Asthma vs Pneumonia Pathophysiology Essays

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Asthma vs Pneumonia Pathophysiology Essays

Brian is a 7-year-old boy who presents to the primary care office with his mother. His mom has noticed that Brian has been coughing frequently and seems to have shortness of breath at times. She reports that Brian had a “cold” with a low grade fever and runny nose about 2 weeks ago and the symptoms seem to appear after the cold.

 

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On physical examination, Brian appears in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a temperature of 100 A°F, a respiratory rate of 32 breaths per minute, heart rate of 120 beats per minute, and pulse oximetry of 95% on room air. Lung exam is notable for diffuse symmetrical expiratory wheezes. His nasal mucosa is erythematous with boggy turbinates and clear mucus. The remainder of the exam is unremarkable. Asthma vs Pneumonia Pathophysiology Essays

1. Based on this case, discuss the differences in the pathophysiology  for asthma vs pneumonia.  Include your thougths as to the diagnosis for this case.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

 

    • The bronchoconstriction causes Brian to have suffered from shortness of breath and wheezing. Mucus is also a clinical manifestation of asthma. Mucus is a breeding ground for bacteria; in Brian’s case, these were opportunistic bacteria, while his body defense system was low. Macrophages serve to protect the lung from foreign pathogens. Ironically, the inflammatory reaction triggered by these very macrophages is what is responsible for the histopathological and clinical findings seen in pneumonia (Jain et al., 2020). Pneumonia signs and symptoms are tachypnea, tachycardia, fever, and crackles on auscultation of the affected regions of the lung to which Brian was presenting. Huether et al. (2020) explain pneumonia’s pathophysiology as an “aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infection; thus, the nasopharynx and oropharynx constitute the first line of defense for most infectious agents” (p. 1682).
    • Respiratory discussion by Aina OluwoSubscribe
    • Aina Oluwo posted Feb 17, 2021 11:22 PM
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    • Brian is our 7 year old patient on presentation with symptoms associated with alteration of respiratory system and appears to be in distress with the results of the physical examination.  Along with the assessment and presumptive diagnosis of asthma, it is notable based on the patient’s history to also have a differential diagnosis such as pneumonia. Asthma is defined by Chinonso et al. (2020) as a common chronic disease in children and adults characterized by airway inflammation and increased mucus production leading to airway obstruction. Basic symptoms of asthma are expiratory wheezing, shortness of breath, chest tightness, tachycardia, tachypnea, use of accessory muscles and cough (Huether et al., 2020). It’s pathophysiology involves the “airway epithelial exposure to antigens which activate both innate and adaptive immune response and causes vasodilation , bronchospasm, and mucus secretion with airway constriction and airflow obstruction” (Huether et al., 2020, p. 681). Pneumonia on the other hand is defined as an inflammation of lung primarily affecting the air sacs called alveoli or interstitial spaces caused by bacteria, viruses, or fungi (Zambare & Thalkari, 2019). Symptoms of pneumonia includes fever, chills, a productive or dry cough, pleural pain and sometimes dyspnea (Huether et al., 2020).ReferencesJan;23(1):27-33. doi: 10.1097/MCP.0000000000000338. PMID: 27801711.Chinonso, C. O., Taylor, T., Fleming, L. E., & Osborne, N. J. (2019). Phthalates and asthma inResearch International, 26(27), 28256-28269. Pathophysiology (7th ed.).  Elsevier.Zambare, K. K., & Thalkari, A. B. (2019). Overview on Pathophysiology of Pneumonia. Asianhttps://wilkes.idm.oclc.org/login?url=https://www-proquest-pneumonia/docview/2305722840/se-2?accountid=62703less1 UnreadUnread5 ViewsViews
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    • com.wilkes.idm.oclc.org/scholarly-journals/overview-on-pathophysiology-
    • Journal of Pharmaceutical Research, 9(3)
    • Huether, S., McCance, K., and Brashers, V.  (2020).  Understanding
    • http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s11356-019-06003-2
    • children and adults: US NHANES 2007–2012. Environmental Science and Pollution
    • Bakirtas A. (2017). Diagnostic challenges of childhood asthma. Curr Opin Pulm Med.
    • With regards to our patient’s clinical presentation, the symptoms of shortness of breath, wheezing, persistent cough, and chest tightness are the most common presenting symptoms of asthma and a clinical finding of fever is not typically associated with this respiratory disorder and as such additional respiratory diagnosis can be added to the underlying diagnosis with viral pneumonia infection as a key differential particularly in this case based on the history obtained from Brian’s mother making mention that he had cold symptoms two weeks before bringing him to the clinic, along with a “low grade” fever. Diagnosis of asthma in children should be made by combining relevant history with at least two confirmatory diagnostic tests whenever possible (Bakirtas, 2017). Brian is showing signs associated with both asthma and a possible mild viral pneumonia.  The patient will require further testing to essentially make the diagnosis that will require effective management of his underlying symptoms.  Management of asthma will defer from the management of pneumonia and further testing to include spirometry to test lung function and a chest x-ray to look at lung involvement.  (Huether et. al, 2020) would be two avenues to aid in diagnosis. Asthma vs Pneumonia Pathophysiology Essays
    • Module 5- RespiratorySubscribe
    • Joanne Hogan posted Feb 17, 2021 7:21 PM
