NURS 6501 WeeK 6 Asthma Assignment
It is important as an advanced practice nurse to recognize many alterations of the respiratory system. Differentiating between the many respiratory disease processes is a necessity for accurate diagnosis and treatment. Most pulmonary diseases cause altered breathing patterns, chest pain, clubbing, cough, cyanosis, dyspnea, sputum production, and wheeze (Huether, and McCance, 2017).NURS 6501 WeeK 6 Asthma Assignment
Asthma is a frequently diagnosed pulmonary disease process in both children and adults. Asthma main characteristic is a cough and wheeze from bronchospasm, produced by chronic bronchial hyperactivity, inflammation and smooth muscle hypertrophy and reversible airflow obstruction, in response to a trigger (Huether, and McCance, 2017). In fact, the Centers for Disease Control and Prevention, (CDC, 2017) details 1 in 13 people in the United States has asthma, which is approximately 18.4 million adults and 6.2 million children. Asthma accounts for 14 million doctor visits, 439,000 hospitalizations, (Asthma and Allergy Foundation of America (AAFA), 2015) 1.6 million emergency department visits and over 3600 deaths each year (CDC, 2017). African-Americans have 47% higher incidence rate, and their mortality rate is 3:1 compared to whites (AAFA, 2015). Asthma costs the U.S. about $56 billion each year and accounts for more than 14 million missed work days and 13.8 million missed school days (AAFA, 2015).
Asthma is a devastating respiratory alteration. Asthma is a complicated interaction comprising of a person’s genetic susceptibility and environmental factors (Hammer, and McPhee, 2014). When attacks or flares of asthma are upon an individual, the intermittent symptoms can range from mild to severe to a medical emergency. Asthma clinical manifestations include chest tightness, cough, expiratory wheeze, rapid breathing, and shortness of breath (AAFA, 2015). Other symptoms include accessory muscle use, anxiety, barrel chest, clubbing, dyspnea, nasal flaring, pulsus paradoxus and head bobbing in infants (Huether, and McCance, 2017). The purpose of this paper is to discuss the pathophysiology of asthma identifying key differences in chronic asthma versus an acute exacerbation, isolating the behaviors of individuals influencing asthma, and providing a mind map for each presentation of asthma. NURS 6501 WeeK 6 Asthma Assignment
Pathophysiology of Acute Asthma Exacerbation
Asthma’s onset in acute situations is precipitated by exposure to an allergen or trigger (Hammer, and McPhee, 2014). The trigger then stimulates a type I immune reaction mediated by T helper two lymphocytes cells (Th2) (Huether, and McCance, 2017). Antigen exposure causes the Th2 cells release cytokines. Then activates mast cells, dendritic cells, plasma cells presenting IgE antigens, and eosinophils (Huether, and McCance, 2017). The activation of the immune response cells causes an inflamed, narrowed airway, impaired mucociliary function, and vascular congestion resulting in bronchospasm increased mucus production and other intermittent asthma symptoms (Huether, and McCance, 2017). In an acute asthma exacerbation compromised inhalation and exhalation cause an increased work of breathing because of air trapping, distal hyperinflation of alveoli, and decreased perfusion (Huether, and McCance, 2017). Furthermore, airway constriction and inflammation cause ventilation-perfusion changes leading to hypoxemia, decrease in tidal volumes, increasing carbon dioxide retention resulting in respiratory alkalosis and respiratory failure (Huether, and McCance, 2017).
Acute asthma exacerbations are intermittent and due to a trigger, such as allergens (dust, pollens), air irritants (air pollution, smoke), chemicals, exercise, and stress (American Lung Association, n.d.). Acute asthma is best controlled with the use of a short-acting beta agonists such as albuterol (Mayo Clinic, 2016).NURS 6501 WeeK 6 Asthma Assignment
Pathophysiology Chronic Asthma
The pathophysiology of chronic asthma is similar to an acute asthma exacerbation. However, the persistent inflammatory response results in hyperresponsiveness and bronchial remodeling that is permanent. With proliferation, the bronchial smooth muscle mass of both large and small airways of the respiratory tract become irreversibly increased from poorly controlled inflammatory responses of intermittent asthma (Girodet et al, 2016). Over time the remodeling narrows the inner lumen of the airways, increases mucous production, and damages the epithelium heightening resistance to airflow and airway obstruction (Huether, and McCance, 2017). Alveolar hyperinflation occurs as a compensatory mechanism to airway obstruction (Hammer, and McPhee, 2014). Just as with acute asthma the impaired respiratory function causes variable and uneven ventilation-perfusion relationships resulting in hypoxemia, decrease in tidal volumes, carbon dioxide retention putting and individual at risk for developing respiratory alkalosis and respiratory failure (Huether, and McCance, 2017).
