Understanding Allergic Asthma: Pathophysiology, Treatment and Education

This paper discusses a patient case study of a 6-year-old girl with allergic asthma. It identifies the type of asthma, its pathophysiology and treatment in the Australian perspective. It also discusses the standard asthma management education for parents and children. The paper highlights the types of asthma, treatment options and standard asthma management education.

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Students name
Institutional affiliation

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Introduction
The current paper is a discussion of a patient case study with a view of understanding the
clinical scenario offered. The case study is that of Tegan Smith, a 6-year-old girl with asthma. In
the context of the case, the type of asthma will be identified, and its pathophysiology and
treatment highlighted in the Australian perspective. Lastly, the Australian standards of asthma
management education for parents and children will be discussed.
Type of asthma presented.
The types of asthma include allergic asthma, late-onset non-allergic asthma, cough
variant asthma, occupational asthma, exercise-induced asthma, and nocturnal asthma (Mukherjee
& Zhang, 2011). This is due to the different presentations and causes of asthma in different
individuals. Tegan Smith has allergic asthma. This is because; 1) Her asthma is an early onset
asthma which is usually due to allergy. She developed symptoms at 6 years of age (Guibas,
Mathioudakis, Tsoumani, & Tsabouri, 2017). 2) Her asthma attack is accompanied by some
allergic signs and symptoms. In addition to the common symptoms of a cough and wheezing,
Tegan had allergic symptoms including watery eyes, postnasal drainage and an allergy like
prodrome. This ties in with allergic asthma being linked to other allergic conditions including
allergic rhinitis that gives post nasal drainage and allergic conjunctivitis that manifests as watery
eyes (Van Aalderen, 2012). 3) There is a familial history of atopy. Atopy, which is a genetic
predisposition to allergy, is hereditary. Following the history that shows Tegan’s mother having
allergy, sinusitis and nasal polyps, it is plausible to say she inherited the atopy. 4) The disease is
triggered by environmental allergens including pollen, foods, animal dander or dust just to
mention a few (Janssens & Ritz, 2013). This corresponds to Tegan and his family moving to

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Mount Buller Alpine resort prior to the symptoms starting. This being a highland area is teaming
with environmental allergens including pollen.
Pathophysiology of allergic asthma
Asthma is a chronic condition characterized by airway hyperresponsiveness to allergens,
bronchoconstriction, acute and chronic inflammation and airway remodeling (Kumar, Abbas &
Aster, 2015). There is an interplay between genetics shown by atopy and environmental factors
shown by environmental triggers. The initial event is exposure to the allergen or trigger leading
to Th2 immune response with production of IgE antibodies (Kumar, Abbas & Aster, 2015). On
repeated exposure crosslinking of IgE leads to mast cell degranulation with release of cytokines
(Bonsignore et al, 2015). This is the reason for the hyperresponsiveness to various stimuli. The
release of inflammatory mediators leads to two phases of reactions, an early phase, and a late
phase. During the early phase, there is bronchoconstriction, mucosal hyperstimulation leading to
overproduction of mucus and vasodilation (Kumar, Abbas & Aster, 2015). The early phase
reaction is due to mast cell degranulation with release of mediators including histamine.
Bronchoconstriction is due to direct influence of the mediators on vagal receptors. The late phase
is due to recruitment of neutrophils, eosinophils and more T cells (Bonsignore et al, 2015. There
are repeated episodes of inflammation leading to changes in the bronchial smooth muscle termed
airway remodeling. It involves deposition of collagen, hypertrophy of smooth muscle in the
bronchial walls and increased glands (Kumar, Abbas & Aster, 2015). This process is what
underlies the presentation of asthma with a cough due to increased mucus production, wheezing
due to bronchoconstriction and airflow obstruction (Lødrup & Pijnenburg, 2015).

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Treatment options for asthma
The treatment of asthma involves the use of medications, lifestyle modifications and
control of risk factors including avoidance of triggers (Queensland Health, 2015). The initial
intervention is an assessment of the pattern of symptoms in order to stratify the severity of
asthma (National Asthma Control Council of Australia, 2018). In Tegan’s case, this is her initial
diagnosis and no prior records of asthma control are available. Monitoring after prescription of
drugs will help in this regard.
The initial treatment requires the prescription of a reliever that is taken in case of a flare
up and a controller that is taken daily as a preventive measure (National Asthma Control Council
of Australia, 2018). This is coupled with education to parents and the child that these
medications are to make sure the disease does not interfere with the daily activities of the child.
Recommended relievers include salbutamol 2 -4 puffs (100 mcg per puff) via a pressurized
metered dose inhaler or terbutaline for children over 6 years, 1-2 puffs (500 mcg per puff) via a
breath- actuated powder inhaler (National Asthma Control Council of Australia, 2018). The
choice of using a controller depends on the severity of asthma. In infrequent intermittent asthma,
a controller is not needed and control of risk factors alone and treatment of acute attacks is
enough. In frequent to severe asthma, however, controllers are needed. They should include an
inhaled corticosteroid, Montelukast, and sodium cromoglycate (National Asthma Control
Council of Australia, 2018). The pattern of treatment is stepwise, increasing doses if the
medication does not work or gradually reducing doses if good control is achieved (National
Asthma Control Council of Australia, 2018).
Standard asthma management education.

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According to the National Asthma Control Council of Australia, (2018), the
recommended education for parents and children involves information on asthma, explaining that
it is a chronic condition, the causes, severity, warning signs of an impending asthmatic attack and
triggers of asthma. The medications are explained as relievers that help during an attack or
before attacks are imminent, controllers help prevent the attacks and should be used regularly.
The side effects and alternative choices of the inhaled corticosteroids should be explained. The
next piece is education on inhaler devices. The parents and child should be taught how to use a
puffer and spacer or any other inhaler device properly. The education should be via
demonstration with the parents and child repeating the process to evaluate the outcome of
teaching. Also, in this regard, the cleaning and care of inhalers are taught. The final issue is to
provide a written action plan for them and for any institution the child is in including school and
explain to them how to use it. A written action plan makes it easier to follow management goals
set and includes a list of medications and actions to take in several scenarios (National Asthma
Control Council of Australia, 2018).
Conclusion
In conclusion, Tegan has allergic asthma due to his presentation and family history of
atopy. Allergic asthma is a chronic condition that is characterized by airway hyperresponsiveness
to allergens, bronchoconstriction, acute and chronic inflammation and airway remodeling leading
to symptoms of wheezing, cough, associated allergic rhinitis, allergic conjunctivitis, and eczema.
The treatment options for asthma include reliever and controller medication coupled with
avoidance of triggers and reduction of risk factors. A standard asthma education is given before
discharged to help in self-management of asthma by the parents and child.

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