Asthma Physiology, Immunopharmacology, And Treatment

Pathophysiology of asthma

Discuss about the Asthma Physiology, Immunopharmacology, and Treatment.

Asthma involves the inflammation of the airways causing obstruction and bronchial hyper responsiveness. It is characterized by coughing and wheezing and is an airway chronic inflammatory disorder. In the given case study, Jessica Ainija White, a five year old girl was diagnosed with asthma. She was born prematurely at 33 weeks of gestation as her mother went into premature labor. Her past medical history showed that she was diagnosed with seasonal asthma and eczema. Her home life is unsettled as her brother and father are exposed to alcohol, drug abuse and subjected to violence at home. Recently, she moved to her new home in the northern suburbs of Adelaide to love with her grandmother, Greta who returned from rehabilitation after a recent cerebrovascular (CVA).  She had an acute hospital admission exacerbated of her asthma. She was excited about her new school; however, she experienced some learning disabilities. The following study deals with the pathophysiology, related signs and symptoms and pharmacology of Jessica’s asthma.

The inflammation of the airways plays the major role in the pathophysiology of asthma. The recurrent coughs, shortness of breath and wheezing are manifested by inflammation of the various types of cell and multiple mediators (Melen and Pershagen 2012, pp.108-120).The profile of the cells and cellular response is quite consistent in asthma. The pathophysiology of asthma in Jessica might be linked to her premature birth. She was a premature baby as she was born at the thirty three weeks when her mother went into premature labor. According to Bisgaard, Jensen and Bønnelykke (2012) asthma is strongly associated with the premature babies who are born before the thirty three weeks of gestation period as compared to the babies born full term. Jessica’s premature birth leads to her breathing problems as her lungs were not properly developed. According to Vatti and Teuber (2012) in premature babies, the lungs are immature and results in breathing problems in them. There is gradual narrowing of the breathing tubes as the surrounding muscles of the airways get tightened. This results in rapid breathing with whistling or wheezing sound as the air is forced through the narrow airways. This is the reason Jessica experienced wheezing and shortness of breath.

Children under the age of five manifest the asthma like symptoms.  Jessica manifested asthma like symptoms before the age of three. The children have smaller airways and when swelling occurs due to viral infections blocks or tightens the air flow due to increased mucus (Stocks, Hislop and Sonnappa 2013, pp.728-742). This results in breathing problems in the small children. The asthma primarily narrows down the breathing airways as inflammation occurs in the lungs airways. Jessica’s airways are swollen and she is having difficulty in breathing. She was not able to get proper sleep as she experienced shortness and noisy breathing.

Signs and symptoms of asthma

Allergens irritate the airways and constrict the airways. Moreover, there is excess mucus production that also triggers the asthmatic symptoms. The expansion of the wall linings leads to contraction of the bronchioles as well as the pathway.  Her past medical history showed that she had viral infection and eczema after the common cold during winters. Jessica suffered from eczema which is a mild allergic skin infection that triggered during the winter season after she had common cold. The irritants expose the airways to allergic response and triggers responses like swelling, spasm and excess mucus production (Agache et al. 2012, pp.835-846). This response results in high pitched wheezing sound during exhalation. In the same way, eczema might have caused Jessica’s airways to swell and difficulty in breathing. These were the early signs of asthma in Jessica leading to inflammation and breathing problems.

The asthma is characterized by coughing, wheezing, shortness of breath and tightness in the chest (Austen and Lichtenstein 2013, pp.1-13). While breathing, Jessica made a noisy sound and experienced shortness of breath while sleeping and that resulted in interrupted sleep. The main symptoms of asthma that Jessica manifested as a result of her illness are persistent coughing, wheezing or whistling sound while breathing and shortness of breath. She had a past medical history of viral infections, common cold and eczema might have contributed to the pathophysiology of asthma in Jessica. She also experienced troubled or fast breathing when breathing out. The tightness in the chest is caused due to tight pulling of the skin surrounding the ribs or neck (van der Wiel et al. 2013, pp.646-657).

During the winters, she suffered from common cold that had settled her chest. Gradually, the symptoms recurred giving a clear indication of asthma like symptoms in Jessica. The whistling and high-pitched sound during exhalation that worsened during night is a clear indication of asthma in Jessica (Centers for Disease Control and Prevention 2013). The mild skin disorder like eczema worsened the conditions of asthma in Jessica. At times, the pet animals are also a source of allergy as the children play with them. Jessica’s family background reported that the family had pets. There are two long-haired dogs and one short-haired cat in the family. Jessica also helped her grandmother with the pets. The pet animals are also a potential source of allergy that might have triggered asthma symptoms in Jessica (Huckvale, Car, Morrison and Car 2012, p.144). When she was taken to the emergency department, her mother, Anne reported that she gets interrupted sleep and often wakes up as she had short periods of coughing and wheezing. She breathed so hard that her abdomen got sucked under her ribs due to restricted breathing. She also coughs at school while playing in the playground. The asthmatic symptoms get worsened when she performs her daily activities or during physical exercise. She also leaned forward in a sitting position so that she could breathe.

Link between pathophysiology, pharmacology and theory

The above mentioned symptoms like coughing, wheezing, shortness of breath and troubled breathing manifested as a part of her illness and moderately severe asthma while she was admitted in the emergency department.

Salbutamol is prescribed to Jessica as it assists in the widening of the respiratory airways. When it is sprayed, it helps to open the blocked air passage so that there is free flow of air into the lungs (Murphy et al. 2012). This salbutamol puffs helped Jessica to breathe properly and is very helpful in moderately severe asthma condition. It is very useful in relieving the patient from asthma symptoms like coughing, wheezing, shortness of breath and tightness in the chest. It helps to relieve the patient from breathlessness; however, it does not prevent the symptoms from happening. It acts as an instant reliever from the symptoms of asthma. Jessica is prescribed inhaled salbutamol 2.5mgs six puffs three doses 20 minutes apart. Salbutamol is weight or age dependent. Jessica weighed 20 kgs and is below the age of six. So, she requires 2.5mgs of six puffs Salbutamol via a nebulizer.

