Asthma: Pathogenesis, Clinical Manifestations, and Treatment

This document provides an explanation of the pathogenesis of asthma and the clinical manifestations it presents. It discusses the role of inflammation, airway hyperresponsiveness, and airway remodeling in asthma. The document also covers the treatment options for asthma, including the use of medications like Salbutamol, Hydrocortisone, and Ipratropium Bromide. It includes nursing considerations and expected clinical responses to these medications.

ASTHMA

TABLE OF CONTENTS
Question 1..................................................................................................................................1
Explanation of Pathogenesis that is causing the clinical manifestations with which Poppy
presents...................................................................................................................................1
Question 2..................................................................................................................................1
1. Sit Poppy in a High Fowlers position................................................................................1
2. Apply and titrate oxygen...................................................................................................2
Question 3..................................................................................................................................2
Salbutamol via nebulizer........................................................................................................2
Hydrocortisone IV..................................................................................................................3
Ipratropium Bromide via nebuliser........................................................................................3
REREFENCES...........................................................................................................................4

Question 1
Explanation of Pathogenesis that is causing the clinical manifestations with which Poppy
presents
Asthma is one of those diseases in which a person’s airways becomes inflamed, swelled, narrow
produce extra mucus which makes it difficult to breath (Petsky, Kew & Chang, 2016). This
disease is mostly found in children. Acute asthma is an exaggerated response to numerous
endogenous and exogenous stimuli. It includes bronchial hyperresponsiveness, airways
inflammation and intermittent airflow obstruction (Bar‐Yoseph, Kugelman, Livnat, Gur, Hakim,
Nir & Bentur, 2017). Poppy was initially diagnosed with acute asthma at the age of two and
recently she was diagnosed with acute exacerbations of asthma. The inflammatory, physiologic,
and structural factors mainly contribute to the pathogenesis of asthma. Asthma is a inflammatory
disorder of airways in which many cells and cellular elements plays a vital and important role,
especially in mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial
cells. In most of the individuals this inflammation causes recurrent episodes of wheezing,
breathlessness, chest tightness, and coughing specifically in morning. This episode is usually
episode associated with widespread especially in airflow obstruction which is reversable either
with treatment or spontaneously. This inflammation also causes increase in the existing bronchial
hyperresponsiveness to a variety of stimuli.
In this condition variety of changes are observed in airway of a patient such as:
 One of the changes is known as Bronchoconstriction which is a kind of psychological event
in which airway of the patient get narrowed and subsequent interference with airflow.
 Airway remodelling is another condition in which airflow limitation is sometimes partially
reversable. In such condition permanent changes can occur within the body.
 When asthma becomes more persistent and airways inflammation becomes more progressive,
this is a case of Airway edema. In such condition there are various other factors because of
which airflow is limited.
 Airway hyperresponsiveness is one of the major situations or features of asthma in which
bronchoconstrictor response is exaggerated to variety of stimuli.
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Question 2
1. Sit Poppy in a High Fowlers position
How does positioning a patient with acute asthma in a High Fowlers position assist to
alleviate respiratory distress?
In case of acute asthma, position of a patient plays a vital role. It mainly comes into picture
when there is a requirement of bringing improvement within oxygenation of the patient (Reddel,
Lembke & Zwar, 2018). Positional strategies can be used for any kind of patients who are
suffering from any kind of respiratory disease. High Fowlers position can be quite supportive for
poppy as it will help her in breathing, support her airways make her feel comfortable encourage
her to relax as well as will also help in monitoring her vital signs and clinical status. This
position will also assist Poppy and her acute asthma and will also help the staff members to
ensure her safety and if healthcare professionals need to take an X-ray of her chest then it can be
taken by them at bed side. Other then this medical staff can also provide all kinds of effective
breathing treatment.
2. Apply and titrate oxygen
What kind of oxygen delivery device will be used and why?
High-flow oxygen device will be used for Poppy as it will help in providing her comfort
and will maintain oxygen concentration equivalent to poppy’s respiratory flow demand. In case
of acute asthma especially in children provide high flow of oxygen at desired concentration.
Regardless of the respiratory rate it helps in maintaining FiO2 level (Zöllner, 2019).
Ways in which providing supplemental oxygen work and reason because of which this will
assist Poppy
In case of poppy it will help in providing a support to her deteriorating respiratory functioning. It
will maintain oxygen supply as per the respiratory demand of Poppy. It is one of the best and
safest devices that can be used for children who are suffering from acute asthma.
