, leading to respiratory acidosis and acidemia. Case Study on Child and Adolescent Asthma Essay

Aside from the above pathophysiological changes in the respiratory system, there are also alterations in the circulatory system. Hypoxemia develops as a consequence of the airway obstruction preventing enough oxygen from reaching the lungs (Suau & DeBlieux, 2016). The heart starts pumping blood more quickly than usual, which raises the pulse rate, in an effort to get the body’s limited supply of oxygen to all of the cells (Jameson et al., 2018). There will be compensatory erythropoiesis if the asthma is chronic in an effort to increase the number of erythrocytes in the blood to transport the limited amount of oxygen available (Hammer & McPhee, 2018; Patel & Teach, 2019). Eosinophilia can occasionally result from the production of inflamed eosinophils. Here, the eosinophil levels are significantly higher than what is typically anticipated. Case Study on Child and Adolescent Asthma Essay

Classification of Childhood Asthma from Subjective and Objective Data

Healthcare professionals are advised to make an asthma diagnosis based on a combination of clinical findings and an objective assessment of lung function, according to the National Asthma Education and Prevention Program (NAEPP) guidelines. According to Patel and Teach (2019), age-based criteria were established by the NAEPP recommendations revised in 2007 to standardize the diagnosis and treatment of pediatric asthma. The criteria for categorization are based on a child’s risk (the frequency of acute, serious exacerbations in the previous 12 months) and dysfunction (day-to-day symptoms over the past 4 weeks). Asthma is therefore divided into intermittent, mild persistent, moderate persistent, and severe persistent categories based on risk and impairment. In other words, this categorization into 4 classes is based on the frequency of symptoms and either spirometric (forced expiratory volume in 1 second [FEV1]) or peak expiratory flow (PEF) measurements.

Every three months during routine asthma visits, control should be evaluated and categorized as well-controlled, not-well-controlled, or very poorly controlled using identical evaluations of risk and disability (Patel and Teach, 2019). According to NAEPP recommendations, classification and control designation of asthma guidelines should be made at each visit. This is significant as it has a bearing on what alterations may need to be made in the treatment plan. Case Study on Child and Adolescent Asthma Essay

Treatment Plan

Reducing impairment is the overarching aim of treating asthma in children. This entails preserving a high standard of living, enabling regular activities unrestricted, and minimizing lost school days. Risk reduction is the other objective. This entails avoiding systemic corticosteroids in children, keeping them out of the hospital and emergency department, and preserving healthy lung function to ward off the airway changes brought on by persistent inflammation (Maaks et al., 2019; Patel & Teach, 2019). The treatment plan comprises of pharmacological and non-pharmacological interventions.

  1. Pharmacotherapy

Beta-2 adrenoceptor agonists like salbutamol and locally active anticholinergic drugs (muscarinic receptor antagonists) like ipratropium or tiotropium are both commonly used treatments for asthma in children (Gupta et al., 2018). Frequently administering high doses of albuterol (Salbutamol) is helpful in treating acute asthma in children, according to evidence-based practice (EBP). In addition, the greatest results are obtained when beta-2 adrenergic agonists like salbutamol and muscarinic receptor antagonists like ipratropium bromide are paired to treat acute asthma in children (Gupta et al., 2018). The inflammation can then be treated with a steroid (preferably inhaled for maximum local activity) (Rosenthal & Burchum, 2018). Most significantly, a child should be given antibiotics if an infection is suspected or present. Case Study on Child and Adolescent Asthma Essay

Salbutamol and other sympathomimetic drugs are beta-2 agonists. By simulating the sympathetic division of the autonomic nervous system’s actions on the smooth muscle of the airway passages, they exert their action. They compete with one another to bind to the adrenergic receptors, which relaxes the smooth muscle. On the other hand, cholinergic receptors are competitively attached to by muscarinic receptor inhibitors like ipratropium bromide (Rosenthal & Burchum, 2018). However, they have the opposite impact of stimulating the smooth muscle of the airways to contract and prevent this action. Case Study on Child and Adolescent Asthma Essay

By preventing contraction and relaxing the smooth muscle, these two effects work together to widen the airways, enabling enough air to enter the lungs to re-establish the rate and depth of breathing. In the treatment of acute asthma in children, Gupta et al. (2018) found that combining an anticholinergic and a sympathomimetic (beta-2 agonist) has a positive synergistic impact. The following drug therapy is initiated for this child:

  1. Salbutamol (100 microgram-strength) 12 puffs via metered dose inhaler (MDI) TDS/ PRN.
  2. Oral prednisolone at 1 mg/ kg body weight once daily.
  • Ipratropium bromide 8 puffs (20 micrograms/ puff) TDS/ PRN.
  1. Oxygen by mask at 2 L/ minute (if the SpO2 reading drops below 95%).