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    • Module 5 – RespiratoryWhen compared with pneumonia, asthma is also a disease the effects the respiratory system. Asthma, however, is a chronic condition in which bronchial hyperactivity and reversible airway obstruction is caused by exposure to some type of allergen or irritant (Huether et al., 2020, p. 706). Over 300 million people are affected by asthma in the world and the prevalence in children has reached worrying levels in western countries (Sullivan et al., 2016). IgE antibodies, mast cells, and eosinophils are responsible for driving cell hyperactivity in the bronchial, creating an inflammatory response (Sullivan et al., 2016). Inflammation, bronchospasm, and mucus production lead to ventilation and perfusion mismatch leading to hypoxemia and increased work of breathing (Huether et al., 2020, p. 706). Asthma is typically worse in children due to the smaller diameter of their airway (Sullivan et al., 2016). Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.Zambare, K. K., & Thalkari, A. B. (2019). Overview on pathophysiology of pneumonia. Asian Journal of Pharmaceutical Research, 9(3). https://doi.org/10.5958/2231-5691.2019.00028.5more1 UnreadUnread4 ViewsViews
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    • Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma. Respiratory Research, 17(1). https://doi.org/10.1186/s12931-016-0479-4
  • References
    • When looking at Brian’s presentation, it appears that he could be suffering from either asthma or pneumonia. Based on his history of a cold in the previous weeks leading up to his PCP visit, pneumonia appears to be more likely. Brian likely aspirated on some of his own secretions from his runny nose during the period of his cold. His turbinates are swollen and red which could be caused by the sloughing of tissue seen in pneumonia cases. Brian also has a low-grade fever and continued rhinitis, which is are common symptoms in pneumonia. To confirm this diagnosis though, we need more information. A chest x ray and WBC count would be helpful for confirming a diagnosis. It is possible that Brian is having a first flare of asthma secondary to the pneumonia diagnosis. Blood work would still be helpful in this case to determine inflammatory markers if asthma was a suspected component.  Nebulizers would be a helpful first line treatment while running other tests in order to improved Brian’s breathing.
    • Pneumonia is clinically defined as an infection in one or both lungs caused by a virus, bacteria, or fungi where the lungs typically fill with fluid or pus (Zambare & Thalkari, 2019). Pneumonia can be life threatening and is often more severe in infants, children, and people over the age of 65 with pre-existing conditions (Zambare & Thalkari, 2019). According to Huether et al. (2020), viral pneumonia is two to three times as likely to occur in children than in adults and is the most common type of pneumonia in young children (p. 705). Initially the ciliated epithelium is sloughed off, creating an inflammatory response (Huether et al., 2020, p. 705). Bacterial pneumonia has similar presentation; however, it is often preceded by aspiration of one’s own secretions in combination with a previous viral infection (Huether et al., 2020, p. 705). Previous infection can cause damage to the epithelial cells, reduced mucus clearance, and an impaired immune response leading to the likely hood of a secondary infection (Heuther et al., 2020, p. 705). Common presentations of PNA are shortness of breath, fever, productive cough, diminished or crackled breath sounds, impaired oxygen sat, and increased respiratory rate (Zambare & Thalkari, 2019). Asthma vs Pneumonia Pathophysiology Essays
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      • Steven Bartos posted Feb 17, 2021 6:23 PM
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      • Regarding the pathophysiology of pneumonia, it can be broken down into three common types of pneumonia in children: viral, bacteria, and atypical.  Viral pneumonia in children is usually caused by viruses like RSV or influenza, either by direct contact, droplet transmission, or aerosol exposure. The pathophysiology of viral pneumonia is characterized by the destruction of the ciliated epithelial cells in the airway and the sloughing of those dead cells throughout the respiratory tract, resulting in decreased mucociliary clearance. This initiates an inflammatory response. Bacterial pneumonia likely originates from bacteria, most common is Streptococcus pneumoniae, that enters the lungs via aspiration of contaminated food from the GI tract, or possibly by inhalation. When the bacteria enter the alveoli, alveolar macrophages attempt to ingest them; however, if this fails, cytokines are released and neutrophils enter the lung, causing inflammation and edema. Gas exchange can become interrupted, resulting in respiratory failure (Zambare & Thalkari, 2019).  Atypical pneumonia is caused by Mycoplasma microorganisms, which attach to the ciliated epithelial cells, leading to cellular sloughing. Lymphocytes and neutrophils enter the respiratory tract and inflammation follows (Huether et al., 2020).Regarding a diagnosis, in children, viral pneumonia is characterized by cough and no fever, normal WBC, and also immunofluorescence tests may help solidify the diagnosis. Bacterial pneumonia sometimes follows a viral infection, and is characterized by fever with chills and rigor, shortness of breath, and a productive cough. Atypical pneumonia presents gradually, and there is a 2 – 3 week incubation period. It consists of a low-grade fever, cough, and chest pain, but it may seem like a typical upper respiratory tract infection. To diagnose pneumonia, besides a history and physical exam, you would also need a white blood cell count and chest x-rays. Asthma presents with coughing, expiratory wheezing, and shortness of breath. It also includes increased respiratory rate and pulse. Nasal flaring and retractions in the substernal, subcostal, intercostal, suprasternal, or sternocleidomastoid areas are evident (Huether et al., 2020).ReferencesSullivan, A., Hunt, E., MacSharry, J., & Murphy, D.M. (2016). The microbiome and the pathophysiology of asthma. Respiratory Research, 17(163), 1 – 11. https://dx.doi.org/10.1186%2Fs12931-016-0479-4less1 UnreadUnread3 ViewsViews
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    • Zambare, K.K. & Thalkari, A.B. (2019). Overview on pathophysiology of pneumonia. Asian Journal of Pharmaceutical Research, 9(3), 1 – 9. https://wilkes.idm.oclc.org/login?url=https://www-proquest-com.wilkes.idm.oclc.org/scholarly-journals/overview-on-pathophysiology-pneumonia/docview/2305722840/se-2?accountid=62703
    • Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier. Asthma vs Pneumonia Pathophysiology Essays