Impact of Severe Eosinophilic Asthma Population

The provided content discusses various aspects of severe eosinophilic asthma. It highlights case reports, studies, and reviews that explore different topics such as hospital length of stay in children and adults with asthma exacerbation, caregiver's functional status during a young child's asthma exacerbation, and the impact of self-identified race and genetic ancestry on airway inflammation in asthma. The content also includes articles that discuss the pathophysiology of asthma, acute exacerbations of asthma, and different types of asthma, including severe eosinophilic asthma. Overall, the provided content provides insights into various aspects of severe eosinophilic asthma, its diagnosis, treatment, and management.

The Relevant
Pathophysiology of Acute
Exacerbation of Asthma

TABLE OF CONTENTS
Introduction .....................................................................................................................................3
What is asthma and relate this to the patient and the scenario. ...................................................3
What is an acute exacerbation of asthma?...................................................................................3
what are the different types of asthma, relate this to the clinical observations and the patient 4
Which does the patient have and why: relate to the scenario......................................................5
Pathophysiology of asthma..........................................................................................................5
Signs and symptoms of Acute Exacerbation of Asthma.............................................................6
What is the nurses role?...............................................................................................................6
Conclusion.......................................................................................................................................7
REFERENCE...................................................................................................................................8
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INTRODUCTION
Asthma is the most common chronic disease that is described as an inflammation of
pulmonary airways and complex bronchial hyper-responsiveness that leads to clinical expression
of lower airway obstruction which is reversible (Casale and et. al., 2015). The present report
features Part A which includes Asthma and Pathophysiology of the acute exacerbation of the
chronic disease in the given scenario. In addition to this, it presents various signs, symptoms and
forms of Asthma and its clinical observation. Besides this, it also features critical discussion over
role of nurses in assessing patient with acute exacerbation of asthma.
What is asthma and relate this to the patient and the scenario.
Asthma can be defined as a common chronic disease of pulmonary airways that is
complicated and characterized by airflow obstruction, bronchial hyper-responsiveness,
inflammation and recurrence of symptoms. The chronic respiratory disease affected around 300
million people in the world. In terms of physiology, it can be classified as variable and reversible
obstruction to bronchial airflow. In terms of pathology, it can be explained as overdeveloped
mucous glands thickening of airway due to inflammation and narrowing pulmonary airways in
lungs due to rigidity of surrounding smooth muscles (Fireman, 2003). During asthma, the
patient's airways get swollen up and react with external environmental allergens such as dust,
pollen and smoke. As a result, the narrowed airways produce excess mucus which makes the
breathing process difficult for the patient. The airways of asthma patient are highly sensitive to
certain allergens or stimuli. The examples of allergens that are inhaled by patient include grass
pollen, pests, dust mites, mold pores, organic compounds found in perfumes, etc. In response to
these stimuli, there is contraction in large airways resulting into asthmatic attack which is
followed by inflammation. This further leads to narrowing of airways and excess mucous
production that consequently cause coughing and breathing becomes difficult for the affected
patient.
What is an acute exacerbation of asthma?
Asthma Exacerbation can be defined as an acute episode of progressive symptoms of the
chronic disorder which includes shortness of breath, cough, wheezing and chest tightness among
affected asthmatic patients according to National Asthma Education and Prevention Guidelines,
UK (Dougherty and Fahy, 2009). Respiratory viruses such as rhino-virus are the major causal
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agent of acute asthma exacerbation in children and adults. The rhino-virus infects the epithelial
cells of airways which lead to release of pro-inflammatory cytokines and chemokines along with
employment of inflammatory cells including neutophiles and eosinophils. The body of patient
responses against viral infection that is likely to affect the susceptibility of acute asthma
exacerbation. The episodes are very stressful for patients and results into absenteeism from work
and school. Females are more affected with asthma exacerbation as compared to their male
counterparts (Hasegawa and et.al., 2015). The prevalence of acute asthma exacerbation is higher
in adult females and male children. It has been observed that it is due to the sex hormone called
estrogen in females which is likely to complicate the chronic condition during menses. The risk
of asthma exacerbation is also influenced by race and ethnicity. It has been observed that
African- Americans are at higher risk of acute asthma exacerbation as compared to Caucasians.
What are the different types of asthma, relate this to the clinical observations and the patient
There are various types of Asthma are described in the following points: Allergic Asthma: This Asthma is induced by certain allergens such as pollen, mold
spores, dust mites, pests, cockroaches and epithelial cells of pets. In addition to this,
chronic condition is also induced by food allergens such as casein present in milk or
cheese, yeast, gluten and sugar. In response to these allergens, patient body releases
histamines that cause symptoms of asthmatic allergy. Physicians often prescribe
medication to control allergies and cure allergic asthma in the affected patient. Non Allergic Asthma: This type causes asthma among patient which is not triggered by
