Understanding the Pathophysiology of Acute Asthma and Nursing Interventions

This article discusses the pathophysiology of acute asthma and nursing interventions to control the condition. It explains the role of pharmacological treatment and peak flow monitoring in controlling asthma. The article also discusses the effectiveness of nebulised ipratropium bromide and salbutamol in treating asthma.

Running head: NURSING ASSIGNMENT
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Name of the Student:
Name of the University:

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Author Note:

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Concept Map:

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Pathophysiology
Pathogenesis includes bronchial responsiveness, intermittent airflow and airway inflammation [2]
Acute Severe Asthma
Clinical manifestation
Increased pain, chest related concerns, breathing problem, wheezing and coughing [3], respiratory infection, allergic reaction and smoking, stress and cold weather [1]
Management
The management process includes corticosteroids, bronchodilators and oxygen
ma can lead to obstructive pulmonary disorder, however chances of remission depends on proper care and medication [7]Causes
Over academia is the reason for the acute severe asthma and therefore, it decreases the capacity of the lung and thereby leading to asthma [6]
Diagnostic procedure
Diagnosis depends on the functionality test such as spirometry and methacholine challeng
using peak flow monitor and monitoring asthma trigger can help in the identification of acute care asthma [8]

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References
1. Holt, P. G., & Sly, P. D. (2012). Viral infections and atopy in asthma pathogenesis: new rationales for asthma prevention and
treatment. Nature medicine, 18(5), 726. Retrieved from: https://www.nature.com/articles/nm.2768
2. Olin, J. T., & Wechsler, M. E. (2014). Asthma: pathogenesis and novel drugs for treatment. Bmj, 349, g5517.
DOI: https://doi.org/10.1136/bmj.g5517
3. Sicherer, S. H., & Sampson, H. A. (2014). Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy
and Clinical Immunology, 133(2), 291-307. DOI: https://doi.org/10.1016/j.jaci.2013.11.020
4. Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P. (2013). International ERS/ATS
guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013. Retrieved
from: https://patients.thoracic.org/statements/resources/allergy-asthma/severe-asthma-full.pdf
5. Papadopoulos, N. G., Arakawa, H., Carlsen, K. H., Custovic, A., Gern, J., Lemanske, R., ... & Zar, H. (2012). International
consensus on (ICON) pediatric asthma. Allergy, 67(8), 976-997. https://doi.org/10.1111/j.1398-9995.2012.02865.x
6. Garcia, G., Taillé, C., Laveneziana, P., Bourdin, A., Chanez, P., & Humbert, M. (2013). Anti-interleukin-5 therapy in severe
asthma. European Respiratory Review, 22(129), 251-257. DOI: 10.1183/09059180.00004013
7. Holgate, S. T. (2013). Mechanisms of asthma and implications for its prevention and treatment: a personal journey. Allergy,
asthma & immunology research, 5(6), 343-347. DOI: https://doi.org/10.4168/aair.2013.5.6.343

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8. Brusselle, G. G., VanderStichele, C., Jordens, P., Deman, R., Slabbynck, H., Ringoet, V., ... & Demeyere, B. (2013).
Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-
controlled trial. Thorax, 68(4), 322-329. Retrieved from: https://thorax.bmj.com/content/68/4/322.short

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Answer 1:
The pathophysiology of acute asthma relies upon the inflammatory symptoms and underlying interaction of the cells and their mediators
in order to elicit a physiological response. The case study states that Jackson Smith was affected with acute asthma and was admitted to the
emergency department on account of severe breathlessness. While noting the patient details for documentation, it was notice that the client had
been suffering from asthma since childhood. Several other details were documented which included information about episodes of Dyspnea and
shortness of breath. Further, it was also noted that the client had an increased heart beat which was approximately 32 beats per minute. Further,
the blood pressure was also elevated and the pulse rate was approximately around 130 beats per minute which is not normal. In addition to this,
it should also be mentioned that that that a deep wheezing sound was also detected. This has also been known as the process of auscultation of
the lungs (Ayala et al., 2014). The physicians proceeded with an X-ray that determined an inflamed appearance of the lungs and the adjoining
area. The gaseous concentration in the blood was estimated to be approximately 90% SO2, PCO2: 50mm HG and HCO3 which was equivalent to
be around 25mEq/L (Ayala et al., 2014). Based upon the above clinical cues, the pathogenesis of Jackson’s acute asthma could be determined.
The pathogenesis of asthma can be understood on the basis of the genetic impact and the environmental influence. In close association to
the case study, it can be stated that the emergence of asthma in the client was based on the weakened immunity, respiratory infections, natural
allergens, genetic and environmental components (Castro et al., 2015). The underlying defence mechanism of the disease can be explained as the
process where the antigen presenting cells elicit their action by engulfing the allergens from the surrounding environment to the T cells. The
inflammation factors further activate the respiratory epithelium (Chung et al., 2013). This leads to the release of thymic stromal lymphoprotein