Behavior in Asthma
Asthma can be affected by the behaviors of individuals. A person’s lifestyle and behavior can expose them to environmental triggers of asthma. Unhealthy behaviors such as obesity and smoking increase risk factors. Many people with asthma have allergies to dust, food, molds, and pollens. Poverty also influences behaviors. Impoverished individuals tend to live in inner cities. They are exposed to poor air quality, have higher exposure to indoor allergens because of dirty, unkempt homes with excess animal dander, cockroach droppings, dust mites, and molds and tend to have higher occupation exposure to triggers (American Academy of Allergy Asthma and Immunology (AAAAI), n.d.). NURS 6501 WeeK 6 Asthma Assignment
Diagnosis Treatment
Referring patients to and allergist or immunologist is one method of assisting individuals in diagnosing and controlling asthma. Allergist or Immunologist are physicians specializing in diagnosis and treatment of asthma. An allergist can test an individual for allergies to common allergens that trigger asthma, and recommend treatment options to better control asthma (American Academy of Allergy Asthma and Immunology (AAAAI), n.d.). Asthma is diagnosed by physical exam and history and through the use of different lung function tests (LFT). LFT include spirometry, peak airflow, and trigger tests (AAFA).
The first recommendation in managing asthma is to avoid common triggers. Treatment options include an inhaled short-acting beta agonists (SABA) for quick relief in all people with asthma. Other choices in the treatment of asthma are to add an inhaled corticosteroid and a long-acting beta-agonist (LABA) such as salmeterol (Mayo Clinic, 2016). Leukotriene modifiers such as Singulair and other daily medications such as theophylline can also help manage asthma (2016). Providers include intermittent oral or intravenous corticosteroids some cases. The specialist usually prescribes asthma medications in a flexible step approach treating the severity of the disease based on symptoms. Other times it’s recommended to receive immunotherapy or allergy shots (AAAAI), n.d.).NURS 6501 WeeK 6 Asthma Assignment
Summary
Asthma is a chronic inflammatory respiratory disease that the body uses compensatory mechanisms to try to balance out and correct ventilation-perfusion issues. The compensatory changes the body goes through including the increasing size of the bronchial smooth muscle, decreasing the diameter of the inner lumen in which the air passes, increase mucous production, and epithelial damage resulting in airflow resistance and airway obstruction. The prevalence of asthma is high, and many ‘s are affected, and the cost of treating asthma is astronomical. Therefore, proper management, treatment, and diagnosis of asthma are essential to controlling morbidity and mortality rates in asthma.
References
American Academy of Allergy Asthma and Immunology (AAAAI), n.d.). Asthma library. Retrieved from https://www.aaaai.org/conditions-and-treatments/library/asthma-library
Asthma and Allergy Foundation of America. (2015). Asthma. Retrieved from http://www.aafa.org/page/asthma-symptoms.aspx
American Lung Association. (n.d.). Asthma. Retrieved from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/
Centers for Disease Control and Prevention. (2017). Asthma. Retrieved from http://www.cdc.gov/asthma/default.htm.
Girodet, P., Allard, B., Thumerel, M., Begueret, H., Dupin, I., Ousova, O., & … Berger, P. (2016). Bronchial Smooth Muscle Remodeling in Nonsevere Asthma. American Journal Of Respiratory & Critical Care Medicine, 193(6), 627-633. doi:10.1164/rccm.201507-1404OC
Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.). China: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Mayo Clinic. (2016). Asthma. Retrieved from http://www.mayoclinic.org/diseases-conditions/asthma/basics/definition/con-20026992
NURS 6501 WeeK 6 Asthma Assignment