The beta-2 adrenoceptor agonist called salbutamol attaches to postganglionic beta-2 receptors and causes the smooth muscle in the respiratory passages to relax. The anticholinergic drug ipratropium attaches to the muscarinic (postganglionic postsynaptic cholinergic) receptors on the smooth muscle of the respiratory system. This action stops the smooth muscle in the respiratory system from contracting or undergoing bronchospasm (Rosenthal & Burchum, 2018). The combined result widens the constricted airways, allowing more oxygen to enter the lungs. Case Study on Child and Adolescent Asthma Essay

  1. Non-Pharmacologic Interventions

A number of non-pharmacologic interventions belonging to the complementary and alternative medicine (CAM) category are available for managing asthma in children. As an appealing alternative to pharmacotherapy for treating childhood asthma, a variety of complementary or alternative treatments have been attempted, including breathing techniques and yoga/pranayama (Das et al., 2019). Although medications are the primary therapeutic option for childhood asthma, nonpharmacological treatment approaches have also been explored due to the disease’s chronic nature and the need for long-term medication. These latter therapies include practices from the alternative medical system, such as naturopathy, acupuncture, and homeopathy, as well as those that are biologically based, such as folk medicine, natural products, and dietary therapies, as well as mind-body practices, like yoga, meditation, and breathing exercises. Case Study on Child and Adolescent Asthma Essay

In India, the term “pranayama” refers to a type of breathing exercise that is actually used to develop and control one’s life energy. Breathing exercises are the most popular form of complementary medicine used by asthmatics among the non-pharmacological adjuncts listed above (Das et al., 2019). The physiological justification for using breathing techniques is hidden hyperventilation brought on by dysfunctional breathing and hypocapnia-induced bronchoconstriction. Exercises to improve breathing regulate hyperventilation and its consequences. Numerous breathing techniques, including Butyeko, the Papworth method, physiotherapy, and yoga/pranayama, have been shown to contribute to better results, including fewer acute attacks, less reliance on rescue medicines, and enhanced pulmonary function tests (Das et al., 2019). Randomized controlled studies evaluating the efficacy of these methods are scarce, though. Case Study on Child and Adolescent Asthma Essay

Teaching and Follow Up Instructions

When the diagnosis of asthma in a child is established, treatment of the condition is focused on three main areas: pharmacologic therapy, management of underlying conditions, and education of the patient and caretakers regarding the value of adherence and device technique (for MDIs). Additionally, symptom burden and therapy response are greatly impacted by social determinants of health (Maaks et al., 2019; Shipp et al., 2023). The severity of asthma and how well it responds to treatment depend on a number of contextual variables, including social determinants of health (SDOH), the physical environment, access to, and the standard of, health care. Shipp et al. (2023) posit that these situational factors, especially socioeconomic status, which can be conceptualized as the resources that one has or to which one has access, are significant contributors to racial and ethnic disparities in both asthma frequency and management. Patient and carer education needs to focus on these areas.

Children in poverty are less likely to have access to affordable or adequate health coverage, which affects their ability to receive care and complete prescriptions. Access to care is equally hampered by poor transportation options. Access issues and prescription drug shortages also add to uncontrolled asthma and emergency room visits. Health literacy is another socioeconomic resource as it is linked to educational attainment and quality of education (Shipp et al., 2023). Low health literacy decreases drug compliance, which reduces patient responsiveness to the treatment plan and increases the risk of mortality rates. Case Study on Child and Adolescent Asthma Essay

A further asset is time; when a parent works multiple jobs or irregular shifts, he or she may have less health coverage, be unable to take time off for appointments, and be unable to consistently monitor controller medication dosing, which may result in an increase in visits to the emergency room. Before they are developmentally ready, children might be in charge of medication compliance. As a result, identifying these social needs and connecting patients to resources, like social worker assistance, should be an essential component of asthma management. To reduce obstacles to asthma self-management or family management, treatment strategies should be created through shared decision-making with parents and their children (Maaks et al., 2019; Shipp et al., 2023). Some instances include contemplating telemedicine visits, ordering controller medications with the lowest co-pays, or working with the child’s school to execute at least some of the treatment program.

