Category: Asthma

Patient Initials: L. M., a 65-year-old female.

Subjective Data

Chief Complaint: I suffer from severe wheezing, shortness of breath, and coughing at least once daily.

HPI: Being discharged from the facility ten weeks ago, the patient reports having shortness of breath, severe wheezing, and coughing. When she speaks, she needs to take breaks and catch her breath. The patient suffers from frequent asthma attacks for two months.

PMH: She has a history of asthma attacks since her early 20s. Taken medications include Albuterol (when necessary) and Theophylline (300 mg PO BID). She was diagnosed with mild congestive heart failure (CHF) three years ago. To control symptoms, the patient takes HTCZ (50 mg PO BID) and Enalapril (5 mg PO BID). The patient follows a sodium restrictive diet. She was hospitalized after a motor vehicle accident (MVA). After two weeks following the MVA, the patient had the post-traumatic seizure. She started to consume Phenytoin (300 mg PO QHS). No known drug or food allergies. No surgery.

Significant Family History: Father deceased at the age of 59 (kidney failure secondary to HTN). The mother deceased at the age of 62 (CHF).

Social History: The patient denies smoking and consuming alcohol, drinks four cups of coffee, and four diet colas daily.

ROS: General: pale, appearing anxious; Integumentary: denies bruising; HEENT: denies problems; Cardiovascular: denies problems; Respiratory: positive for coughing, wheezing, shortness of breath; Gastrointestinal: denies problems; Genitourinary: denies problems; Musculoskeletal: positive for exercise intolerance, denies swelling in the extremities; Neurological: denies a headache; Endocrine: denies problems; Hematologic: denies bruising; Psychologic: denies problems.

Objective Data

Vital Signs: BP: 171/94; HR: 122; RR: 31; T: 96.7 F; Wt.: 145; Ht.: 53; BMI: 25.7.

Physical Assessment Findings

HEENT: PERRLA, no lesions in the oral cavity; TM without inflammation; no nystagmus.

Lymph Nodes: n/a.

Carotids: n/a.

Lungs: bilateral expiratory wheezes.

Heart: rate and rhythm are regular; normal S1 and S2.

Abdomen: non-tender, soft, no masses.

Genital/Pelvic: n/a.

Rectum: guaiac negative.

Extremities/Pulses: +1 ankle edema (right), normal pulses, no bruising.

Neurologic: A&O X3, intact cranial nerves.

Laboratory and Diagnostic Test Results: X-ray results: blunting of the right and left costophrenic angles; FEV1/FVC 60%; peak flow  75/min, improved after Albuterol (asthma). Total cholesterol  190 (extremely high).

Assessment

ICD-10-CM: J45.90 Asthma, unspecified.

ICD-10-CM: J90 Pleural effusion.

ICD-10-CM: I50.30 Diastolic (congestive) heart failure.

Plan of Care

Asthma

The patients diagnosis is asthma associated with wheezing, coughing, and shortness of breath. Spirometry tests (FEV1/FVC) indicate abnormalities in the lungs capacity (Lee et al., 2015). Pharmacological treatment: The patient should shift to the combination therapy while taking Theophylline (300 mg PO BID) and the salmeterol/fluticasone propionate product (50/250 mg PO BID) (Nie et al., 2013). The patient should continue using Albuterol when needed. Non-pharmacological treatment: The patient should avoid secondhand smoke, allergens, and viral infections. Education: The patient should know that improvements can be unobserved for two weeks, and possible side effects include throat irritation and dry mouth (Nie et al., 2013). Follow-up: It is required in two weeks.

Pleural effusion

This state is characterized by the presence of fluid in the pleural cavity (Freeman, 2015). X-ray results indicate blunting of costophrenic angles as a sign of pleural effusion. Pharmacological treatment: Amiloride (15 mg daily) should be used to address swelling and decrease high blood pressure (Platz, Jhund, Campbell, & McMurray, 2015). Non-pharmacological treatment: The patient can perform breathing exercises to prevent shortness of breath. Education: The patient should avoid dust and allergens that can provoke coughing. Counseling: It is required to decrease anxiety associated with shortness of breath. Follow-up: It is required in two weeks.

Heart failure

As a chronic condition, congestive heart failure is characterized by the impossibility of a heart to transmit blood and oxygen to organs and tissues (Gandhi, Mosleh, & Myers, 2014). Pharmacological treatment: The patient can start using Captopril (25 mg PO BID) (McMurray et al., 2014). Non-pharmacological treatment: The patient should modify a diet to consume more grains and vegetables. Education: The patient should be informed about possible side effects of using Captopril (loss of appetite, insomnia, nausea). Follow-up: It is required in two weeks.

References

Freeman, R. K. (2015). Treatment options for patients with recurrent, symptomatic pleural effusions secondary to heart failure. Current Opinion in Pulmonary Medicine, 21(4), 363-367.

Gandhi, S., Mosleh, W., & Myers, R. B. (2014). Hypertonic saline with furosemide for the treatment of acute congestive heart failure: A systematic review and meta-analysis. International Journal of Cardiology, 173(2), 139-145.

Lee, L. A., Yang, S., Kerwin, E., Trivedi, R., Edwards, L. D., & Pascoe, S. (2015). The effect of fluticasone furoate/umeclidinium in adult patients with asthma: A randomized, dose-ranging study. Respiratory Medicine, 109(1), 54-62.

McMurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R.,& Zile, M. R. (2014). Angiotensin-neprilysin inhibition versus enalapril in heart failure. New England Journal of Medicine, 371(11), 993-1004.

Nie, H., Zhang, G., Liu, M., Ding, X., Huang, Y., & Hu, S. (2013). Efficacy of theophylline plus salmeterol/fluticasone propionate combination therapy in patients with asthma. Respiratory Medicine, 107(3), 347-354.

Platz, E., Jhund, P. S., Campbell, R. T., & McMurray, J. J. (2015). Assessment and prevalence of pulmonary edema in contemporary acute heart failure trials: A systematic review. European Journal of Heart Failure, 17(9), 906-916.

Gaining basic understanding of your familys medical history or the story of your familys health is one of the most important activities available to people of all ages. Acquire this knowledge and improve the familys ability to fight the onset of preventable diseases and lifestyle-induced ailments. In my case, some of my family members are suffering from the effects of high blood pressure, colon cancer, asthma, and diabetes. However, for the purpose of this study, my focus is to look into my mothers struggle with asthma. A deeper understanding of asthma makes it possible to apply effective treatment and prevention strategies.

My mother is named Lakisha. She is a 38-year old African American woman. She weighs approximately 160 pounds. My mother adheres to the belief that she has asthma as a result of repeated exposure to second hand smoke. In her opinion, she has no known allergies.

Definition of the Disease

Ancient historians left behind recorded references of respiratory diseases, and they described the medical condition as noisy breathing (Allergy & Asthma Medical Group & Research Center, 2017). Hippocrates was the one who labeled the disease as asthma, a Greek word that was used to denote the idea of wind or to blow, perhaps an attempt to describe the wheezing sound produced by those suffering from the effects of the said condition (Allergy & Asthma Medical Group & Research Center, 2017).

Modern medicine defined asthma as a disease characterized by recurring spasms of difficulty with breathing (Rizzo, 2011). Physicians pointed out that those with asthma produces wheezing sound when inhaling or exhaling (Rizzo, 2011). There are also instances when symptoms are manifested through coughing or shortness of breath (Rizzo, 2011).

