Etiology:

Lung illnesses such as asthma can affect an individual for a long period of time. It makes the airways to become narrowed and inflamed, causing difficulty in breathing. Severe asthma can cause difficulty in speaking and inability to exercise. It’s commonly called bronchial asthma or chronic respiratory condition.  Although there is no single cause of asthma, certain variables may make it more likely to develop.  These include smoke exposure (through a smoking pregnant mother), low birth weight, and premature birth; A history of asthma or other allergic diseases such as food allergies, hay fever, or eczema in the family. Prepubescent boys are more susceptible to asthma, whereas girls are more likely to have asthma during adolescence. (Hikichi et al., 2018)

Pathophysiology:

Understanding asthma pathophysiology aids in the diagnosis and treatment of the condition. Airway inflammation is induced by a complicated interaction of many cell types and mediators with the airways, as described in the asthma description. This contributes to the condition’s characteristic pathophysiological aspects, which are airflow restriction and bronchial inflammation, which cause a higher incidence of shortness of breath, wheezing, and coughing. The mechanisms that cause these interrelated events to occur and lead to clinical asthma are still being studied. Moreover, regardless of the fact that asthma has a variety of phenotypes (e.g., severe asthma, aspirin-sensitive, persistent, or intermittent), airway inflammation is a regular trend.

Allergic reactions to an allergen related to immunoglobulin E (IgE) usually cause asthma. IgE is secreted during a reaction to allergens like animal dander or pollen. Initial exposure hypersensitivity occurs when allergen-specific IgE antibodies attach to the surfaces of labrocytes. When an allergen attaches to allergen-specific IgE antibodies on the membrane of labrocytes, inflammatory mediators such as prostaglandins, histamine, and leukotrienes are secreted. Mast cells(labrocytes), T-helper cells, and Eosinophils travel into the respiratory tract if an attack is left untreated. Goblet cells secrete excess mucus, which blocks the respiratory cavities. If it is coupled with rising hyperresponsiveness and airway tone, it causes the respiratory cavities to shrink, hence exacerbating symptoms.

Research indicates that poor treatment of asthma over time, can cause airway remodeling to develop. Chronic inflammation resulted in interstitial collagen deposition, new artery development and bronchial smooth muscle hypertrophy resulting in prolonged airflow blockage similar to that found in individuals with chronic obstructive pulmonary disease (COPD). However, the airway’s inflammation pattern in asthma does not always change based on the duration, perseverance, and severity of the disease.

Clinical Manifestations:

The signs and symptoms of asthma differ from individual to individual and from period to period. They include continuous coughing at night and early morning, wheezing sounds, shortness of breath, perspiration, pale lips and cheeks, anxiousness, and chest tightness are all symptoms of asthma (King et al., 2018). Other significant signs and symptoms include skin pulling in between the ribs during breathing (intercostal retractions); some people have a productive cough, while others have abnormal breathing patterns, sticky mucus, hypoxia, persistent dry cough, and tachycardia (Hikichi et al., 2018).

Asthma cannot be diagnosed with a simple test. General practitioners, on the other hand, commonly diagnose asthma by getting to know it symptoms, what triggers them, how often it occurs, and the means of relief. Along with some inquiries regarding the medications the patient is taking, their routine, their career, and their work and home environment. Spirometry, which assesses how well your lungs perform, is another type of assessment. A small hand held instrument known as a peak flow meter can be utilized to assess how quickly you can blast air out of your lungs in one breath during a peak expiratory flow rate test (Macdonald, et al., 2018).

In addition, chest radiography, blood gas analysis, lung function test, physical observations, and swab test can all be used to diagnose asthma. A complete blood count can reveal an increase in eosinophils, as well as an increase in white blood cells. To detect the type of allergens, skin tests and inhalation tests are equally significant. Skin testing, on the other hand, is usually more beneficial in young patients with chronic asthma. In moderate conditions, arterial blood gases may be normal, but if the condition worsens, respiratory hypoxia and alkalosis will be evident (Macdonald, et al., 2018).