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and other associated inflammatory mediators that mediate the allergic reaction. It should also be noted here that, the Dendritic cells also play an
important role in presenting the allergens to the T-cells (Catro et al., 2015). The allergens are presented to the two subcategory of T-cells
namely, the T-helper 2 cells and Th17 cells. The Th2 cell is responsible for the formation of immunoglobulin E from the B cells under the
influence of interleukin 4 and interleukin 13 (Chung et al., 2013). Immunoglobulin E or (IGE) binds to the cell surface of the mast cells and the
basophiles under the influence of interleukin 4 which has been primarily considered as the root cause for the inflammatory reaction (Chung et
al., 2013). A number of reasons such as an inflammatory response generated by the neutrophils, macrophages, eosinophiles have been reported
to cause bronchoconstriction of lungs, lung infect ions and acute asthma which has been the case for the client in the case study.
It can hence be stated that on account of the chronic inflammation, Jackson experienced symptoms of shortness of breath and higher
respiration rate. Research studies state that on account of the presence of respiratory epithelium cells and leukocytes the pathway is blocked. On
account of the presence of mediators, the inflammatory cells are recruited to the epithelium cells and this eventually infiltrates the lungs (Chung
et al., 2013). Further, it should also be noted that the epithelium cells thus create a cycle for the manifestation of chronic symptoms leading to
damage and obstruction in the airway that elevates the blood pressure. In addition to this, the genetic environment could also be held responsible
for the manifestation of asthma in the client. The genetics involved in the production of IgE affects the dysfunctional regulation of inflammatory
mediators including chemokines, cytokines and other growth factors (Gadomski & Scribani, 2014). This modification in the genetic pattern leads
to the development of asthma. In the case study, Jackson had also been affected with the similar condition.

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Answer 2:
In order to provide medical assistance to Jackson, the two nursing interventions that would be provided would include the
pharmacological treatment and the peak flow monitoring which has been found to be effective in controlling asthma. The following paragraph
would discuss the rationale behind the proposed intervention and would also use scientific evidences to back up the intervention strategies.
The case study clearly reveals that the client had been admitted to the hospital because of acute shortness of breath, hence to control the
worsening condition of the client, an immediate drug must be administered to the client. It should also be critically noted here that the patient
presents symptoms of progressive dyspnea that further leads to symptoms of aggressiveness and anxiety. Hence, it can be stated that the
administration of corticosteroids as the primary medication can help in controlling the condition of the patient. According to research studies, it
is stated that corticosteroids have the potential to decrease the peak flow variability and at the same time clear the airway obstruction.
Pharmaceutical drugs such as immunomodulators and anticholinergics can also be used in order to control the condition of the patient and
restore normal breathing (Griffiths & Ducharme, 2013). Research papers state that immunomodulators and anticholinergic drugs help in the
prevention of asthma by disrupting the binding of the mast cells to the basophile (Garcia-Cardenas et al., 2015). This leads to the clearance of the
airway passage and as a result normal breathing is restored.
The peak flow monitoring has been reported to be an efficient strategy to deal with patients suffering from acute asthma (Koch et al.,
2013). Through this system, the highest airflow during the period of a forced inhalation or exhalation is recorded. Based on the recorded pattern

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appropriate interventions can be taken, so as to control the condition of the patient. Preventive strategies can successfully help in the
improvement of congestion and breath sounds so as to effectively reduce the implication of the disease (Olson et al., 2013).
Answer 3:
Research studies state that the administration of Nebulised ipratropium bromide has been found to be effective in treating pulmonary
disorders (Shan et al., 2013). On administering the drug in combination with the β2-agonists it has been reported that the airway obstruction
could be effectively treated (Siddiqui et al., 2013). The drug effectively blocks the muscarinic receptors that is tightly linked to the acetylcholine
receptors. This helps in relieving the COPD condition. In order to treat other symptoms such as nausea, headache and dizziness the patient would
be kept under strict observation and based upon the recorded vital signs the intervention would be devised.
The pharamaceutical drug Salbutamol has been found to be effective in the treatment of asthma. The drug is inhaled in the form of aerosol and
acts upon the β2-adrenoreceptors. This further elicits the effect on the smooth muscles that cover the bronchi and help in the restoration of
normal breathing. It further helps in the binding of the active site of epinephrine that leads to increase in the production of cAMP that further
generates release of potassium ion (Wark et al., 2013). The calcium ion concentration decreases intra cellularly and this interferes with the
contraction ability of the muscles. Salbutamol has been found to be an effective drug that helps in relaxation of the muscles. It acts by binding to
the β2 receptors. The impact of the applied nursing intervention would be evaluated by keeping the patient under strict observation. The positive
signs of improvement in the patient will determine the level to which the intervention has been able to elicit a positive effect (Wark et al., 2013).

