chronic asthma and acute asthma

Asthma

�Describe the pathophysiological mechanisms of chronic asthma and acute asthma
exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an
exacerbation.
�Explain how the factor you selected might impact the pathophysiology of both disorders.
Describe how you would diagnose and prescribe treatment for a patient based on the factor you
selected.
�Construct two mind maps-one for chronic asthma and one for acute asthma exacerbation.
Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis
and treatment you explained in your paper.

PATHOPHYSIOLOGY OF ASTHMA

PATHOPHYSIOLOGY OF ASTHMA

Asthma is a chronic disorder that involves the inflammation of the airways resulting into
a breathing difficulty in patients due to airflow limitation and airway hyper-responsiveness.
Statistics show that over seven million children are usually diagnosed with acute asthma
exacerbation globally with the same disorder affecting close to 30 million Americans. On the
other hand, over 300 million people globally are affected with chronic asthma and most of these
people are from underdeveloped countries. (In Heaney & In Menzies-Gow, 2013, pg 1)
A number of inflammatory cells are involved in asthma with some of these cells being
more predominant than the others. Macrophages from blood monocytes may find their way into
the airways thus triggering the inflammatory cells to produce a number of different products
which in turn initiates the inflammation.
In chronic asthma, the triggered inflammation causes a number of changes to occur in the
airway with one of these changes being the contraction of bronchial muscles also known as
bronchoconstriction. Airway edema, continuous secretion of mucus and formation of thick
mucus plugs along the airway causes more obstruction of the airway as the inflammation
progresses. Structural changes in the airway are also experienced and these include hypertrophy
and hyperplasia of the airway muscles. Airway remodeling is also experienced and this involves
a number of structural cells being activated hence a number of changes such as sub-epithelial
fibrosis and a thickening of the sub-basement membrane. The result of this is that a patient
becomes less responsive to therapy. (Banerjee, 2014, pg 92)
In acute asthma exacerbation, the process of bronchoconstriction usually occurs rapidly
in order to minimize the size of the airway as a result of being exposed to a number of stimuli

PATHOPHYSIOLOGY OF ASTHMA
such as allergens. Both the inflammation and bronchoconstriction result into obstruction of the
airway in patients and dynamic hyper-inflation which is also called air trapping. Bronchospasm,
edema, excessive secretions and mucus plugs trigger the continuous narrowing of the airway.
This usually results into dynamic hyper-inflation and an increased positive and expiratory
pressure (PEEPi). An increased PEEPi in the patient is often a reflection of additional air being
remaining in the lungs of a patient at the end of the expiration process more than the amount of
air that would be left in the lungs of healthy person. Once the process of airflow has been
obstructed, oxygen intake in the body’s patient is reduced; ventilation/perfusion mismatching is
increased thus resulting in the patient experiencing frequent coughing so as to clear the sputum
and secretions that have accumulated in the airway. If treatment is not sought in due time, the
patient may also start experiencing hypoxemia and hypercapnia resulting to anaerobic
metabolism, lactic acidosis and an unproportional level in the acid-base level of the body.
(Broaddus, Mason, Ernst, King, Lazarus, Murray, Nadel, Gotway, 2015, pg 748)
Age is one of the factors that impact the Pathophysiology of both chronic asthma and
acute asthma exacerbation. Children, compared to adults, are usually at a higher risk of suffering
from these two disorders with chronic asthma being more dangerous than acute asthma
exacerbation in terms of causing death. The main reason as to why children are at a higher risk
than adults is that adults have body cells which are more resistant. Usually, adults who have been
diagnosed with asthma can tolerate the disorder for weeks but children can die in less than a day
after the asthma attack and this is evident from the case of Bradley Wilson and Dynasty Reese. A
number of allergens at home and school such as dust and pollen always trigger acute asthma
exacerbation in children hence a high level of risk of the disorder in children. (Shaw & DeMaso,
2010, pg 308)

PATHOPHYSIOLOGY OF ASTHMA
Asthma can be diagnosed through a number of signs and symptoms in patients with the
most common signs and symptoms being wheezing, coughing, tachypnea, tachycardia and
shortness of breath and this is as seen in the case of Bradley Wilson and Dynasty Reese. The
diagnosis in most cases is made easier if the patient’s family has a history of the disorder.
Spirometry is done on the patient as a way of confirming the diagnosis and it involves the
measurement of the FEVI of a patient. Chest rays may also be used for the diagnosis. For
children, two types of medications are usually prescribed for treatment of asthma. The first type
is maintenance medications and such include inhaled corticosteroids like budesonide and
fluticasone. The second type is rescue medications and such include bronchodilators like
albuterol and levalbuterol. Oral drugs such as prednisone can also be administered to children
with asthma attacks with bronchodilators. For adults with asthma anti-inflammatory drugs are
the most appropriate prescribed medications. An example of an anti-inflammatory drug is
inhaled steroids. (Cecil, In Goldman & In Schafer , 2012, pg 534)

PATHOPHYSIOLOGY OF ASTHMA

CHRONIC ASTHMA

EPIDEMIOLOGY;300 million people affected
worldwide and is common in countries that are

underdeveloped

TREATMENT;
Anticholinergic
medications, cell
stabilizers and
corticosteroids

CLINICAL
PRESENTATION;
increased mucus
secretion, swelling and
inflammation of the
airway and tightening of
the airway muscle.

PATHOPHYSIOLOGY;
Shortness of breath,
wheezing, chronic
cough, chest tightness

DIAGNOSIS; Spirometry
and chest x-ray

PATHOPHYSIOLOGY OF ASTHMA

ACUTE ASTHMA
EXACERBATION
EPIDEMIOLOGY; over 30 million
Americans are affected, over
seven million children are
diagnosed worldwide

TREATMENT;Oxygen
administration,
bronchodillators,
cortosteroids

CLINICAL PRESENTATION;
Hypoxemia and respiratory
alkalosis, wheezing, coughing,
dyspnea, hyperventilation

PATHOPHYSIOLOGY;
Bronchoconstricion, airway
obstruction, increased mucus
secretion, cross link with mast

cells
DIAGNOSIS; chest x-ray
and spirometer

PATHOPHYSIOLOGY OF ASTHMA

References

Banerjee, E. R. (2014). Perspectives in inflammation biology. New Delhi: Imprint:
Springer
Broaddus, V. C., Mason, R. C., Ernst, J. D., King, T. E. J., Lazarus, S. C., Murray, J. F.,
Nadel, J. A., … Gotway, M. (2015). Murray & Nadel’s Textbook of Respiratory Medicine.
London: Elsevier Health Sciences.
Cecil, R. L., In Goldman, L., & In Schafer, A. I. (2012). Goldman’s Cecil medicine.
In Heaney, L. G., & In Menzies-Gow, A. (2013). Difficult asthma.
Shaw, R. J., & DeMaso, D. R. (2010). Textbook of pediatric psychosomatic medicine.
Washington, DC: American Psychiatric Pub.

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