Risk Factors and Physiological Factors

Experts in the field of anatomy and physiology shed some light into this ancient medical problem. They revealed that this medical condition is brought about by the narrowing of the bronchial passageway (Murphy, 2011). At the same time, air passages are being constricted by the buildup of mucous secretions, a process that occurs in the bronchial tubes (Murphy, 2011). Nevertheless, it is a challenge to pinpoint risk factors, because medical experts are unable to figure out the exact root cause of the said ailment. In other words, people are not predisposed to acquire this disease on the basis of weight issues, age, and diet. However, health specialists in the field of respiratory diseases made assertions that allergies are the culprits in asthma attacks (Rizzo, 2011). Although it is impossible to identify the ultimate causative factor, health experts are saying that the inhalation of pollen, dust mites, animal dander, emotional stress, rigorous exercise or exposure to extremely cold air may trigger the manifestation of an asthma attack (Murphy, 2011).

Treatment and Prevention

Before going any further into the discussion about treatment strategies, it is imperative to point out that symptoms may reverse spontaneously even without the application of proven medical procedures. For example, in 20 to 50 percent of cases of patients known to suffer from asthma attacks, doctors were able to document the absence of symptoms when patients reached the age of adolescence (Rizzo, 2011). However, in most cases, therapy is needed in order for the patient to become symptom-free (Rizzo, 2011). It is possible to accomplish this goal by evaluating the causative agent. It is also a common practice to use an aerosol bronchodilator or the short-term application of corticosteroids (Rizzo, 2011). It is also important to clarify that these drug-based intervention strategies are not going to treat asthma in the same way that medicines may purge the presence of pathogens that caused measles or cholera.

As discussed earlier asthma is a different type of disease, unlike those that are caused by bacteria or an unhealthy diet. In fact, asthma is a non-contagious disease. Thus, there is no clear prevention strategy that asthma-suffering patients may adopt in order to prevent the onset of the said medical condition. Nevertheless, it is prudent to take note of possible causative agents.

In the case of my mother, she repeatedly made it clear that her asthma problem has nothing to do with certain allergies. However, in the aftermath of seasonal changes, she struggles from shortness of breath and she requires medical attention. During specific times in a given year asthma attacks occur more frequently. She needed appropriate medical intervention in order to prevent complications rising out from more serious medical issues due to the inability to breath oxygen into her lungs.

It is prudent to develop prevention strategies based on the simple description of my mothers health history. The development of the said prevention strategy must take into consideration the physiological factors linked to asthma attacks. Furthermore, an effective prevention effort is more effective after integrating insights regarding the causative agents associated to asthma attacks. After taking everything into consideration, one can make the argument that my mother will have to learn to live with seasonal bouts of asthma problems. Thus, it is important to monitor her health especially during certain times of the year when weather patterns may affect the temperature of the air, a phenomenon that specialist considered as one of the causative factors of asthma attacks.

Conclusion

It is interesting to note that health experts in the field of respiratory diseases are unable to pinpoint the exact root cause of asthma. This assertion about the inability to determine specific anatomical processes that may help explain the onset of symptoms manifested by the patients makes sense when perceived from the point of view of my mothers health history. She suffers from shortness of breath each time she is afflicted with the manifestation of the said ailment. However, she made it clear that her asthma problems were in no way linked to allergies. Although it is safe to assume that changes in seasons or weather patterns are causative factors, there is no way to figure out the exact physiological process that may explain the said outcome. As a result, my family had to accept the fact that my mother is going to deal with this medical problem until a medical breakthrough cures asthma for good. At this point the best thing that her family members can hope for is the application of effective therapeutic-based interventions in order to remedy her discomfort each time she suffers from shortness of breath. Looking back to the process of collecting information linked to my mothers medical issue made me realize the value of understanding a persons family health history. It is of great value to understand the science behind a specific ailment or medical problem. Insights into common ailments like asthma and high blood pressure helps in the development of effective treatment or prevention strategies.

References

Allergy & Asthma Medical Group & Research Center. (2017). History of asthma. Web.

Murphy, W. (2011). Asthma. Minneapolis, MN: Twenty-First Century Books.

Rizzo, D. (2011). Introduction to physiology and anatomy. Mason, OH: Cengage.

Asthma considered the disease of airway hypersensitivity and narrowing, causing shortness of breath, chest tightness, wheezing sound while breathing, and coughing that frequently get worse at night or early in the morning and often wakes a patient up. Asthma is mostly detected during childhood, yet it affects people of all ages. The identified disease has no cure, and it can occur anytime even when one is feeling well (Arcangelo & Peterson, 2013). A patient with chronic asthma most of the times might not have any signs and symptoms, although the inflammation may exist.

When an acute asthma attack occurs, the airway muscles tighten and swell making the airway narrow, thus decreasing the airflow into the lungs. When the cells in the airway thin, mucus is produced making more thick mucus that further narrows a patients airway and causes mucus plugs. Patients struggle to take a breath experiencing dyspnea, chest tightness, and lung functions decrease (What is asthma?, 2014). This paper will focus on a quick relief and a long-term control asthma treatment and management. This essay will also explain the stepwise management approach that can help healthcare personnel in maintaining and gaining control of asthma.

Long-Term Control and Quick Relief Treatment

While asthma cannot be cured, it can be controlled. Every patient experiences asthma differently. Therefore, healthcare providers need to create an asthma treatment plan specific to a certain patient. There are two categories of asthma medications such as long-term controllers and quick-relievers (GINA, 2016).

Long-Term Control

Long-term control medications are essential and should be taken every day to sustain control persistently. These medications are the most effective ones when it comes to preventing asthma attacks and controlling chronic symptoms. Inhaled corticosteroids help to prevent and reduce airway swelling, while inhaled Long-Acting Beta Agonists (LABAs) open the airway by making the smooth muscles relax. Oral corticosteroids are prescribed for the treatment of asthma attacks when a patient does not respond to other asthma medicines (What is asthma?, 2014). Sometimes medication is combined containing both corticosteroids and beta agonists. Omalizumab (anti-IgE) is to be given every two or four weeks to anticipate a patients reaction to allergic triggers. Leukotriene modifiers help to reduce swelling inside the airways and improve it as well as relax the smooth muscles. Cromolyn sodium non-steroid medicine inhalation prevents airways from swelling when a patient encounters an asthma trigger. Theophylline medicine helps to relax the smooth muscles, hence opening the airway.

These medications have side effects, and it is the responsibility of a healthcare provider to educate a patient on potential complications. Among the key side effects, one may note voice changes (hoarseness), cough, and oral thrush (candidiasis) (Arcangelo & Peterson, 2013). Taken systematically in high doses, the described long-term control medications may cause adrenal suppression or skin thinning.

Quick-Relief Treatment

These medications are used to relieve asthma symptoms when they occur quickly. They act fast to relax constricted muscles around a patients airways by opening them so that air can flow through them. Patients are supposed to take their quick-relief medications once they develop asthma symptoms. In case they use them more than two days in a week, the patients should consult with their health professional as they may need to make changes in their treatment process. These medications include Short-Acting Beta Agonists (SABAs), which are inhaled to rapidly relieve asthma symptoms. They relax the smooth muscles around the airways and reduce swelling that blocks the airflow. These medicines are the initial choice for quick relief of symptoms. Anticholinergics are inhaled medication that acts slower than SABA as they open the airways by relaxing the smooth muscles in the airways and reduce mucus production. The combination contains both an anticholinergic and a short-acting beta agonist (GINA, 2016). Even though these medications eliminate symptoms, it is essential to clarify for a patient that the side effects of the medicines such as anxiety, restlessness, tremors, headaches, and fast and irregular heartbeats may occur (Arcangelo & Peterson, 2013).