In the same way, salbutamol relieved Jessica of her asthmatic symptoms with salbutamol puffs. Whenever she had episodes of wheezing or the airways get narrowed and there is difficulty in breathing, salbutamol is administered so that she is able to breathe. It greatly relieved her of the asthma attack (Vichyanond, Pensrichon and Kurasirikul 2012, pp.15-25). She uses the salbutamol through an inhaler and spacer that help in direct assistance and passing this into her lungs. In the given case study, Jessica was prescribed salbutamol puff and spacer by the emergency department consultant and administered by the registered nurses. With the continuous administration of salbutamol puff, she was able to breathe properly. It significantly reduced the episodes of asthmatic attacks in Jessica. Gradually, she reported that her breathing is becoming normal with increased spacing between the salbutamol doses.

Another steroid named prednisolone was also given to Jessica as it helped to prevent the inflammatory substance release in the body. She is prescribed with Prednisolone 22mg as a STAT dose for the treatment of moderate asthma. It is mentioned that prednisolone of 20-22 mg is given to the children between the age of 2-5 years. The allergic reactions are greatly treated using this medicine. It is also helpful in the prevention and control of asthma attacks like wheezing. When prednisolone is taken orally, it is absorbed into the body and passes directly into the lungs and helps to control the asthma attacks (Brodlie et al. 2012, pp.604-609). As it is taken orally, it will be helpful for Jessica to use during travelling or going to school. It will help her to gain better control over the asthmatic attacks outside her home. In addition, the asthma plan comprising of patient education, discharge medication, action plan and medical follow up are also important for Jessica and her family to control the episodes of asthma attack.

She was also prescribed inhaled Ipratropium 250mcg four puffs three doses 20 minutes apart through nebulizer as it enhances bronchodilation by blocking the acetylcholine action at parasympathetic sites in smooth muscles of bronchia.

Jessica was also prescribed high flow 0₂ via a non-re-breather facemask with reservoir – SaO₂ to remain above 93%. When she arrived at the emergency department at 0400 hours, her oxygen saturation levels were 90% on air. So, the doctor prescribed non-re-breather facemask with reservoir consists of one-way valve system that prevents mixing of exhaled gases with fresh gas flow. It ensures highest concentration of oxygen to Jessica practiced in emergency department.

Conclusion

Asthma is a chronic disorder that involves the inflammation of the respiratory pathways. It obstructs the airflow, airway inflammation and bronchial inflammation in the patients. It greatly affects the breathing patterns resulting difficulty in breathing. In children below the age of five, asthma occurs as a result of premature birth. In the given case study, Jessica White was born premature as she was born at the thirty three weeks of gestation period when her mother went for premature labor. This is the main reason for Jessica’s asthma as in premature babies, the lungs are immature with smaller airways. Moreover, the viral infection in Jessica caused swelling in her airways with excess mucus production. She showed clear symptoms of asthma like coughing, wheezing, tightness in the chest and shortness of breath. To control her asthmatic attacks, she was administered with salbutamol puffer and spacer to relieve her of breathing problems with predisolone for the prevention of inflammatory substances release in the body. The asthma plan also helped Jessica and her family to gain control over her episodes of asthma attack.

References

Agache, I., Akdis, C., Jutel, M. and Virchow, J.C., 2012. Untangling asthma phenotypes and endotypes. Allergy, 67(7), pp.835-846.

Austen, K.F. and Lichtenstein, L.M. eds., 2013. Asthma: physiology, immunopharmacology, and treatment. Elsevier.

Bisgaard, H., Jensen, S.M. and Bønnelykke, K., 2012. Interaction between asthma and lung function growth in early life. American journal of respiratory and critical care medicine, 185(11), pp.1183-1189.

Brodlie, M., McKean, M.C., Moss, S. and Spencer, D.A., 2012. The oral corticosteroid-sparing effect of omalizumab in children with severe asthma. Archives of disease in childhood, 97(7), pp.604-609.

Centers for Disease Control and Prevention, 2013. Asthma facts—CDC’s national asthma control program grantees. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.

Huckvale, K., Car, M., Morrison, C. and Car, J., 2012. Apps for asthma self-management: a systematic assessment of content and tools. BMC medicine, 10(1), p.144.

Melen, E. and Pershagen, G., 2012. Pathophysiology of asthma: lessons from genetic research with particular focus on severe asthma. Journal of internal medicine, 272(2), pp.108-120.

Murphy, A.C., Proeschal, A., Brightling, C.E., Wardlaw, A.J., Pavord, I., Bradding, P. and Green, R.H., 2012. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma. Thorax, pp.thoraxjnl-2011.

Stocks, J., Hislop, A. and Sonnappa, S., 2013. Early lung development: lifelong effect on respiratory health and disease. The Lancet Respiratory medicine, 1(9), pp.728-742.

van der Wiel, E., ten Hacken, N.H., Postma, D.S. and van den Berge, M., 2013. Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: a systematic review. Journal of allergy and clinical immunology, 131(3), pp.646-657.

Vatti, R.R. and Teuber, S.S., 2012. Asthma and pregnancy. Clinical reviews in allergy & immunology, 43(1-2), pp.45-56.

Vichyanond, P., Pensrichon, R. and Kurasirikul, S., 2012. Progress in the management of childhood asthma. Asia Pacific Allergy, 2(1), pp.15-25.