Asthma creates difficulties in breathing for millions of people across the world. Symptoms include coughing, wheezing, and chest stiffness. Asthma may be acute or chronic. For one to glean what causes asthma and its symptoms, it helps to know how the airways function. These tubes carry air into and out of the lungs. For asthma patients, the airways inflame. This makes air tube swollen and extremely sensitive. Because of this, they tend to react to substances the person inhales. The reaction of airways makes the muscles around them to tighten. This narrows the trachea allowing little air to pass into the lungs. The swelling may worsen making the airways narrower than before the condition. Cells in the airway tend to produce more mucus that when a person does not have asthma (Holgate, 2011). This further increases the narrowing of airways. The chain reaction results in asthma symptoms. This paper will analyze the symptoms and factors that impact on asthma. The paper will also discuss the pathophysiological mechanism of chronic asthma and acute asthma exacerbation.
The pathophysiology mechanisms of chronic and acute asthma exacerbation are complex and involve airway inflammation, intermittent airflow obstruction, and bronchial hyperactive responsiveness (Huether & McCance, 2012). Asthma is an inflammatory illness that involves a range of cellular and cytokine mechanisms of tissue destruction. Sometimes the inflammations of bronchial wall cause sudden death in patients of asthma. This is usually in severe cases where the inflammation prevents air from reaching the lungs resulting in a patient’s sudden death. Asthma exacerbations refer to exaggerated lower airway reactions to substances in the environment. Respiratory virus is the most common form of substances in the environment that cause asthma exacerbation. Airways’ inflammation is a significant part of the lower airway response to asthma exacerbation. This comes together with airflow obstruction and increased airway sensitivity. The pattern of inflammation varies depending on the factor responsible for the exacerbation. Health specialists are yet to identify the actual reasons for exacerbated airway response.
Analysis of arterial blood gases patterns during an exacerbation is helpful in asthma management. During the first stages, of an exacerbation arterial blood gases show mild hypercapnia, hypoxemia and respiratory alkalosis. If the situation lasts for some time, there may be some compensatory renal bicarbonate secretion, which manifests as a non-anion-gap metabolic acidosis (Huether & McCance, 2012). As the severity of airflow obstruction increases, arterial carbon dioxide (PaCO2) first normalizes and subsequently increases because of patient's exhaustion, inadequate alveolar ventilation and/or an increase in physiologic death space (Pauwels, et al, 2012).
Several factors affect the pathophysiology of both chronic and acute asthma. Behaviors of people are a major influence on the pathophysiology of asthma. Behaviors such as smoking exercising trigger the disease. This is because such behaviors increase the chances of developing lung infections and breathing disorders. Smoking tobacco leads to lung problems and trachea issues. This reduces the amount of air that reaches the lungs and as a result, aggravating asthma. Lack of enough air getting into and leaving the lungs is one of the causes of asthma. Lack of exercise on the other hand, encourages the development of a layer of fat in the body organs including the airways. This narrows the airways and as a result, reduces air entering the lungs. Diagnosing asthma especially because of the behavior factor is tricky. One has to rule out any other cause and symptoms (Rees, Kanabar & Pattani, 2012). This will involve asking the patient about his background to ascertain that asthma is not because of genetic factors. Ask of the symptoms to determine the level of severity and then rule out any other possibility. Patients of asthma have different symptom pattern, which makes it difficult to identify the condition. For exercise-induced asthma, such people will develop asthma after rigorous exercises. The doctor can prescribe medication to ease the tightening of airways before exercising. For smoking, the best prescription is to stop smoking and use medications that eliminate the urge to smoke (Barnes, 2008).
Below are acute and chronic asthma mind maps. The mind maps show the epidemiology, pathophysiology, and diagnosis as well as treatment options of the two diseases.
Acute Asthma Mind Map
Chronic Asthma Mind Map
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In conclusion, asthma kills many children and adults every year throughout the world. This makes it essential for one to understand the development, causes, and diagnosis of asthma. The fact that health practitioners do not know of any cause of the disease makes it difficult for them to treat it. The symptoms also differ from patient to patient further aggravating the situation.