Stepwise Approach to Asthma Treatment and Management

The goal of asthma patients is to prevent symptoms, reduce morbidity from acute occurrences, and lead a healthy lifestyle without exacerbations and outbreaks. The stepwise approach to asthma treatment and management is a six-step approach, according to which the number and the dose of medications and frequency of management are increased as necessary when symptoms persist and then decreased when goals are achieved and maintained (Arcangelo & Peterson, 2013).

All asthma patients regardless of the severity require SABA bronchodilator for quick relief of symptoms. The treatment depends on the severity of symptoms, while fast acting is used for more than two days in a week for symptoms control, stepping up is necessary. Patients are reassessed one to three months after starting their treatment and every three to twelve months after it. Treatments can be stepped down to a lesser regimen if the symptoms are well controlled during three months. Stepping down of treatment is done systematically accompanied by close monitoring of signs and symptoms. At this point, medication adherence and environmental exposures should be assessed before stepping up to a more intense medication regimen (Arcangelo & Peterson, 2013).

Stepwise Management Assists Health Care Providers and Patients

The stepwise approach can be utilized by health care providers and patients to optimize asthma treatment. This tool can help to determine the effectiveness of medications and reduce overusing of unnecessary drugs. By reassessing patients three to 12 months, it is possible to determine if a patient is adhering to the stipulated regimen, if he or she is getting exposed to triggers that prevent decreasing the symptoms, or if the symptoms are not being controlled by the current medications (Arcangelo & Peterson, 2013). Due to a step-by-step monitoring, it helps to promote understanding of asthma and benefits both healthcare providers and patients in recognizing the conditions of asthma and knowing how to manage and treat the symptoms. In other words, the stepwise management improves the quality of treatment by preventing overdose and complications in patients as well as clarifying for health care providers how to treat a certain patient.

Conclusion

To conclude, asthma is a chronic condition that often remains uncontrolled for reasons that may be associated with the disease progression, symptoms management by clinicians, a patients perceptions of the disease and self-management behaviors, or a combination of these factors. All in all, the goal of asthma treatment is symptoms control and management so that a patient can live comfortably. The use of pharmacotherapy and the stepwise approach can significantly help to achieve these goals (Rance, 2011). If quick-relief treatment should be used to rapidly react to asthma symptoms and eliminate them, long-term control is important to ensure a sustainable control. Apart from treating symptoms, triggers should be identified early to decrease the burden of the disease, and even though there is no cure, asthma symptoms can be controlled.

Introduction

Asthma is one of the ailments that cause persistent morbidity and deaths across the globe. Studies show that its dominance has augmented in the past two decades. This chronic disease affects the lungs and causes reversible airway barriers due to swellings along the lung airways as well as contraction of the muscles surrounding the lungs.

The airway obstruction is present in most asthma patients, but a number of triggers exacerbate this condition depending on the patients environment. Some of these triggers include smoke, pollen grains, dust, industrial chemicals, fur, and cold air. Asthma can be managed successfully; however, most of its morbidity is due to bad management and particularly when taking preventive medication.

Pathophysiology of Asthma

The pathology observed in the lungs of asthmatic patients who succumb to the disease indicates that a high degree of lung inflation. A closer view of this over-inflation shows a striking alveoli distention. The smooth muscles located in the bronchi undergo substantial hyperplasia whilst the submucosal layers become dangerously thick.

Furthermore, mucosa is present in the lungs with a bogged mucosal epithelium due to the inadequate quantity of ciliated epithelium cells. The submucosa undergoes an upsurge in mucus gland hypertrophy. The upsurge in quantity of muscle, mucous glands, and tissue edema causes the airway wall to congeal while the caliber minimizes (Harver & Kotses, 2010).

The alteration of the latter structures is known as remodeling, which generally explains the intricate morphological modifications in the bronchial wall. The changes in the bronchial wall make the columnar cells detach themselves from basal attachments (Clark, 2010). The inconsistent quantity of mucous in the lumen of a patients airway triggers the airway obstruction that can even utterly block the airway. The complete occlusion of the airway can lead to growth of a distal at the atelectasis in the lung parenchyma.

Inflammation

Most patients who succumb to asthma have acutely inflamed airways. Inflammation is caused by a convoluted multifactorial process that entails the collaboration of various cells coming from disparate tissues and organs such as bone marrow, the lymphoid, and nervous system among other organ systems.

The cells, which include respiratory cells, CD4 helper T- lymphocytes, and leukocytes, produce cytokine that causes inflammation. Two possible pathways facilitate asthma inflammation. In the first pathway, large amount of immunoglobulin E (IgE) facilitates allergic inflammation. The second pathway is structural change in the bronchial wall (remodeling), which is by caused enzymes, proinflammatory cytokines, and the destroyed bronchial epithelium (Clark, 2010).

The indicators of inflammation include calor and rubor, tumour, and dolor. In the case of asthma, inflammation occurs when triggered by IgE-dependent agents. This allergic reaction is facilitated by eosinophils that accumulate when worms or parasites attack the body. Apart from providing a severe protection against harm, inflammation helps in healing and restituting tissues following an attack by toxins. Nevertheless, in the case of asthma, inflammatory reaction is triggered in an erroneous way, which leads to harm rather than gain.

Medical practitioners do not have a conclusive research on the link between inflammation and indicators of asthma. Probably, the level of inflammation is influenced by the airway responsiveness (AHR). The level of AHR is connected to the signs of asthma and the urgency of one to seek medical attention. Swelling of the airways has the potential to raise AHR and thus enable triggers that compress the airways even when such triggers did not initially have the potential (Harver & Kotses, 2010).

Inflammation can also be an express indication for asthma in various ways such as cough and chest constriction. Apart from inflammatory mechanisms, some anti-inflammatory mechanisms can exacerbate inflammatory responses. Endogenous cortisol can act as a good controller of allergic inflammatory reactions.

Diagnosis

Detecting asthma in children can be difficult particularly in children below the age of 5 years. There is no definite form, severity, or regularity of indication. The ambiguity in the description implies that the evidence-based recommendations are not likely to be certain.

However, common symptoms in children include wheezing, cough, obscurity breathing, and chest constriction (Redwood & Neil, 2013). During the initial clinical assessment, the latter signs are checked, and if most observations are linked with getting consistent wheezing or other respiratory symptoms, then it can be deduced that the patient has asthma.

Nursing Management of Asthma

As aforementioned, poor management of Asthma leads to high morbidity cases; however, following doctors prescriptions can help in managing the condition. The prescriptions differ from one patient to another. Two forms of treatment can be offered including quick relief and prolonged management. Quick-relief medication plan helps in relieving the patient from the signs of asthmatic attacks. Patients who aspire to have a longer quick-relief plan should consult their doctors to check if the medication needs to be changed.

In the case of long-term management plan, a patient protects him/herself from frequent attack, but it cannot relieve one from asthmatic attacks. The medications often have side effects and patients should seek the relevant information from their doctors (Clark, 2010). Patients should develop asthma management plan to ensure that the treatment is in line with the symptoms. Patients should share their management plan with individuals that they trust in a bid to monitor them.

Special Treatment for Particular Asthma Patients

Pregnant asthmatic patients should be given specific treatments, as at the time of pregnancy, the condition becomes very severe, hence the need for a closer supervision and modifications in medications. The unborn child is at risk if the mother does not adhere to the doctors prescription. Obese patients should receive similar treatment as those who are not, as a reduced weight in obese patients enhances lung function and reduces asthma severity.