As previously said, asthma is divided into four categories: persistent, severe, intermittent, and mild.   Other classifications include status asthmatics, which is defined as a long-term episode lasting more than 24 hours and resulting in dehydration. Asthma asphyxia causes cardiac arrest within an hour or minutes. Another is nocturnal asthma, which is asthma that occurs during the night but has no symptoms during the day. Occupational asthma, on the other hand, is more common in adults and is linked to substances in the workplace. In addition to drug-induced asthma, intolerance to aspirin affects roughly 10% of asthmatics since it reacts with the body within hours after ingestion. Another is premenstrual asthma, which manifests as an extremely devastating monthly asthma attack in the five to ten days preceding menstruation. Asthma caused by exercise is also frequent in children and teenagers. Bronchospasm usually occurs three minutes after an activity session ends and lasts for 60 minutes.

Risk Factors:

Gender, weight, smoking, and population differences are all risk factors for asthma. Males are more susceptible to asthma before puberty, while girls are more likely to get asthma after puberty. Some specialists believe that putting too much weight on the lungs can cause a hyperactive reaction in the airways, which is characteristic of asthma. Others claim that asthma causes fat by preventing physical exercise, despite the fact that multiple studies have revealed no difference in activity levels between those with asthma and those who do not (King et al., 2018)

According to King et al. (2018), there is a history of asthma or other allergic diseases such as hay fever, food allergies, and eczema in the family. Tobacco smoke exposure during childhood, especially if your mother smoked while pregnant, and the development of other atopic conditions such as food allergies. Pre-mature birth (especially if you needed a ventilator) and having bronchiolitis as a child (a frequent lung infection in children).  In addition to being born with a birth weight of less than 2 kg (4.5 lbs),

Journal Summary #1:

Asthma Pathophysiology (Macdonald, 2018)

Repeated attacks of acute asthma can lead to lung damage that is irreversible and the development of chronic asthma. The thickening of the airway, generation of thick, sticky mucus, increased vascular permeability, vascular congestion, and Impaired mucociliary function are related to asthma pathogenesis.   The risk factors associated with asthma are population differences, smoking, obesity, and gender. It’s critical to limit the number and intensity of acute attacks in order to avoid irreversible lung damage, infection, and chronic lung diseases like asthma. Some children suffer from low self-esteem as a result of asthma, while others may be afraid of having an asthma episode at school or around peers. Children with asthma who live in economically disadvantaged metropolitan regions have more severe asthma and have poorer long-term results.

Breastfeeding exclusively and regularly reduces the incidence of asthma in infants. Moreover, allowing patients to be conscious of all risk factors linked with the development of asthma, such as poor lifestyle, illnesses, animal allergies and food allergies also helps reduce the incidence of asthma in the general population.

Secondary asthma prevention is described as a treatment for children or patients who are at higher risk of developing asthma but have not yet shown clinical signs of the disease. Secondary asthma prevention is divided into three phases: allergen-specific immunotherapy, environmental allergy control, and pharmaceutical treatment, all of which have been shown to prevent the development of asthma and avoid a rise in bronchial hyperactivity.

Journal Summary #2:

Asthma (2021)

The examination of symptoms is used to diagnose asthma in both children and adults. Asthma kills 1,200 people in the UK per year, or one person every eight hours. Although asthma is more common in prepubescent boys, boys are more likely than girls to grow out of it during adolescence. There are a variety of reasons that might cause an asthma attack, and the causes differ from patient to patient. Asthma is diagnosed based on a patient’s history, treatment response, lung function tests and physical assessment. Peak flow diaries are preferable for evaluating patients who already have an asthma diagnosis than for making an initial diagnosis. This test is helpful in separating asthma from other illnesses that can be mistaken for asthma. Following the trial, an improvement in FEV1 of 400ml or more is strongly suggestive of an underlying diagnosis of asthma. Noninvasive sputum eosinophil and exhaled nitric oxide concentration testing can also aid in the diagnosis of asthma. A level of exhaled nitric oxide greater than 25 parts per billion also aids in the diagnosis of asthma.