- Barnes, P. J. (2008). Immunology of asthma and chronic obstructive pulmonary disease. Nature Reviews Immunology, 8(3), 183-192.
- Holgate, S. T. (2011). Pathophysiology of asthma: what has our current understanding taught us about new therapeutic approaches?. Journal of Allergy and Clinical Immunology, 128(3), 495-505.
- Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom edition). St Louis MO: Mosby.
- Pauwels, R. A., Buist, A. S., Calverley, P. M., Jenkins, C. R., & Hurd, S. S. (2012). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 163(5).
- Rees, J, Pattani, S & Kanabar, D. (2010). ABC of Asthma (Vol. 157). Wiley. Com.
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Asthma is a long-term illness of respiratory tract involving inflammation and constriction of the airways. Asthma causes a recurrence wheezing, shortness of breath and coughing. Coughing occurs mainly in the morning and early in the night (Edmunds & Mayhew, 2013). Asthma as the illness affects people of all ages and starts early from childhood. Airways play a critical role in carrying air into and out of the lungs. Inflammation of the airways due to asthma makes them sensitive to many substances including inhaled dust and fur. Severe reaction involving the tightening of the muscles on the airways occur due to the above named trigger factors (Edmunds & Mayhew, 2013). In the United States alone, 7.8 percent of the population is asthmatic with the disease afflicting people of all races, genders and socioeconomic status(Frandsen, Pennington, & Abrams, 2014).. The disease occurs disproportionately among ethnic and racial populations. Despite the disease being chronic, death from asthma is rare though the propensity increases with age. (Frandsen, Pennington, & Abrams, 2014).
Many people are unaware of asthma especially in situations when the symptoms are not severe. The severity of the symptoms makes the disease serious. The patient coughs in the morning and early in the night or during exercise. Apart from coughing, the individual experiences troubled breathing in the presence of trigger factors. Troubled breathing is also known as shortness of breath. Individuals experience tightness in the chest and a characteristic wheezing (whistling) sound. Sometimes a cough persists and would not go away (Edmunds & Mayhew, 2013). The problem of breathing is coupled to excessive production of mucus. In severe cases, asthma is associated with hypoxia necessitating oxygen to be given in a clinical setting. Most of the symptoms can appear in isolation ranging to mild to severe cases (Frandsen, Pennington, & Abrams, 2014). Symptoms of asthma happen every time the airways are blocked and irritated.
Medications used in the treatment of asthma targets various factors influencing the appearance of the symptoms. Autacoids play a significant role in the symptoms development with a profound effect on the smooth muscles (Frandsen, Pennington, & Abrams, 2014). An example of autacoid is histamine, angiotensin and prostaglandin. With the inflammation of the air pathways in the respiratory system, the individual experiences bronchoconstriction inducing the development of symptoms. Leukotrienes are inflammatory mediators that lead to airway edema and over secretion of mucus. Furthermore, they initiate the contraction of smooth muscles. The most important leukotriene for asthma fall in the classes LC4, LD4 and LE4 (Frandsen, Pennington, & Abrams, 2014). Medications that block these mediators play a significant role in preventing asthmatic symptoms.
Cyclooxygenase remains the main enzyme for eicosanoid production. Eicosanoids are arachidonate metabolites which include prostaglandin, thromboxane and prostacyclin (Judd, 2012). Inflammation result from eicosanoids with Cyclooxygenase being the first enzyme involved in the syntheses of prostanoids; prostacyclins, prostaglandin and thromboxanes each having varying degrees of the inflammatory response (Judd, 2012). Most of the medication used in the treatment of asthma induces inhibitory effect on cyclooxygenases to reduce the production of eicosanoids.