The pharmacology treatment of occupational asthma is similar to management of other kinds of asthma, but it does not act as a replacement for sufficient exposure. Asthma patients who undergo thoracic or respiratory surgeries are likely to have trouble during and after the surgery. Doctors should conduct a lung function test prior to the surgery and in case it is below the 80% of the patients best, then he or she should take glucocorticosteroids drugs (Redwood & Neil, 2013).

Patients with other respiratory infections apart from asthma should also have special attention. Patients suffering from aspirin-induced asthma also deserve special consideration. Most asthmatic adults are allergic to aspirin and several nonsteroidal anti-inflammatory medicines. Doctors should carryout checkups first before prescribing the medication. Checkups can be done using cardiopulmonary which are able to do resuscitation (Redwood & Neil, 2013).

Conclusion

Asthma is an intricate disease. Evidently, it is not a single disease, but a combination of interaction between different phenotypes that encompass disparate cells and mediators. Currently, the treatment of asthma emphasizes on managing inflammation.

Perhaps, as further studies are done on the subject, medical practitioners will develop more a definite treatment. However, the existing management methods can reduce morbidity as long as patients are loyal to take their treatment as advised. Moreover, application of non-pharmacological management interventions can reduce the dominance of asthma.

References

Clark, M. (2010). Asthma: A Clinicians Guide. Sudbury, MA: Jones & Bartlett Learning.

Harver, A., & Kotses, H. (2010). Asthma, Health and Society: A Public Health Perspective. New York, NY: Springer.

Redwood, T., & Neill, S. (2013). Diagnosis and treatment of asthma in children. Practice Nursing, 24(5), 222-229.

Michelle is at a free clinic and is uninsured. Who will pay for the testing that you recommend like CBC, IgE, and spirometry?

CBC and spirometry are the only tests prescribed by me for Michelle me as mandatory. The first test is not prohibitively expensive, and the patient should be able to afford it if she can pay for the medications. Spirometry costs considerably more, but as it is scheduled to happen 2 or 3 months from now, Michelle should be able to save enough money given sufficient warning. As such, I believe she can pay for the testing if necessary. However, a situation where the patient cannot afford the procedure is possible, and alternatives should be explored. It is likely that an organization that helps less affluent people without insurance is nearby and can assist Michelle.

What do the guidelines recommend for further testing when a diagnosis of asthma has been made based on patient symptoms and PFTs?

The result of a PFT may not be conclusive, and so it is necessary to consider other possible diagnoses. The National Heart, Lung, and Blood Institute (2007) recommends additional studies, bronchoprovocation, a chest x-ray, allergy testing, and biomarkers of inflammation, to identify or rule out other potential conditions. The guideline by Global initiatives for asthma (2017) shows similar suggestions, but limits the options to bronchial provocation, allergy, and exhaled nitric oxide tests, suggesting that spirometry with a reversibility test that supports the asthma diagnosis is sufficient to begin treatment.

Williams, Schmidt, Redd, and Storms (2003) indicate that the patient should be referred to a specialist if the diagnosis is uncertain or if the condition may be influenced by occupational exposures, which is the case in the present scenario. Ultimately, however, the scope of the question restricts it to suggesting the array of tests provided above, with preference given to the newer guideline.

Given Michelles history of allergic rhinitis, what do the GINA guidelines (Global Initiative for Asthma) support as a therapeutic option(s)?

Allergic rhinitis suggests a need to use slightly different medicinal options than usual. The Global initiatives for asthma (2017) guideline note that leukotriene receptor antagonists may be appropriate for Michelle, though they are less effective than ICS in the general scenario. Furthermore, Global initiatives for asthma (2017) propose the use of sublingual immunotherapy if the patient is sensitive to house dust mites. However, Michelle feels fine at home, which eliminates the possibility and makes the treatment unnecessary.

Nevertheless, the guideline suggests the use of specific measures to address the patients allergic rhinitis. Global initiatives for asthma (2017) point out that the use of intranasal corticosteroids in response to the condition reduces the incidences of asthma-related hospitalizations and emergency department visits, unlike nasal mometasone, which has no effect on the same statistics. As such, the guideline suggests that Michelle should undergo the first treatment, although the matter of her financial situation remains in question.

What guidance can you provide Michelle so that she will know definitely that her symptoms are not controlled?

Asthma symptoms can be complicated, and so guidelines do not include the full list and suggest that the practitioner should refer the patient to a separate plan or flowchart. The National Heart, Lung, and Blood Institute (2007) provides a chart that mentions the patient missing work, waking up at night, believing his or her asthma is well controlled, and frequently using an inhaler, but cautions that the questionnaire does not assess the risk domain. It does not provide a tool to measure the characteristic, although there are suggestions as to the indicators.

Nevertheless, keeping track of ones symptoms is an essential and helpful activity. Global initiatives for asthma (2017) offer a set of suggestions for short-term and long-term monitoring through the use of peak-flow monitoring using a chart that can be obtained from numerous online sources. The goals include observing exacerbation recovery and changes in treatment, which are appropriate for Michelle, and identifying domestic and occupational triggers, which are not. Ultimately, the approach warrants consideration and potential adoption for self-monitoring.

References

Global initiatives for asthma. (2017). Global strategy for asthma treatment and prevention. Web.

National Heart, Lung, and Blood Institute. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma. Web.

Williams, S. G., Schmidt, D. K., Redd, S. C., & Storms, W. (2003). Key clinical activities for quality asthma care: Recommendations of the National Asthma Education and Prevention Program. MMWR Recommendations and Reports, 52(RR-6), 1-8.

Introduction

Osteopathic manipulation is an alternative mode of medical therapy and is gradually gaining popularity and acceptance in the medical community especially in the United States and European nations (Bockenhauer et al. 2002). There are however no controlled trials and studies supporting its efficiency. Osteopathic manipulation principles are based on the interrelationship between body organs and their function and the belief in the bodys natural ability to heal itself.

This article seeks to criticise the application of osteopathic manipulation in the treatment of asthma patients. Several articles investigating the effectiveness of acupuncture as a treatment of asthma have generated conflicting results (Guyton & Hall 2009). Investigations by a group of researchers showed quantifiable improvement in bronchial response to histamine and asthma severity. This study was however limited to spinal thrusting, a technique applied by chiropractors.

Aims of Study

The study reported in this article seeks to critic the hypothesis that osteopathic manipulation techniques can be designed to increase respiratory motion. It also pinpoints the weaknesses of these techniques and their inefficiencies. The study is designed to collect both objective and subjective statistics before and after the application of four well-defined osteopathic manipulation therapy techniques. Benefits that would arise from multiple treatment sessions are sacrificed in a bid to exclude confounding factors.

The focus is on the intervention of osteopathic manipulation therapy in restoring normal functioning and compliance to the thoracic cage that is objectively measurable. Patients reports of asthma symptoms and progressive severity have also been monitored to establish any immediate or future change that can be associated with the therapy. The article also seeks to use thoracic vertebrae articulation to find a statistically viable improvement in hyper-reactivity explainable by the effect of treating viscerosomatic reflex areas and return to normal sympathetic nervous system response. Care should be taken to determine whether this therapy will have adverse effects on the patient.

Methodology Used by the Researchers

The researchers used a pre-test-post-test crossover approach where every patient was treated through osteopathic manipulation procedures in line with sham procedures on different dates at least a week apart. This way the patients would serve as their control. Patients underwent two cycles of the pre-test-intervention-post-test protocol. One of these cycles consisted of four recognized Osteopathic Manipulation procedures that included balanced ligamentous tension in the occipitoatloid and cardiothoracic junctions (Ziment 2008).