Journal Summary #3:

Asthma (Ratini, 2002)

Asthmatics experience symptoms when their airways become constricted, inflamed, or clogged with mucus. Not everyone who suffers from asthma experiences the same symptoms in the same way.  Symptoms could also differ from one asthmatic attack to another, with one being minor and the next being severe. Some asthmatics can go for lengthy periods of time without experiencing any symptoms. Even moderate asthmatic symptoms should be recognized and treated to help you avoid severe attacks and keep asthma within tighter control. If you have an asthmatic episode, immediately follow your asthma action plan’s “Red Zone” or emergency recommendations.

When you take aspirin, you may develop asthmatic symptoms such as a cough, sinus tightness, sneezing and runny nose. You may also get asthma if your spirometry tests and symptoms test are unclear. You can obtain therapy to prevent allergy and asthma episodes after you know your allergy triggers. If your asthma is severe and your meds aren’t working, you might want to try a biologic: Allergen-induced asthma is treated with omalizumab.

Assessment:  Subjective Data:

For patient data collection, according to Lewis (2007),  I will assess my patient by asking the following questions

• Is there a history of allergies or asthma in your family?
• Do you experience any difficulty in breathing, how often do you feel so, and what are the circumstances?
• When did the symptoms begin, how often do they occur, and for how long do they last and under what circumstances?
• Have you been prescribed drugs before, how have they worked out for you?
• Do you have any pets, smoke cigarettes, or any potential triggers in your home?
• Have any of these been present in the environment since the onset of the symptoms?
• Does the patient have any other medical issues that need to be addressed, such as infectious diseases, joint issues, skin issues and gastrointestinal issues?

Assessment:  Objective Data:

For a physical examination;

• Examine the patient’s skin for symptoms of hives or eczema, which are both allergic disorders.
• Listen to the patient’s breathing with a stethoscope. One of the most common symptoms of asthma is wheezing, which is characterized by high pitched whizzing sounds as you exhale.
• Examine the patient’s nose, throat, and upper airways for any signs of infection.

Diagnostics:

Spirometry. I will let the patient breathe into the spirometer to determine how quickly and how much air is expelled from their lungs. This will help determine if the patient has any obstructions in the airway.

Exhaled nitric oxide. An increase in the amount of exhaled nitric oxide is commonly related to swollen airways.

Prevention and Treatments:

Avoiding frequent asthma triggers, as well as conducting a skin test to determine the stimuli that cause allergies and avoiding them, are all general strategies to take to prevent asthma. For school-aged children, regular swimming sessions, good ventilation at school and at home can help them build their chest muscles. As children return to school and at the first sign of a cold, they should be given prophylactic medication. 

Bronchodilators contain beta androgenic drugs like Ventolin which can be used to prevent attacks before exercises or other stimuli. For the same reason many people take inhalers with them so that they can self-administer a bronchodilator hence preventing an asthmatic attack.

The severity of an attack can typically be reduced by using controlled breathing methods and reducing anxiety. When chronic inflammation occurs, glucocorticoids like Beclovent are indicated since they are more efficient in decreasing the second phase of inflammation in the airway. Because patients with status asthmatics do not react to bronchodilators, hospitalization is required. Patients with chronic conditions are given prophylactic drugs, such as Cromolyn sodium, which is administered through an inhaler on a daily basis.

References

Asthma: pathophysiology, causes and diagnosis. (2021, February 12). The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/ld/asthma-pathophysiology-causes-and-diagnosis

Hikichi, M., Hashimoto, S., & Gon, Y. (2018). Asthma and COPD overlap the pathophysiology of ACO. Allergology International, 67(2), 179-186.

King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of severe asthma: We’ve only just started. Respirology, 23(3), 262-271.

Lewis, S. M. (2007). Lewis’s Medical-surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Australia.

McDonald, V. M., Hiles, S. A., Jones, K. A., Clark, V. L., & Yorke, J. (2018). Health‐related quality of life burden in severe asthma. Medical Journal of Australia, 209(S2), S28-S33.

Ratini, M. (2002, February 12). Asthma. WebMD. https://www.webmd.com/asthma/what-is-asthma