Environmental factors play a significant role in the impact of asthma and affect how well treatments work. Asthma symptoms and exacerbations are brought on by outdoor air pollution, which includes carbon, ozone, and nitrogen dioxide (NO2). It also prevents the development of lung function (Maaks et al., 2019; Shipp et al., 2023). As a result, the parents or caretakers must be taught about avoidance of air pollution or areas in which the child will be exposed to air pollution. There is additionally data that shows asthma symptoms brought on by exposure to air pollution are less receptive to inhaled corticosteroids (ICS) or that ICS may make a person more susceptible to exposure to ICS. Case Study on Child and Adolescent Asthma Essay

Asthma manifestations are also brought on by indoor air pollution, such as cigarette smoke and NO2, which can also affect how well a treatment works and guide treatment plans. Exposure to second-hand smoke is the main cause of indoor PM, and counseling to enact a house smoking ban can decrease PM exposure and improve asthma (Shipp et al., 2023). In addition to lowering indoor PM concentrations by 25% to 50%, portable high efficiency particulate air purifiers also lessen asthma symptoms and exacerbations in kids who have the condition and reside with a smoker.

Allergens play a significant role in the burden of asthma, including the development of lung function, and can influence how well a therapy works (Shipp et al., 2023). Dust mites, cats, dogs, cockroaches, and mice are some of the main allergies to take into account. Approaches to lessen vulnerability to the relevant allergen or allergens may be beneficial for children who are sensitized and subjected to an indoor irritant. This is basically achieved through health education and promotion. The follow up instructions will include potential side effects of medications, importance of adherence to treatment, avoidance of allergens and irritants, and prompt treatment of respiratory infections amongst others. Case Study on Child and Adolescent Asthma Essay

Conclusion

Asthma is a serious and chronic respiratory illness that affects both children and adults. Treatment follows established guidelines and includes both pharmacotherapeutic modalities such as with short-acting beta agonists (SABA) and inhaled corticosteroids (ICS). Also included in the management are various non-pharmacologic or CAM strategies such as breathing exercises and yoga amongst others. Because the condition is chronic, it is very crucial that parents or guardians are educated on the avoidance of air pollutants and irritants that may exacerbate the child’s asthma. Case Study on Child and Adolescent Asthma Essay

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References

Das, R.R., Sankar, J., & Kabra, S.K. (2019). Role of breathing exercises and yoga/pranayama in childhood asthma: A systematic review. Current Pediatric Reviews, 15(3), 175–183. https://doi.org/10.2174/1573396315666190121122452

Gupta, A., Bhat, G., & Pianosi, P. (2018). What is new in the management of childhood asthma? The Indian Journal of Pediatrics, 85, 773–781. https://doi.org/10.1007/s12098-018-2705-1

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. McGraw-Hill Education.

Licari, A., Castagnoli, R., Brambilla, I., Marseglia, A., Tosca, M. A., Marseglia, G. L., & Ciprandi, G. (2018). Asthma endotyping and Biomarkers in Childhood Asthma. Pediatric Allergy, Immunology, and Pulmonology, 31(2), 44–55. https://doi.org/10.1089/ped.2018.0886

Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Burns’ pediatric primary care, 7th ed. Elsevier.

Patel, S.J., & Teach, S.J. (2019). Asthma. Pediatrics in Review, 40(11), 549–567. https://doi.org/10.1542/pir.2018-0282

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Shipp, C.L., Gergen, P.J., Gern, J.E., Matsui, E.C., & Guilbert, T.W. (2023). Asthma management in children. The Journal of Allergy and Clinical Immunology: In Practice, 11(1), 9-18. https://doi.org/10.1016/j.jaip.2022.10.031

Suau, S.J. & DeBlieux, P.M.C. (2016). Management of acute exacerbation of asthma and chronic obstructive pulmonary disease in the emergency department. Emergency Medicine Clinics of North America, 34(1), 15–37. https://doi.org/10.1016/j.emc.2015.08.002 Case Study on Child and Adolescent Asthma Essay