The examiner measured thoracic excursion at two different locations in 15 minutes before and after each intervention. This methodology ensured that the patients progress was closely monitored. The methodology however leaves a loophole in the sense that the patients condition and response to the therapy may fluctuate after some time (Ziment 2008). The environmental conditions such as humidity, temperature and oxygen concentration may also influence the results of this study (Szentivaneji & Goldman 2009).

A handheld peak-flow meter was used to measure and monitor the thoracic excursions and collect the patients subjective assessment of symptoms. Information as to whether the patients were going to receive osteopathic manipulation, or a sham was concealed from the examiners by the investigator. For thoracic wall measurements, patients were undressed and instructed to take in full inspiration followed by complete expiration. These points in the human body are hard to spot and will require specialized expertise. This procedure is also prone to error (Guyton & Hall 2009).

The osteopathic manipulation procedures took place in settings similar to those of subjects in the same position on the therapy table. Manual pressure was applied on the thoracic outlet region, the occipitoatloid and cervicothoracic junction and the epigastric region. Upper extremities were circumducted at the shoulder region through a passive motion at a partial range.

The researchers in this article chose to recruit patients from Brooklyn, New York. This was because patients from this population were likely to be familiar with osteopathic manipulation therapy. They held a belief that previously treated patients would be able to recognize sham procedures. This selection method is however not completely effective since there is a possibility that some of the patients may not have undertaken osteopathic manipulation therapy (Ziment 2008). Primary care physicians from community-based clinics were requested to recruit and refer all asthma patients who had attained the age of 18 diagnosed through their history and physical examination (Bockenhauer et al. 2002).

Those patients found to have had a change in asthma medication in the past 4 weeks, concomitant diagnosis of congestive heart failure, cancer, cirrhosis, renal failure and expectant mothers were however excluded from the research since it was believed that they were likely to face complications that would confound data. Ten eligible individuals were used in the research. The patients volunteered to participate in the research and signed a consent agreement. It is however hard to establish this since patients are vulnerable and can be easily manipulated (Ziment 2008).

Results

After carefully administering osteopathic manipulation therapy, no complications were recorded. Some patients reported having felt relaxed after both osteopathic manipulation and sham procedures. Two of the patients reported light-headedness after osteopathic manipulation. However, complications might arise days or even months after administering osteopathic manipulation procedures. The patients reaction should be monitored closely over a long period to ascertain that the patient has been fully treated.

Patients showed increased respiration motions after undergoing osteopathic manipulation procedures as compared to sham procedures. Upper thoracic excursion significantly increased with osteopathic manipulation while no increase was noted on the application of sham procedures. This is evidence that osteopathic procedures are more reliable than sham procedures. It is however hard to tell how long these effects will last. Repeated administration of these procedures would mean extra costs being incurred by the patient.

Subjects reported improved ease in breathing after receiving both osteopathic manipulation and sham procedures. The difference between the two was of no statistical significance. Ease in breathing is also a feeling hence not tangible. This implies that improved breathing cannot be used as a measure of osteopathic manipulations success.

Conclusion

Osteopathic manipulation procedures showed desirable results on patients. Such results included improved ease of breathing, increased respiratory motion and reduced complications. As a result of this, osteopathic manipulation procedures are preferable as compared to sham procedures. Focus however must be put on the availability of these services. It is also not surprising that these services are expensive and out of reach of low and middle-income patients.

Literature Review

The study reported in this article seeks to test the hypothesis that osteopathic manipulation procedure is a viable treatment for asthma patients. Osteopathic manipulation therapy aims to affect therapeutic responses through three distinct physiological mechanisms. At first, physicians attempt to restore full compliance to the thoracic cage aimed at increasing the patients respiratory motion. Asthma patients suffer from respiratory exacerbation resulting in overuse injury to the respiratory system. Osteopathic manipulation helps release such strains (Szentivaneji & Goldman 2009).

The second physiological mechanism intends to affect the response of the patient autonomic nervous system function. Study shows branches of the nervus vagus provides parasympathetic intervention to pulmonary structures and diaphragm. Though considered helpful, these procedures are not present in many developing countries and are limited to the privileged few.

Finally, osteopathic manipulation can facilitate lymphatic flow to and from the bronchus. Tissues at times become oedematous and metabolic waste accumulates when the lymphatic flow is inhibited. This adversely affects cellular functions causing diseases. Osteopathic Manipulation Therapy can be used to release strains in the myofascial and lymphatic vessels.

Despite the numerous benefits associated with osteopathic manipulation, this form of therapy also has some shortcomings. Some measures of the therapys success are not quantifiable. Some patients reportedly feel lightheaded after therapy. It is however not possible to tell how lightheaded one feels. This makes one question the success of the therapy.

Osteopathic manipulation therapy is also not very popular, especially in developing countries. Therapy can only be fully adopted as a success if it has been widely tested and proven to produce consistent results. Many costly activities are also involved making the service unaffordable to many. This therapy should thus be offered widely to win over peoples support.

Clinical Relevance

Osteopathic manipulation therapy is gaining popularity among members of society especially in European countries and the United States. Research has shown that this therapy is complication-free and can help treat respiratory disorders such as asthma. Although used on small scale, osteopathic manipulation has shown great potential and can turn out to be a preferable treatment for such ailments.

References

Bockenhauer, S et al. 2002, Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma, JAOA, vol. 102 no. 7, pp. 371-375.

Guyton, H & Hall, G 2009, Medical physiology, Free Press, New York.

Szentivaneji, A & Goldman, A 2009, Vagotonia and bronchial asthma, Thomas Learning, South Carolina.

Ziment, I 2008, Alternative therapies for asthma, Free Press, New York.

Summary

Bronchial asthma, being one of the significant health problems due to the high prevalence of the disease worldwide, has not received an adequate assessment concerning coronavirus disease, the most relevant today. The article focuses on research on this problem because respiratory allergy is associated with a significant decrease in the expression of ACE2 receptors, which are the entry receptor for COVID-19. The research reflected in the article aims to trace the susceptibility of patients with bronchial asthma to coronavirus disease. The observed results served as the basis for recommendations for the treatment of bronchial asthma.

Significance

The article COVID-19 susceptibility in bronchial asthma can be assessed as significant for society, and that is why it was selected as the object for review. Bronchial asthma itself is a significant threat to human death; constant monitoring is necessary to prevent the onset of asthma attacks. The acute problem with coronavirus today still requires attention and further research. The importance and relevance of the article are that it explores this relationship and can offer some statistics and figures indicating low susceptibility to COVID-19 in patients with pre-existing asthma. (Green et al., 2021, 688) Thus, research makes it possible to comfort these patients and shield them from the greater fear that they suffer in such a situation. Bronchial asthma is a chronic disease, and most often, genetic causes are the main ones for the onset of the disease. However, asthma can develop under the influence of unfavorable working environment factors, and in this case, more people are at risk.

Personal Response

The article reviewed is of particular interest, as it explores the relationship between diseases and hence susceptibility, which are the most relevant at the moment. The new coronavirus infection continues to spread worldwide, and research related to it is also relevant and necessary to the current state of affairs. In addition, the situation in the world with bronchial asthma has been aggravated in recent decades. Despite the fact that the second has been studied much more than the first, asthma is a severe disease that cannot be cured entirely; coronavirus disease overlaps with asthma and can be an additional trigger for asthma patients.