Question 3
Salbutamol via nebulizer
Mechanism of action
Salbutamol shows its effect by relaxing smooth muscles of airways and increasing
airflow which further helps in relieving symptoms of acute asthma (Del Giudice, Indolfi,
Capasso, Maiello, Decimo & Ciprandi, 2017). When Salbutamol via nebulizer is provided to the
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patient then it begins effect within 10 to 15 minutes but its peak effect take place within 30
minutes. It also helps in increasing bronchial smooth muscle relaxation.
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
Poppy is receiving this medication because of her worsening respiratory functioning and
providing bronchospasm treatment for her acute asthma. It will help in easing her respiratory
condition so that she can breathe properly by relaxing her airways muscles and increasing her
airflow which will further help in providing her a relief over her acute asthma symptoms.
Nursing considerations for this medication
Like any other medicine Salbutamol has its own side effects as well. It is important for
nurses to be well aware of the amount of dose they are required to give to the patients especially
to children. Overdose of Salbutamol is never good as it increases the heart rate and overdose can
increase heart rate to an abnormal level which is dangerous. So, in order to reduce adverse effect
of Salbutamol, Poppy should be given adequate amount of Salbutamol, its overdose should be
avoided.
Clinical response you expect
If Salbutamol via nebulizer is provided in adequate amount then it can help the patient in
relaxing their bronchial smooth muscle with the help of which patient and her condition can be
stabilized easily, her condition can be improved and she can be discharged easily (Petsky, Kew
& Chang, 2016). If improvement within air inflammation condition is observed then and patient
is showing improvement then dose can be maintained but if current dose is not sufficient then
after observing current condition of the patient and her stabilization dose can be increased.
What continuing clinical observations will be required to be undertaken will be required to
be undertaken
While taking Salbutamol via nebulizer respiratory or breathing rate should be
continuously monitored and measured especially before increasing overall dose of the
Salbutamol.
Hydrocortisone IV
Mechanism of action
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Mechanism of action of Hydrocortisone is as a Corticosteroid Hormone Receptor
Agonist. It also helps in reducing vasodilation and permeability of capillaries. It also helps in
reducing leukocyte migration to sites of inflammation.
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
Poppy is receiving this medication because low corticosteroid levels have been diagnosed
in her body which are required for normal body functioning and are usually produced by body
(Bar‐Yoseph, Kugelman, Livnat, Gur, Hakim, Nir & Bentur, 2017). This medication is used for
the management of multiple sclerosis which cause improper functioning of nerves. Certain
condition of Kidney and lungs is also treated by this medication which is one of the reason
Poppy is receiving this medication.
Nursing considerations for this medication
` Some of the important consideration for nurses in this is that they should be well aware of
the immune system of the patient because this medication makes immune system les able to fight
infection. Sudden stopping taking of medication might result in some of the problems like low
blood pressure, vomiting, dizziness etc so nurses should take action accordingly.
Clinical response you expect
Use of this medication improves level of corticosteroid which is important for normal
body functioning. This also includes treatment for disorders of kidney and lungs which help in
treatment of asthma.
What continuing clinical observations will be required to be undertaken
While doing this patient is required to be monitored about the requirement of quantity
and along with that it is also required to ensure that medication does not stop suddenly this might
result in common to severe side effects.
Ipratropium Bromide via nebuliser
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
This is used to control and prevent symptoms which are caused by ongoing lung disease.
Asthma is also a lung disease and this is why it is used for Poppy (Zöllner, 2019).
Nursing considerations for this medication
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Mouth needs to be rinsed immediately after using the medication to prevent dry mouth
and throat irritation.
Clinical response you expect
This is used for quick relief from wheezing and sudden shortness of breath.
What continuing clinical observations will be required to be undertaken
More often use of this medication might seem to be not working well. This is why it
should be used when significantly required.
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REREFENCES
Books and journals
Reddel, H. K., Lembke, K., & Zwar, N. J. (2018). The cost of asthma medicines. Australian
prescriber. 41(2). 34.
Petsky, H. L., Kew, K. M., & Chang, A. B. (2016). Exhaled nitric oxide levels to guide treatment
for children with asthma. Cochrane Database of Systematic Reviews, (11).
Bar‐Yoseph, R., Kugelman, N., Livnat, G., Gur, M., Hakim, F., Nir, V., & Bentur, L. (2017).
Halotherapy as asthma treatment in children: A randomized, controlled, prospective
pilot study. Pediatric pulmonology. 52(5). 580-587.
Zöllner, E. W. (2019). Asthma treatment in children: A guide to screening for and management
of hypothalamic-pituitary-adrenal axis suppression. SAMJ: South African Medical
Journal. 109(5). 306-309.
Del Giudice, M. M., Indolfi, C., Capasso, M., Maiello, N., Decimo, F., & Ciprandi, G. (2017).
Bifidobacterium mixture (B longum BB536, B infantis M-63, B breve M-16V)
treatment in children with seasonal allergic rhinitis and intermittent asthma. Italian
journal of pediatrics. 43(1). 25.
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