NSG 5003 SU Asthma Patients Inflammation of Their Bronchial Tubes Discussion

Respond to the question using the lessons and vocabulary found in the readings. Support your answers with examples and research. Your responses should clarify your understanding of the topic. They should be your own, original, and free from plagiarism. Follow APA format for writing style, spelling and grammar, and citation of sources.

POST #1 write about the reversibility of asthma.

POST #2

Amanda Lahman posted Oct 23, 2020 3:30 AM

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This week’s case study describes an 18-year-old woman who reports intermittent episodes of shortness of breath and wheezing. She also reports a dry cough which is sometimes accompanied by sneezing, itchy nose, and itchy eyes. She reports worsening symptoms at night and associates her symptoms with “catching a cold”. She reports taking cough syrup and her prescribed inhaler. But she stopped using her inhaler due to fear of dependence. She is a college student and lives at home with her family where she has a high probability of environmental smoke inhalation.

According to a medical journal article from 2020, it is reported that asthma in children and adolescents has a prevalence rate a 5 to 10% (Ciprandi et al., 2020). It’s occurrence among many people has encouraged increased studies and research to enhance management of symptoms and severe reactions. Asthma is an obstructive pulmonary condition that is characterized by airway inflammation and hypersensitivity to environmental antigens (Ciprandi er al., 2020). The exaggerated immune reaction associated with asthma begins with exposure to an antigen that elicits the body’s innate and adaptive immune responses. This involves the release of inflammatory cytokines in the bronchial mucosa (McCance & Huether, 2019). The resulting edema in the bronchioles and bronchospasm is what contributes to the obstructive nature of the condition. The airway obstruction is manifested as chest tightness, non-productive cough, and expiratory wheezing (McCance & Huether, 2019). Based on the patient’s symptoms of episodic dry cough, chest tightness, and wheezing, it is clear she is experiencing the effects of an obstructive pulmonary condition, asthma.

According to McCance and Huether (2019), asthma affects 24 million people in the United States alone (McCance & Huether, 2019). The understanding of the disease process can help to create treatment regimens that may lessen the effects. There is a familial component of asthma, relating the disease to over 100 genes (McCance & Huether, 2019). These genes influence the immunologic antibodies and cells that illicit the hypersensitivity response. The cells and antibodies that contribute to the asthmatic response are mast cells, eosinophils, basophils, neutrophils, lymphocytes, and IgE antibodies (McCance & Huether, 2019). The hypersensitivity response triggers the release of inflammatory cytokines which cause vasodilation, increased capillary permeability, mucus secretion and bronchial constriction (McCance & Huether, 2019). The manifestations caused by the bronchospasm and bronchial edema are reversed with inhaled bronchodilators and corticosteroids. A late asthmatic response is associated with severe hyperresponsiveness and damage to the bronchial tissue. This can form plugs in airway which further obstruct ability to breathe. Without treatment, this eventually leads to CO2 retention and respiratory failure (McCance & Huether, 2019).

According to the World Health Organization (2020), global deaths from asthma reached 417,918 (WHO, 2020). They note that the death toll is contributed to the under-diagnosed and therefore, the under-treatment of the disease. The two strongest risk factors for asthma development are the genetic predisposition and environmental triggers (WHO, 2020). The identification of the triggers is an important component to the physiology of the attack as well as providing prevention of a severe reaction. The exaggerated immune response can be triggered by allergens such as mold, pollen, dust, and animal dander. Other common triggers include irritants such as smoke, pollution, and strong odors. The WHO notes other triggers can be stress, fear, cold, and exercise (WHO, 2020). The main goals of management are to relieve symptoms and avoid triggers. Based on the information provided in the case study, it can be suspected that environmental smoke inhalation could be a trigger for this patient. She also reports itchy eyes, itchy nose, and sneezing which could indicate an allergen as a contributing factor. Given that she is also a college student, stress could also contribute to an attack. Her lessened use of her prescribed inhaler may add to the worsening asthmatic attacks.

The main form on confirmatory testing is pulmonary function tests. This includes spirometry measurements and FEV1 evaluations (McCance & Huether, 2019). Pulmonary function tests assess the amount of air an individual can force out of their lungs in one second. FEV1 measurement is the forced expiratory volume measured in a pulmonary function test. A reading of less than 70% of predicted forced expiratory volume indicates obstruction (Booth, 2020). This measurement as well as its occurrence during identifiable triggers provides a diagnosis of asthma. Andrew Booth (2020) notes in his journal article that the variable nature of asthma based on the severity of attack, type of trigger, and age can lead to decreased reliance on FEV1 testing (Booth, 2020). This would require multiple assessments of risk for individuals suspected of asthma.

The pulmonary function tests and trigger identification would lead to proper treatment and education about avoidance of future attacks. In the case study, the patient could benefit from both to receive proper treatment. A treatment plan that would be beneficial to this patient would include prescribing of a beta-agonist inhaler to lessen airway obstruction and education to use inhaler during attack. The avoidance of triggers could include decreased smoke and allergen exposure, as well as lessening stress that may be related to school. Continued follow-up to assess severity and effectiveness of medical management would also be beneficial to continue to decrease effects of asthma.