It is noted that the receptors that respond to those occurring in the environment are the same, and the susceptibility of patients with bronchial asthma to COVID-19 remains a crucial topic for study. However, the study cited in the article suggests low susceptibility, which is to some extent consolation and good news for patients with asthma. Cases of coronavirus infection are more common in people who smoke, so they are more at risk compared to asthmatics. The article is not difficult to read; the information provided and the evidence base on statistics, tables, figures, and relevance are traceable and do not require any changes.

Describing the Bronchial Asthma

Etiology and Mechanism the Bronchial Asthma

Bronchial asthma is a chronic inflammation of the airways; respiratory symptoms can vary in time and intensity and appear with airway obstruction. The following internal and external etiological factors can influence the development of BA:

• genetic, hereditary, allergic, and/or dysmetabolic predisposition;
• allergens and / or non-specific agents  pollutants;
• auxiliary adverse environmental factors (Hall & Agrawal, 2017).

BA symptoms develop after contact with allergens, which are non-infectious and infectious. Pollen, household, food, epidermal, chemical, insect, medicinal, professional allergens are considered non-infectious, and fungal, bacterial, parasitic, viral ones are infectious. In addition, chemical substances, tobacco smoke, biological inducers, and neuropsychic effects can serve as allergens; this group is non-specific inducers of pollutants. Allergens are responsible for 60-85% of asthma in adults and 64-90% of asthma in children. The central mechanism of the pathogenesis of bronchial obstruction in any clinical and pathogenetic variant of asthma is congenital or acquired hyperreactivity and hypersensitivity of the bronchi. Hypersensitivity is the condition of bronchial receptors to low doses of allergens and pollutants (Semernik et al., 2017). Hyperreactivity of the bronchi is an increased, in contrast to the norm, response to allergens or non-specific agents, characterized by a decrease in the threshold of sensitivity to them.

Signs and symptoms

The following signs of bronchial asthma are noted:

• Asphyxiation can arise both during physical exertion and in complete rest and when inhaling the allergenic particles in the air.
• Shortness of breath co-occurs with cough and has a harsh character.
• An asthma attack involves an inability to breathe deeply and frequent shallow breathing.
• Wheezing accompanies the breathing of a person during an attack and is sometimes listened to even remotely.
• Orthopnea is a posture that a person reflexively assumes during an attack; this pose promotes deeper exhalation (Hou et al., 2018).

Without treatment, symptoms can progress over time; as the disease develops in the body, such disorders arise as:

• General weakness
• Cyanosis of the skin
• Difficulty breathing
• Shortness of breath
• Dry cough
• Dizziness and headache
• Susceptibility to various diseases.

Diagnostic methods

A clinical diagnosis of bronchial asthma should be established by a doctor based on patient complaints, medical history, and diagnostic methods. A specific examination for allergic pathology is carried out, while it is necessary to consider the bronchial obstruction and the degree of its reversibility. The following methods are used to assess lung function and the degree of reversibility of bronchoconstriction:

• Spirometry is an essential method of investigating the reversibility and severity of bronchial obstruction.
• Peakflowmetry is performed with a peak flow meter and is used to measure the maximum expiratory flow rate.
• Bronchoconstrictor test is currently the most common method for studying bronchial hypersensitivity at present.
• The allergological examination includes provocative tests on the skin, laboratory tests for the detection of specific IgE antibodies are also relevant.

Pathology, pathophysiology, systems affected

Bronchial asthma affects the respiratory system; it is provoked by bronchial hyperactivity, leading to shortness of breath, repeated attacks of suffocation, chest congestion, and wheezing. It manifests in the form of shortness of breath that occurs in the area of the bronchi. At the later stages of asthma, structural changes occur in the airways: fibrosis, vascular proliferationan increase in the number of mucous glands in the submucous layer. The progression of these processes leads to an aggravation of asthma, a deterioration in lung function, and a decrease in the effectiveness of therapy.

Prognosis, treatments, might we expect a chronic phase?

Predominantly, the disease occurs in the chronic phase, and modern medicine cannot cure bronchial asthma. However, all efforts are aimed at creating a therapy that preserves the patients quality of life. Pharmacotherapy of the disease is divided into two groups:

• Preparations for situational use
• Preparations of constant use (Khaitov et al., 2018).

Medicines aimed at relieving seizures include anticholinergic drugs, combination drugs, theophylline. Medications for the supportive therapy of bronchial asthma include inhalation and systemic glucocorticosteroids, long-acting theophylline, anti leukotriene drugs, antibodies to immunoglobulin E. Treatment of bronchial asthma involves complexity; drugs and methods of using these substances are equally important. The drugs are administered by inhalation, parenterally, or orally. To deliver medicines through the respiratory tract, the following groups of drugs are possible:

• aerosol inhalers;
• powder inhalers;
• nebulizers.

Public health impact: who does this affect, how, why, where?

Bronchial asthma is a severe medical, social and economic problem. On average, 4-18% of the worlds population suffers from asthma of varying degrees. In childhood, the disease is diagnosed to a greater extent, predominantly in boys. The ratio of cases to boys and girls is usually equated to adolescence; in adults, women are at risk and, for the most part, suffer from bronchial asthma. According to statistics, cleanliness increases the incidence of allergies and its clinical climax  asthma (Uwaezuoke, 2018). It is noted that townspeople suffer from asthma more often than rural residents. This is since the human body cannot adequately respond to natural allergens in too clean conditions of civilization and urbanization polluted with exhaust gases.

Technological and research advancements on the horizon

Research in this area is underway, and the article cited confirms this. Many sources also note the need for further research on this problem associated with bronchial asthma. Technological and research advancements are especially relevant in evidence-based medicine, treatment, diagnosis of asthma, etiology of the disease. Fundamental questions of modern directions devoted to bronchial asthma are designed to optimize the treatment and focus on controlled clinical trials in the field.

References

Green, I., Merzon, E., Vinker, S., Golan-Cohen, A., & Magen, E. (2021). COVID-19 susceptibility in bronchial asthma. The Journal of Allergy and Clinical Immunology: In Practice, 9(2), 684-692.

Hall, S. C., & Agrawal, D. K. (2017). Vitamin D and bronchial asthma: an overview of data from the past 5 years. Clinical therapeutics, 39(5), 917-929.

Hou, C., Zhu, X., & Chang, X. (2018). Correlation of vitamin D receptor with bronchial asthma in children. Experimental and therapeutic medicine, 15(3), 2773-2776.

Khaitov, M. R., Gaisina, A. R., Shilovskiy, I. P., Smirnov, V. V., Ramenskaia, G. V., Nikonova, A. A., & Khaitov, R. M. (2018). The role of interleukin-33 in pathogenesis of bronchial asthma. New experimental data. Biochemistry, 83(1), 13-25.

Semernik, I. V., Semernik, O. E., Demyanenko, A. V., & Lebedenko, A. A. (2017). A method for noninvasive diagnosis of bronchial asthma based on microwave technology. Biomedical Engineering, 51(2), 124-127.

Uwaezuoke, S. N., Ayuk, A. C., & Eze, J. N. (2018). Severe bronchial asthma in children: a review of novel biomarkers used as predictors of the disease. Journal of asthma and allergy, 11, 11.

Introduction

Asthma is a disorder that affects the airways. As a result, asthma patients experience cough, short breath, and chest pain. Asthma could be diagnosed using specific test examination. The features of the air passage include the bronchi, alveoli and the bronchioles. As a result, clinical manifestations of asthma include wheezing, short breath, cough, and chest blockade.

The pathophysiological mechanisms of chronic and acute asthma exacerbation

The feature of asthma obstruction includes inflammation, mucus, hypersecretion, and angiogenesis (Huether & McCance, 2012). However, inflammation is influenced by cell interaction with various mediators. The pathophysiological feature of chronic asthma includes bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling. The pathophysiology of chronic and acute asthma exacerbation describes the process and stages that lead to airway obstruction (Barnes, 2013).

