Posted: January 17th, 2023

Asthma NURS6501, Advanced Pathophysiology

Asthma

NURS6501, Advanced Pathophysiology

The purpose of this paper is to identify the pathophysiology mechanisms of acute asthma exacerbation and chronic asthma. Similarities and differences between the two illnesses will be identified and mind maps of each will be included. The patient factor, ethnicity, will be examined and how it may impact the pathophysiology of the disorders. Asthma is considered a chronic disease which may have acute exacerbations. If intervention is not early the disease can become severe and life-threatening. Individuals of all ages can present with asthma symptoms, a thorough history is helpful when making the diagnosis (National Asthma Education, 2007).
Chronic Asthma
Asthma is a serious health issue affecting individuals all over the world, there are more than 300 million individuals diagnosed with this disease. Chronic asthma is an inflammatory disease of the airway which leads to airway hyperresponsiveness, obstruction, over production of mucus and remodeling of the airway (Kudo, Ishigatsubo, & Aoki, 2013). Asthma is triggered when a sensitive person is exposed to an antigen, an innate and adaptive response begins. Asthma triggers may be extrinsic or intrinsic; extrinsic generally have a childhood onset while intrinsic asthma is often triggered by exercise, cold air, infections causing damage to epithelial cells and trigger IgE antibody production (Mattson-Porth & Maftin, 2009). Dendritic cells present the antigen to T-helper cells which leads to a release of inflammatory cytokines and interleukins. Plasma cells produce IgE specific to the antigen triggering the response, IgE binds to the antigen causing further release of inflammatory mediators such as histamine and prostaglandins. Vasodilation occurs causing mucosal edema, an increase in capillary permeability and bronchospasms (Huether & McCance, 2017). Mucus plugs are often formed due to cilia being damaged, if left untreated permanent, irreversible damage may occur this is known as airway remodeling (Huether & McCance, 2017).
Acute Asthma Exacerbation
An acute exacerbation of asthma occurs as airway obstruction continues, and the lungs become hyperinflated causing decreased perfusion of alveoli. As hyperventilation continues the patient experiences respiratory alkalosis which changes to acidosis when respiratory muscles begin failing causing a retention of CO2. When respiratory acidosis is present the patient is in respiratory failure (Huether & McCance, 2017). Symptoms of acute asthma exacerbation may include dyspnea, cough, tightness in the chest, tachypnea, tachycardia, pulses paradoxes, hypoxemia, hypercapnia, and respiratory acidosis in severe exacerbations (Hammer & McPhee, 2014). In the U.S, nearly 4,200 patients die each year from an acute asthma exacerbation (Dougherty & Fahy, 2009).
Treatment
The goal of asthma treatment is for the patient to achieve and maintain control of the disease so that exacerbations are prevented, and the risk of mortality is reduced (Kim & Mazza, 2011). Asthma treatment is not the same for each individual and must be tailored to that person to optimize its benefits (Kim & Mazza, 2011). Patients can benefit from practicing avoidance measure as well as using pharmacological treatments both daily and as needed. Patients may be given inhalers to take, to maintain an open airway, or possibly corticosteroids to help reduce swelling and mucus production.
When a patient is experiencing an acute asthma attack, arterial blood gases should be drawn to determine oxygenation status. Albuterol is the most common medication prescribed in this class and can be given as a “dry powder inhaler (DPI), metered-dose inhaler (MDI), and nebulizer (NEB) solution” (Durham , Fowler, Smith, & Sterrett, 2017). Oxygen should be readily administered. If the patient does not respond to treatment or if hypoxemia progresses, bipap or mechanical ventilation may be required.
Differences and Similarities
Acute asthma exacerbations stem from a trigger or uncontrolled chronic asthma. Once airway remodeling takes place airway obstruction is less responsive to prescribed therapies which can lead to an exacerbation. (National Asthma Education, 2007). While treatment of both chronic and acute asthma is essential, immediate treatment of acute asthma is needed as it can quickly become a fatal illness. Chronic asthma can be treated on an outpatient basis while an acute asthma attack often requires hospitalization, “severe asthma exacerbations result in hospitalization, which constitutes about one-third of the total $14.7 billion in U.S. annual asthma-related health care expenditures” (Dougherty & Fahy, 2009).
Patient Factor
Ethnicity appears to play a role in the development of asthma, according to Huether and McCance (2017) there is a higher incidence of asthma among children from black, Hispanic, American Indian and Native Alaskan, backgrounds. Many researchers believe that the reason for this is due to socioeconomic status of minorities. Forno & Celedon (2009) state “the effect of socioeconomic status on illnesses such as asthma is likely mediated through pathways including environmental exposures, access to health care, stress, and psychological/cultural factors. However, ethnicity is also correlated with racial ancestry, which may influence asthma disparities through differences in the frequency of disease-susceptibility alleles.” It is thought that housing in cities may have an increased level of allergens such as cockroaches, which have been linked to an increase in asthma morbidity.
Conclusion
Management of chronic asthma is key to preventing acute exacerbations which can be life threatening. Chronic asthma that is not controlled or a patient who comes in contact with a trigger may develop a life-threatening reaction which requires immediate medical intervention. Ethnicity appears to be a risk factor for developing the disorder as minorities often live in poverty and are exposed to triggers such as cockroaches more frequently. Advanced practice nurses must be diligent in taking a thorough medical history from patients and educating those with this diagnosis about the dangers of non-compliance to treatment.

References
Dougherty, K., & Fahy, J. (2009). Acute Exacerbations of Asthma: Epidemiology, Biology and the Exacerbation-Prone Phenotype. Journal of the British Society for Allergy and Clinical Immunology, 193-202.
Durham , C., Fowler, T., Smith, W., & Sterrett, J. (2017). Adult asthma: Diagnosis and treatment. The Nurse Practitioner, 16-24.
Forno, E., & Celedon, J. (2009). Asthma and Ethnic Minorities: Socioeconomic Status and Beyond. Current Opinion in Allergy and Immunology, 154-160.
Hammer, G. D., & McPhee, S. j. (2014). Pathophysiology of Disease: An introduction to clinical Medicine. Seventh Edition. Mcgraw-Hill .
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology, sixth edition. St Louis: Elsevier.
Kim, H., & Mazza, J. (2011). Asthma. Allergy, Asthma and Clinical Immunology.
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in Microbiology, 263.
National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute

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