References

Asthma. (2020). https://www.who.int/en/news-room/fact-sheets/detail/asthma.

Booth, A. (2020). Asthma guidelines: the best of three. British Journal of Nursing, 29(13), 730–736. https://doi-org.su.idm.oclc.org/10.12968/bjon.2020…

Ciprandi, G., Marseglia, G. L., Massimo Ricciardolo, F. L., & Tosca, M. A. (2020). Pragmatic Markers in the Management of Asthma: A Real-World-Based Approach. Children, 7(5), 1–9. https://doi-org.su.idm.oclc.org/10.3390/children70…

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier

POST #3 Melissa Fuentes posted Oct 21, 2020 3:08 AM

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1. Based on the history provided, the health care provider suspects asthma with varying frequency and intensity. Describe whether this condition is restrictive or obstructive and support with evidence.

I believe the health care provider’s suspicion of asthma, in this case, to be accurate. The reported episodes the college student is expressing are very symptomatic of asthma, which is a chronic inflaming disease of the bronchial mucosa that is fortunately reversible (McCance & Huether, 2018, p. 1176). This condition is obstructive in nature due to its constriction on the airway during an onset. The symptoms of narrowing and obstruction of the airway are caused by an immune response within the airway itself due to the exposure of the epithelium to a triggering antigen (McCance & Huether, 2018, 1178). Asthma is quite common, especially in those who are exposed to irritants frequently.

Based on further history, I believe the culprits to be the smoke within the patient’s household. Her father smokes inside the home, and dry-wood is used in the fireplace. Both are known to cause various respiratory conditions in those who inhale second-hand smoke and wood-burning smoke. The chemicals that are produced by both sources can be very detrimental to anyone’s health especially, the asthmatic. Cigarette smoke produces approximately 7,000 chemicals, some of which are cancer-causing (CDC, 2020). Firewood produces both methane and carbon dioxide that are dangerous as well and create climate change (American Lung Association, 2018). As a provider, I would educate the family in regards to quitting smoking or smoking outdoors and also discuss alternatives to wood burning.

2. Describe the pathophysiologic process that occurs with asthma and support with evidence from the literature.

The pathophysiology of asthma begins with the initial exposure of the epithelium to an irritating antigen. For example, we will consider cigarette smoke as a specific irritant. The patient breathes in the smoke and as it reaches her airway, the B lymphocytes and eosinophils are activated. This activation then causes the lung’s hyperresponsiveness and initial injury to the epithelium (McCance & Huether, 2018, 1178). Neutrophils are next up to aid in inducing more inflammation within the airway. Then mast cells, IgE, and fibroblast secretion increase with eosinophils causing structural constriction changes within the airway. Here, the neutrophils continue to boost the inflammation up a notch to further worsen the ongoing bronchoconstriction with mucosal edema and bronchospasm. (McCance & Huether, 2018, 1178). The airway continues to restructure as the patient continues to feel short of breath, with dry cough and wheezing similar to our case study.

3. Explain what confirmatory testing is evidence based practice for diagnosing asthma and how this information can guide the treatment plan.

Testing for asthma initially begins with a physical examination of the nose, throat, breath sounds, and full history of symptoms. This can include the sudden onset of or frequency of symptoms such as increased rate of breathing, frequent coughing, coughing after exercise, overall limited activity tolerance, wheezing, chest tightness, and clear runny nasal mucus with worsening symptoms at night (Mayo Clinic, 2020). Next, a spirometry and or challenge test can be performed. The challenge test includes the inhalation of a medication called methacholine that will typically cause the airway to constrict in an asthmatic patient (Mayo Clinic, 2020). Lastly, further invasive testing can be performed, such as a chest x-ray, CT scan of the sinuses and chest, blood work, aspirin-sensitivity test, and sputum test.

The results of the evidence-based practice will determine if the patient indeed has asthma and how to guide a plan to manage it properly. If so, the patient should initially and most importantly learn to avoid any known environmental triggers, especially if they have high sensitivities. In minimal symptomatic cases that can be resolved with quick relief, short-acting beta-antagonist inhalers would work best. Patients with persistent asthma, similar to our case study, should be more dependent on longer-acting medications such as anti-inflammatory and corticosteroid medications (McCance & Huether, 2018, 1181). She stopped using her prescribed inhaler as she was afraid of becoming dependent on it. If she were using the inhaler more than twice a week, it would be more beneficial for her to adhere to a more prescribed treatment plan.

Melissa

Reference

American Lung Association, T. (2018). What You Need to Know About Your Wood-Burning Stove and Heater. https://www.lung.org/blog/wood-burning-stoves-and-heaters

Centers for Disease and Control Prevention, CDC. (2020, March 23). Asthma and Secondhand Smoke. https://www.cdc.gov/tobacco/campaign/tips/diseases/secondhand-smoke-asthma.html

Mayo Clinic. (2020, April 14). Asthma: Testing and diagnosis. https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198

McCance K., L., & Huether, S., E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473