Bronchoconstriction

The major physiological event that causes clinical symptoms is airways obstruction and interference. However, in acute asthma exacerbation the physiological even includes muscle contraction and airway obstruction. Various irritants cause the bronchial contraction. As a result, the irritants catalyzed immunoglobulin to release dependent mediators. Mediators such as tryptase and prostaglandins cause airway obstruction. However, aspirin, cold air, and allergen trigger the hyperresponsiveness of dependent mediators. In acute asthma exacerbation, stress may influence the severity of clinical symptoms.

Airway Edema

At this stage, clinical symptoms become persistent and progressive. As a result, inflammation and other features of chronic and acute asthma exacerbations are activated. The patient may experience persistent inflammation, mucus secretion, and changes in airway muscle.

Airway hyperresponsiveness

The severity of airway obstruction causes hyperresponsiveness. Thus, the degree of responsiveness is assigned to the stimuli. However, contractile responses determine the severity of acute asthma exacerbation. The change mechanism is influenced by inflammation, neuroregulation, and morphological changes.

Airway remodeling

It is a feature of asthma and acute asthma exacerbation. Airway remodeling can be reversible. Thus, changes in airway obstruction include membrane thickness, hypertrophy, and blood muscle dilation. We will discuss the process and stages of airway inflammation.

Inflammatory cells

Lymphocyte subpopulation describes the mechanism of airway inflammation in chronic and acute asthma. Thus, the displacement in helper 2 cells causes eosinophilic inflammation. However, the production of Th2 helper cells explained the development of airway obstructions. The interaction of lymphocytes and other T helper cells describes the severity of airway modeling. Another feature of airway remodeling is the mast cell. The generation of mast cell secretes bronchial mediators.

The changes in the arterial blood gas pattern

Arterial blood gas patterns influence the response to chronic and acute asthma exacerbation. As a result, the arterial blood pattern indicates the severity of the disorder. At the time of the attack, the arterial blood gas fall below 60mmHg, while the PaCO2 drops below 40mm Hg. As the attack progresses, the PaO2 and PaCO2 will drop below optimum levels. In severe cases, the PaO2 and PaCO2 would rise above optimum levels. As a result, the pH will drop below 7.40. Thus, PaO2 level will determine whether the attack is chronic or acute asthma exacerbation.

The impact of gender on the pathophysiological mechanism of chronic and acute asthma exacerbation

Hyperresponsiveness occur when airway muscles contract and narrows due to stimulus (Iannuzzi, Rybicki & Teirstein, 2009). However, the inflammatory response is the progressive stage of hyperreactive response. Risk factors contribute to the amplification of severe response.

Numerous risk factors predisposed an individual to chronic and acute asthma. However, the prevalence of the disorder has not been attributed to the risk factors that predispose an individual to asthma. The risk factors include gender, age, obesity, behavior, and ethnicity. We will discuss the impact of gender on the pathophysiology of chronic and acute asthma. The cause of asthma has not been established, however documented reports revealed that it is prevalent in adolescent male than female. The case is different in adults as women are prone to asthma attack than men.

Diagnosis and treatment of chronic and acute asthma

It is easier to diagnose adults than children. However, the patients family history is an important factor to consider. As a result, a doctor will conduct a physical and diagnostic test. Physical exam includes nasal condition, skin infections, nasal obstruction, and skin conditions. However, diagnostic test includes lung function tests, chest x-rays, vocal cord dysfunction test, and bronchoprovocation. As a result, gender does not affect the treatment and diagnosis of asthma. Asthma treatments are prescribed based on the severity of the attack. However, treatment procedures follow a specific procedure. The aim of treatment will either slow the inflammatory process or eliminate the risk factors that trigger the attack. Treatment interventions include quick relief, inhaled steroids, short acting beta agonist, long acting beta agonist, oral steroids, leukotriene modifiers, anticholinergic, Cromolyn sodium, immunomodulators, and methyl xanthine.

Conclusion

The major changes during an asthma attack include airway hyperresponsiveness and inflammatory response. Quick relief medication can be used to control chronic and acute asthma exacerbation (McPhee & Hammer, 2012). Thus, clinical symptoms such as wheezing, chest tightness, shortness breath, and cough can be treated with quick relief medications.

Mind map of acute asthma exacerbation

Mind map of chronic asthma

References

Barnes, C. (2013). Evidence for common genetic elements in allergic disease. J Allergy Clin Immunol. 106(3), 192200.

Huether, E & McCance, L. (2012). Understanding pathophysiology. Mosby, USA: St.Louis Press.

Iannuzzi, C., Rybicki, A., & Teirstein, S. (2009). Sarcoidosis. The New England Journal of Medicine. 357(21), 2153-2165.

McPhee, J & Hammer, D. (2012). Pathophysiology of disease: An introduction to clinical medicine. New York, USA: McGraw-Hill Medical.

Asthma affects approximately 300 million people (Dharmage et al., ). Asthma is a common childhood disease. Common symptoms are wheezing and cough. Patients also experience shortness of breath. Chest tightness and pain are common. Recurrent respiratory infections may signal asthma.

Pathophysiology

• Inflammation determines the degree of severity (Dharmage et al., 2019).
• Allergic reactions are important environmental factors.
• Disease onset occurs early in life.
• Airway inflammation is the first step.
• Intermittent airflow obstruction limits breathing capacity (Dharmage et al., 2019).
• Bronchial hyperesponsiveness impedes airflow in patients.

Differential Diagnoses

• Some illnesses mimic acute asthmatic attacks.
• Inducible laryngeal obstruction inhibits normal airflow.
• Bronchial and tracheal lesions cause distress. (The National Institute for Health and Care Excellence (NICE), 2017).
• Aspirated foreign bodies may cause wheezing.
• Congestive heart failure causes breathing difficulties.
• Aortic arch anomalies mimic exercise-induce asthma.

Common Causes

• Environmental allergens such as dust mites.
• Viral respiratory tract illnesses and sinusitis.
• Hypersensitivity to medications such as aspirin.
• Emotional factors such as stressful situations (Gautier & Charpin, 2017).
• Certain low-molecular and high-molecular environmental substances.
• Perinatal factors such as low birth-weight (NICE, 2017).

Uncommon Causes

• Gastroesophageal reflux disease sometimes causes asthma.
• Exercise-induced asthma occurs in susceptible individuals.
• Abnormal lipid metabolism may cause asthma.
• Occupational exposure to toxins and chemicals (Gautier & Charpin, 2017).
• Severe beta-adrenergic receptor blocker hypersensitivity reactions.
• Household irritants such as scented candles.

Asthma Classification

• Intermittent asthma commonly varies in severity.
• Mild persistent asthma affects personal activity.
• Moderate persistent asthma has nighttime symptoms.
• It causes daily cough and wheezing.
• Severe persistent asthma causes continued symptoms.
• It causes severe frequent nighttime symptoms.

Diagnosis

• Blood and sputum eosinophil level evaluation (NICE), 2017).
• Pulse oximetry testing of suspected cases.
• Assessment of affected individuals chest radiographs.
• Allergy skin testing in atopic patients.
• Peak expiratory flow monitoring in emergencies (NICE), 2017).
• Pulmonary function tests such as spirometry (NICE), 2017).

Complications

• The disruption of daily life activities.
• Patients are unable to sleep adequately.
• Attacks may cause frequent hospital admissions.
• Chronic asthma leads to airway remodeling.
• Severe attacks may cause respiratory failure.
• Medically induced effects include weight gain.

