Acute Severe Asthma: Pathogenesis, Diagnosis, and Treatment

This article discusses acute severe asthma, its pathogenesis, diagnosis, and treatment. It also covers nursing strategies and drugs used to manage the condition. The article provides valuable information for students and professionals in the healthcare field. Course code, course name, and college/university are not mentioned.

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Asthma Patient
Student

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Acute severe asthma
Question 1
Acute severe asthma is also called status asthmaticus which is defined as the acutely
arising aggregation of an attack of asthma that is not treated with the use of bronchodilaitons
therapy and other conventional treatments. It can be caused by various factors like respiratory
infections, cold weather, severe allergic reactions, and smoking, exposure to chemicals and
other irritants, and air pollution. Some of the symptoms associated with this health condition
include wheezing sounds or reduced sounds during the auscultations, pulse rate exceeds form
120 bpm, more than 30 beats/ minute, pulses paradoxus, use of accessory muscle to breath,
and refusal to decline below the angle of thirty degrees (Powell, s2016). Mr Jackson had the
similar manifestation like severe dyspnoea, respiratory rate of 32 bpm, SppO2 of 90 % on the
room temperature, blood pressure was 150/85 mmHg, Auscultation of lungs revealed
diminished breath sounds and whispered wheezing, and inability to speak a full sentence in a
single breath. Some of the other symptoms associated with this health condition include
difficulty in breathing, heavy sweating, trouble in speaking, fatigue, weakness, abdominal,
back or neck muscle pain, panic or confusion, blue-tinted lip and skin, and loss of
consciousness. The manifestations are associated with the pathogenesis of the acute severe
asthma.
Asthma is the health condition that impacts the airways and the respiratory tract. Most
commonly it triggers by the allergen reactions and further controlled by the secretion of the
cytokines and other cellular molecules. It commonly describes as the disease characterized by
the chronic variable inflammation of the airways and obstruction of airways. During the event
of acute excavation of asthma the airways inflammation and obstruction gets worse. And
further become life-threatening. Sample taken from the patients died due to acute severe

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asthma generally provides evidence of the presence of Mast cells, eosinophil’s, and
neutrophils (Castillo, Peters, & Busse, 2017). The pathogenesis of the life-threatening
disorder includes six different mechanisms that are airways affected by asthma, epithelial
damage, mucus hyper secretion, oedema, bronchospasm, and remodelling of airways. Asthma
can affect the airways of the human body in different ways. It can affect the trachea, the
bronchioles which form a part of the lower respiratory tract. The health condition may lead to
bronchoconstriction or impaired narrowing of the airways due to the epithelial damage,
oedema, over secretion of mucus, muscle damage and bronchospasm (Teodorescu et al.,
2015). Epithelial damage is the other mechanism that impacts the pats of respiratory tracts. In
asthma, the layer of the cells that make built the airways (epithelium) are damaged and peel
away from the area they present. The epithelium shedding may contribute to hyper
responsiveness of the airways via several mays such as loss of the barrier function that
restrict the allergen entry, enzymes that break down the inflammatory mediators, and the
exposure of the sensory nerves that may result in reflex neural effects on the airways. Mucus
hyper secretion may also contribute to the pathophysiology of acute severe asthma which is
caused during the asthma disease. Asthma caused mucus-producing cells present in the
airways to proliferate and multiply and the mucus gland to expand. The mucus viscid lugs
have been formed by the increased secretion of mucus that occludes the human airways. In
oedema, the capillaries of the airways walls may dilate and leak. The result of micro vascular
leakage includes elevation of airway secretion, improper mucociliary clearance, and oedema.
This may further lead to causing hyper responsiveness and narrowing of the airways
((Teodorescu et al., 2015). Bronchospasm can also be characterized as the contributing factor
to asthma. It can be described as the sharp contraction of the bronchial soft muscles which
caused narrowing of airways. Airways remodelling can be caused by poorly controlled or
undertreated stratus asthmaticus, alteration in the structure of cells and tissues that may lead