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In addition to the administration of salbutamol, the patient would also be given anti-depressants which would effectively treat the associated
side-effects. The antidepressants and analgesics would effectively manage the symptoms of anxiety, head ache, body pain and muscular cramps.
Another naturally occurring drug that has been found useful in the treatment of acute asthma is IV Hydrocorticosterone 100mg. The
drug has been reported to be a naturally occurring glucocorticoid that possesses excellent properties to deal with adrenocortical deficiency
syndrome (Siddiqui et al., 2013). It helps in the modification of the immune response in association to a broad range of stimuli and thus
enhances the metabolic effect. However, this drug has similar side-effects that has been mentioned for the other two drugs. Hence, particular
attention would be paid to the condition of the patient and accordingly intervention strategies would be reformed to deal with the side-effects
(Wark et al., 2013). Also the condition of the patient would be evaluated on the basis of critical observation.

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References:
Ayala, G. X., Gillette, C., Williams, D., Davis, S., Yeatts, K. B., Carpenter, D. M., & Sleath, B. (2014). A prospective examination of asthma
symptom monitoring: provider, caregiver and pediatric patient influences on peak flow meter use. Journal of Asthma, 51(1), 84-90.DOI:
https://doi.org/10.3109/02770903.2013.838255
Castro, M., Zangrilli, J., Wechsler, M. E., Bateman, E. D., Brusselle, G. G., Bardin, P., ... & Korn, S. (2015). Reslizumab for inadequately
controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-
controlled, phase 3 trials. The Lancet Respiratory Medicine, 3(5), 355-366. DOI: https://doi.org/10.1016/S2213-2600(15)00042-9
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P. (2013). International ERS/ATS guidelines on
definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013. Retrieved from:
https://patients.thoracic.org/statements/resources/allergy-asthma/severe-asthma-full.pdf
Gadomski, A. M., & Scribani, M. B. (2014). Bronchodilators for bronchiolitis. Cochrane database of systematic reviews, (6). DOI:
10.1002/14651858.CD001266.pub4
Garcia-Cardenas, V., Armour, C., Benrimoj, S. I., Martinez-Martinez, F., Rotta, I., & Fernandez-Llimos, F. (2015). Pharmacists' interventions on
clinical asthma outcomes: a systematic review. European Respiratory Journal, ERJ-01497. DOI: 10.1183/13993003.01497-2015
Griffiths, B., & Ducharme, F. M. (2013). Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma
in children. Paediatric respiratory reviews, 14(4), 234-235.DOI: https://doi.org/10.1016/j.prrv.2013.08.002

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Koch, S., MacInnis, M. J., Sporer, B. C., Rupert, J. L., & Koehle, M. S. (2013). Inhaled salbutamol does not affect athletic performance in
asthmatic and non-asthmatic cyclists. Br J Sports Med, bjsports-2013. DOI: http://dx.doi.org/10.1136/bjsports-2013-092706
Olsson, L. E., Jakobsson Ung, E., Swedberg, K., & Ekman, I. (2013). Efficacy of person‐centred care as an intervention in controlled trials–a
systematic review. Journal of clinical nursing, 22(3-4), 456-465. DOI: https://doi.org/10.1111/jocn.12039
Ritz, T., Meuret, A. E., Trueba, A. F., Fritzsche, A., & von Leupoldt, A. (2013). Psychosocial factors and behavioral medicine interventions in
asthma. Journal of Consulting and Clinical psychology, 81(2), 231. Retrieved from: http://psycnet.apa.org/buy/2012-26671-001
Shan, Z., Rong, Y., Yang, W., Wang, D., Yao, P., Xie, J., & Liu, L. (2013). Intravenous and nebulized magnesium sulfate for treating acute
asthma in adults and children: a systematic review and meta-analysis. Respiratory medicine, 107(3), 321-330.doi:
https://doi.org/10.1016/j.rmed.2012.12.001
Siddiqui, S., Redhu, N. S., Ojo, O. O., Liu, B., Irechukwu, N., Billington, C., ... & Moir, L. M. (2013). Emerging airway smooth muscle targets
to treat asthma. Pulmonary pharmacology & therapeutics, 26(1), 132-144.DOI: https://doi.org/10.1016/j.pupt.2012.08.008
Wark, P. A., Tooze, M., Powell, H., & Parsons, K. (2013). Viral and bacterial infection in acute asthma and chronic obstructive pulmonary
disease increases the risk of readmission. Respirology, 18(6), 996-1002.DOI: https://doi.org/10.1111/resp.12099