Treatment: Quick Relief

• Quick relief medicines relieve acute exacerbations.
• They are commonly called reliever medications.
• They help alleviate acute asthma symptoms.
• They include short-acting beta agonist drugs (NICE, 2017).
• Others include anticholinergics for severe cases.
• Systemic steroids help speed up recovery (Papi et al., 2020).

Treatment: Long-Term Control

• Long-term control facilitates limited acute attacks (Papi et al., 2020).
• Various drugs are combined for synergy.
• Inhaled corticosteroids are ideal chronic medications (NICE, 2017).
• However, they may retard infant growth.
• Long-acting beta agonists are effective agents.
• Others include leukotriene agonists and methylxanthines (NICE, 2017).

Stepwise Management

1. Step1: Reliever medication for symptoms.
2. Step 2: Administer low-dose inhaled cortecosteroids (Dunn et al., 2017).
3. Step 3: Inhaled corticosteroid and beta-agonist (Dunn et al., 2017).
4. Step 4: Medium dose corticostroid and beta-agonist.
5. Step 5: High-dose corticosteroid and beta-agonist (Dunn et al., 2017).
6. Step 6: High-dose corticosteroid and beta-agonist.

Prevention

• Controlling exposure to dangerous occupational irritants (Dunn et al., 2017).
• Self-management based on asthma disease facts.
• Developing effective school-based asthma education programs.
• Screening susceptible individuals for the disease (Dunn et al., 2017).
• Ensuring atopic individuals avoid known irritants.
• Effectively treating recurrent respiratory tract infections.

References

Belleza, M. (2021). Asthma nursing care management and study guide. Nurselabs.

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in Pediatrics, 7(246), 115.

Dunn, N. A., Neff, L. A., & Maurer, D. M. (2017). A stepwise approach to pediatric asthma. Journal of Family Practice, 66(5), 280286.

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management of asthma. Journal of Asthma and Allergy, 10, 4756.

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: Reshaping the concept of asthma management. Allergy, Asthma and Clinical Immunology, 16(1), 111.

Porsbjerg, C., Ulrik, C., Skjold, T., Backer, V., Laerum, B., Lehman, S., Janson, C., Sandstrøm, T., Bjermer, L., Dahlen, B., Lundbäck, B., Ludviksdottir, D., Björnsdóttir, U., Altraja, A., Lehtimäki, L., Kauppi, P., Karjalainen, J., & Kankaanranta, H. (2018). Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults. European Clinical Respiratory Journal, 5(1) 1-21.

The National Institute for Health and Care Excellence (NICE). (2017). Asthma: Diagnosis, monitoring and chronic asthma management. NICE Guidance, 138.

Introduction

Asthma is an allergic respiratory disease where the airways to the lungs swell preventing inflow and outflow of oxygen. The disease has various symptoms including but not limited to coughing, shortness of breath and tightness in the chest. Asthma can be caused by allergies such as pollen and dust that causes respiratory infections. However, the disease can be treated using both prescription and nonprescription drugs. Gershwin and Albertson (2011) argued that the common treatment mechanism is using inhalers (p.56). Moreover, the disease can be treated using prescribed drugs such as lipoxygenase inhibitor, leukotriene receptor antagonist, and mast cell stabilizers. Asthma can also be treated using antiIgEs, methylxanthine, and corticosteroid that may require medical devices to administer the dosage.

Prescription medication for the treatment of Asthma

Prescription medication for Asthma can be classified into different roles including preventers and relievers. Moreover, they can be classified based on their pharmacological and chemical composition or class. Preventers are medications that are regularly used to control the disease by reducing the symptoms and flare-ups. Relievers are used for rapid relief of symptoms when they occur. Moreover, this prescription medication can be used before exercise to prevent bronchoconstriction. The prescription is effective when given by a certified allergist by American Board of Allergy and Immunology. The common treatment mechanism is using inhalers. Moreover, the disease can be treated using prescribed drugs such as lipoxygenase inhibitor, leukotriene receptor antagonist, and mast cell stabilizers.

Antihistamines are one of the best-prescribed medications for itching and nasal discharge including pseudoephedrine and phenylpropanolamine. Decongestants are often combined in this medication to be effective. However, in some cases, antihistamines may result in hypersensitivity reaction after interaction with a pharmacologic agent and body immune system. IgE mediates this allergic reaction from Antihistamines. Patients with Asthma, who experience adverse drug reaction, should always record all prescription and nonprescription medication taken within the last one to two months including the date and the dosage (Whalen, 2014). This will enable allergist to identify the temporal relationship between the dosage and the symptoms. In most cases, when a patient experiences hypersensitivity reaction, the interval between commencement of therapy and allergic reaction is less than one week. When monitoring this condition, the patient should be requested to give details of previous exposures and reaction that might cause drug hypersensitivity reaction. However, allergist must ensure the drugs are included in different diagnosis for patient with Asthma only. The prescription of the drug should be based on the symptoms that are well matched with the immune system of the patient.

During monitoring, the allergist should focus on evaluating signs that might be caused by the generalized reaction because some hypersensitivity reactions are life threatening. An allergist can detect such symptoms of drug adverse reaction including upper airway edema, hypertension, and cardiovascular collapse. Identifying the adverse reaction might be challenging due to multiple drug-to-drug interactions that might not be understood by many allergists. Moreover, the treatment of hypersensitivity is dependent on clinical finding that might not be accurate. The major risk posed by adverse drug reaction is due on the chemical property of the drug. Therefore, the allergist must monitor the adverse effect on the patient through administration therapy. Although therapy can help to monitor adverse effect, it might cause health impairment. The prescriptions of first-generation H 1 receptor are associated with the nerve system that can potentially cause sedation. According to Pescatore (2003), a patient who is prescribed with the second generation of antihistamines H1 receptor can be able to reduce the impact of H1 receptor occupancy thus reducing the impact of sedative effects (p.67). Allergist should be careful when prescribing H1 antihistamines due to their potential impact such as cardiac arrhythmogenic effect. In children, the prescription of intranasal should be administered twice daily for one year. However, the administration of this dosage in children should be given after analysis of height changes together with systematic steroid bioavailability. These factors are critical especially if a child is concurrently receiving inhaled steroids for Asthma to reduce the total steroid in the body.

Nonprescription medication for Asthma

There are varieties of nonprescription medication for Asthma such as over the counter medicine that has little impact on airway inflammation. However, if a patient experiences airway inflammation, they should opt for prescription medication such as Montelukast and corticosteroids. Asthma Bronchodilator is one of the most effective nonprescription medications that relieve the symptoms of Asthma. This drug helps the patient by relaxing muscles that tighten around airway keeping them open. Bronchodilator inhalers can be a better medication option for Asthma especially during wheezing and loss of breath. Moreover, this medication is effective when used before exercise to patients with exercise-induced Asthma. However, Olivieri (2010) argues that this medication should only be used only during exercise rather than being used in routine treatment.

References

Gershwin, M. & Albertson, T. (2011). Bronchial asthma is a guide for practical understanding and treatment. New York: Springer.

Olivieri, D. (2010). Asthma treatment a multidisciplinary approach. New York: Plenum Press.

Pescatore, F. (2003). The allergy and asthma cure a complete 8-step nutritional program. Hoboken, N.J: Wiley.

Whalen, K. (2014). Lippincotts illustrated review: pharmacology (6^th ed.). Philadelphia, PA: Lippincott William & Wilkens. New York: Plenum Press.