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to remodelling of the airways, and further cause permanent damage of fibrosis (Castillo,
Peters, & Busse, 2017).
Acute severe asthma can be diagnosed by various techniques including
electrocardiogram, Arterial blood gas analysis, and the peak expiratory flow and spirometer.
Diagnosis of status asthmaticus by electrocardiogram is a common strategy which is used
worldwide to relate the symptoms of the disorder. Electrocardiogram can diagnose the signs
of strain on the right side of the heart. Mr Jackson has been diagnosed by using Arterial blood
gas analysis method. This method is also used for patients with breathlessness and
unconsciousness (Lefebvre et al., 2015)
Question 2
In the case of Mr Jackson two different high priority nursing strategies that should be
applied are Oxygen therapy and patient assessment. Patient assessment is the strategy that is
beneficial to observe any negative side effects of medication and complication occurs during
the hospital stay. Therefore this strategy should be included in the priority of nurses. The
assessment includes observing any complication before and after the administration of
medicine, checking the equipment's being used to provide oxygen to the patient, analysing
vital signs of the patient such as temperature, breathing, pulse rate, blood pressure,
respiratory rate, oxygen saturation at regular time intervals. A nurse should assess the patient
for the position. The position of the patient should be same as they physiotherapist advised to
follow. The positioning of the patient also contributes to reducing the issues of breathing.
The nursing assessment in the emergency department should be the priority to achieve the
health goals set for the patient.
Lack of oxygen transport may lead to death in the patient with acute severe asthmas.
As mentioned in the case scenario Mr Jackson has been admitted to ICU due to severe

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asthmatic issues including breathing problem. Therefore oxygen therapy can be applied to
achieve good oxygen transport for the patient. The target oxygen saturation in case of Mr
Jackson should be more than 90 %. The oxygen can be supplied by nasal cannula at 2 to 6
litres per minute. The oxygen pressures need to be monitored with the help of types of
equipment like the nasal prong, Hudson mask, and venturi mask with concentration (Frat et
al., 2015).
Question 3
Mr Jackson has been prescribed with three different drugs to improve the health
problems associated with acute severe asthma such as nebulized salbutamol, ipratropium
bromide, and IV hydrocortisone 100 mg. Nebulised salbutamol is used to mediate
bronchodilation by stimulating the β2 receptions present in the soft muscle of the airways of
the respiratory tract. The choice of delivery should be on the basis of choice of the patient.
The side effects of this drug include tachycardia, hypokalaemia, arrhythmias, and perfusion
mismatch worsening (Inayat, Shah, Rahu, & Sahito, 2017). The nurse should assess the
patient for any complication and stop the medication if any complication observed.
Ipratropium bromide is the agent that used to block the muscarinic receptors of the
acetylcholine and affecting the cholinergic nerves that lead to airway dilation by relaxing the
associated muscles. It controls the excavation of asthma, improves lung function and forms
higher bronchodilator that other medicines. The side effects of this drug include dry mouth,
cough, chills, and fever. Nurses should observe this complication and stop the administration
before worsening of the complication. Intravenous hydrocortisone has also been administered
to Mr. Jackson, which are the corticosteroids used to manage the status asthmaticus. It
reduces the inflammation issues by relaxing the muscles of airways. Side effects may arise
are sleeplessness, nausea, weight gain, and increased sweating. The symposiums can be

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observed by the nurse and should be reported to the physician immediately after stopping the
drug administration (Inayat, Shah, Rahu, & Sahito, 2017).

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References
Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma exacerbations: pathogenesis,
prevention, and treatment. The Journal of Allergy and Clinical Immunology: In
Practice, 5(4), 918-927.
Frat, J. P., Thille, A. W., Mercat, A., Girault, C., Ragot, S., Perbet, S., ... & Devaquet, J.
(2015). High-flow oxygen through the nasal cannula in acute hypoxemic respiratory
failure. New England Journal of Medicine, 372(23), 2185-2196.
Inayat, N., Shah, R. H., Rahu, Q. A., & Sahito, R. (2017). Nebulized Salbutamol with and
without Ipratropium Bromide in the treatment of acute Severe Asthma. Pakistan
Journal of Chest Medicine, 22(3), 102-6.
Lefebvre, P., Duh, M. S., Lafeuille, M. H., Gozalo, L., Desai, U., Robitaille, M. N., ... & Lin,
X. (2015). Acute and chronic systemic corticosteroid–related complications in
patients with severe asthma. Journal of Allergy and Clinical Immunology, 136(6),
1488-1495.
Powell, C. V. (2016). Acute severe asthma. Journal of pediatrics and child health, 52(2),
187-191.
Teodorescu, M., Broytman, O., Curran-Everett, D., Sorkness, R. L., Crisafi, G., Bleecker, E.
R., ... & Investigators, S. A. R. P. S. (2015). Obstructive sleep apnea risk, asthma
burden, and lower airway inflammation in adults in the Severe Asthma Research
Program (SARP) II. The Journal of Allergy and Clinical Immunology: In
Practice, 3(4), 566-575.