The NSAID (Non-steroidal anti-inflammatory drugs) class of drugs play a role in the treatment of asthma by inhibiting cyclooxygenase (Judd, 2012). As noted earlier, trigger factors such as pollen grains, dust and animal fur induces asthmatic attack. Histamine plays a significant role in the response towards the presence of allergens in the body. The mammalian cells including those of the respiratory system produces histamine (Judd, 2012). H1 receptor responds to elevated levels of histamine in the cells and exist in endothelium and muscle cells. Inhalation of the trigger factors induces quick response characterized by hypersecretion of mucus, contraction of smooth muscles in the airways and sneezing. Medications in the class of antihistamines such as diphenhydramine prevents the association of histamine with its receptors in the cells (Judd, 2012). All medication used in the treatment of asthma use the common rationale of inhibitory effects to the triggering events leading to a cascade of reactions.
The rationale of the three major drugs used for treatment of asthma is founded both in their mode of action and any side effects. Leukotriene inhibitors are used in the treatment of asthma in both children and adults because they function like NSAIDS with minimal bronchial reactivity. Cyclooxygenase plays a significant role in the body and leukotriene inhibitors require care before admission. Pregnant patients or adults with renal problems are not candidates for leukotriene therapy.
Corticosteroids are used in the treatment of asthma with inhalation being the mode of administration. Some of the corticosteroids should be used with care since they decrease the mast cells and lymphocyte infiltration to bronchial mucosa for both adult and children. Bronchodilators are a class of medicine that relax the smooth muscle of bronchioles making them to open up reverting breathing to normal. Caution should be taken especially when administering theophylline since it induces confusion, seizures, and death.
Drug therapy is the approach that finds applause in treatment and management of asthma. Leukotriene inhibitors serve the same purpose just like NSAIDS because of their antipyretic effects (Edmunds & Mayhew, 2013). They interfere with vasoconstrictive effects induced by leukotriene. In comparison to corticosteroids, they have less bronchial reactivity and airway inflammation. Used to treat asthma in children since they can be taken as chewable tablets or oral syrups. They are effective as an antihistamine in the treatment of allergic rhinitis (Edmunds & Mayhew, 2013). They have minimal side effects and are tolerated in most patients.
Corticosteroids form another class for the treatment of asthma with the useful role in preventing asthmatic attack and chronic asthma. They have immunomodulatory functions and the mode of administration, inhalation prevents the unwanted systemic side effects (Edmunds & Mayhew, 2013). They find use when the leukotriene inhibitors have minimal effects in the body. The drugs act by enhancing the beta-adrenergic response thus relieving the muscle spasm. They have reverse role in mucosal edema, decreasing vasoconstriction and inhibiting the secretion of leukotriene.
Bronchodilators play a significant role in the treatment of asthma. Constriction of the bronchial tubes is one of the symptoms of asthma (Judd, 2012). Bronchodilators are drugs that make the muscles relax and thus dilate. With the relaxation of smooth muscles, breathing revert to normal. Beta 2-agonists and anticholinergic are common bronchodilators for asthma treatment. In the treatment of asthma, short-acting beta 2 agonist helps in acute attack and bronchoconstriction while the long-acting beta2 agonists are used or the long term treatment of asthma symptoms (Frandsen, Pennington, & Abrams, 2014). These drugs adjunct the anti-inflammatory therapy with the common drugs used including the leukotriene inhibitors and corticosteroids. They find relevance for to patients who do not have a positive response to other drugs.
Edmunds, M. W., & Mayhew, M. S. (2013). Pharmacology for the primary care provider. St. Louis, Mo: Elsevier-Mosby.
Judd, S. J. (2012). Asthma sourcebook: Basic consumer health information about allergic, exercise-induced, occupational, and other types of asthma, including facts about causes, risk factors, symptoms, and diagnostic tests and featuring details about treating asthma with medication and other therapies. Detroit, MI: Omnigraphics, Inc.Frandsen, G.,
Pennington, S. S., & Abrams, A. C. (2014). Abrams' clinical drug therapy: Rationales for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.