allergens but upper respiratory infection is caused by rhino-viruses and cold. The patient
is prescribed with short course of inhaled corticosteroids for certain period once the
symptoms of cold appear to cure asthmatic attack. Cough Variant Asthma: It is one of the most difficult types of asthma to diagnosis and is
often characterized by dry hacking cough. It equally affects both adults and children. In
this type of Asthma, coughing occur alone without the presence of other asthmatic
symptoms (Nelson, 2013). Coughing can happen at any time of the day and disturbs sleep
during night. Patients are recommended to inhale corticosteroids to control cough variant
asthma.
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 Occupational Asthma: It is a type of asthma that is caused by workplace stimuli that
leads to asthma attack in patients. This is induced by smoke or inhaled triggers such as
chlorine, fumes, chemicals and vapors. Common occupations that set occupational
asthma are painters, woodworkers, nurses, animal breeders and hairdressers. Exercise Induced Asthma: This type of asthma is triggered by any form of exercise,
physical exertion or sports leading to coughing, wheezing and problematic breathing in
affected person. The condition improves when the person stops physical exertion. The
treatment of exercise induced asthma includes inhaled bronchodilator medication before
exercise to prevent its symptoms.
 Nocturnal Asthma: Nocturnal or nighttime asthma usually occur during midnight and
early morning. The symptoms of nocturnal asthma include cough, wheezing and
breathing problem during nighttime. The symptoms are also common in those patients
with daytime asthma. It has been studied that majority of asthmatic deaths occur during
night.
Which does the patient have and why: relate to the scenario
In the given scenario, the patient suffers from acute asthma exacerbation which is
referred to exaggerated lower airway response to environmental exposure. Severe asthma
exacerbation is caused by respiratory virus infection that is the most common form of
environmental exposure. The causal agent of asthma exacerbation is rhinovirus which causes
airway inflammation followed by airflow obstruction and elevated bronchial responsiveness.
Pathophysiology of asthma
Pathophysiology of Asthma can be understood as a chronic disorder of upper respiratory
tract that include inflammation of airways and bronchial hyper-responsiveness that leads to
clinical expression of obstruction of lower airway. The obstruction is usually reversible. In terms
of physiology bronchial hyper-responsiveness is elaborated as decreased bronchial airflow due to
release of histamines (Fireman, 2003).Other factors that triggers airway obstruction are cold air,
viral respiratory infection, cigarette smoke and natural allergens such as mold spores, dust mites
and pet dander. Bronchial provocation due to allergens induces decrease in bronchial flow due to
early phase of Immunoglobulin E (IgE) mediation. The pathology of asthmatic airways shows
hyperinflation of lungs, hypersecretion of mucus gland, mucosal edema and hypertrophy of
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smooth muscles and disruption of cilia cells. In microscopic terms, Asthma is characterized by
the presence of elevated number of lymphocytes, eosinophils, neutrophils and plasma cells in
tissues of bronchi. Initially, during the onset of the chronic disease, the body recruits leukocytes
from the blood to the airway with the help of activated CD4 T- lymphocytes. These activated T
lymphocytes encourages the release of inflammatory mediators from mast cells, eosiphils and
lymphocytes (Dougherty and Fahy, 2009). The activated eosinophils and mast cells help in
generation of cytokines that further help to perpetuate airway inflation. The repeated cycles of
lung inflammation and injury to pulmonary tissues followed by repair causes long term structural
changes in the airways of affected person.
Signs and symptoms of Acute Exacerbation of Asthma
Signs of Acute Exacerbation of asthma include the following signs:
 The patient may appear pink.
 Agitation (O'Byrnen and Tworek, 2015).
 Serious sign include Cyanosis.
 Respiratory rate is elevated
 Increased pulse rate
 Decreased lung functions
Symptoms of Acute Exacerbation of asthma are as follows:
 Coughing
 Shortness of breath
 rapid breathing
 Severe wheezing
 Feeling of Restlessness and anxiety
 Tightened chest muscles
 Pale or sweaty face (Nair, Pinto, Hirebile, and Maroli, 2015).
 Blue lips or nails
 Trouble sleeping due to constant coughing
What is the nurse’s role?
Nurses play very important role in assessment and management of acute exacerbation of
asthmatic patients. Severe exacerbation of asthma is potentially life threatening therefore it
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requires effective care and proper observation and prompt treatment to control the severity of the
chronic condition. Nurses play crucial role by acting as front line caregivers to asthmatic
patients. They help in assessment, treatment and effective management of acute exacerbation of
asthma. They also play vital role in implementation of guidelines set by National Asthma
Education and Prevention Program to help patients to manage and control their cute asthma
(Rance, 2011).In addition to this, nurses identify patients who are at major risk of chronic disease
and provide effective care and support to control and treat acute asthma exacerbation in the
guidance of specialist physicians.
CONCLUSION
In a nutshell, asthma is the most common chronic respiratory disorder that affects
majority of people all over the world. The report gives a clear understanding of the acute
exacerbation of asthma including its signs and symptoms. In addition to this, it briefly describes
the pathophysiology of the asthma exacerbation. Apart from this, it has been learned that nurses
play very crucial role in assessment, control and management of acute asthmatic exacerbation.
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REFERENCE
Books and Journals
Casale, T.B. And et. al., 2015. Estimated Asthma Exacerbation Reduction from Omalizumab in
an Severe Eosinophilic Asthma Population.Journal of Allergy and Clinical Immunology.
135(2). pp.AB1.
Galasso, T. and et.al., 2015. Severe obstructive pattern mimicking an asthma exacerbation as
first presentation of crack smoking: A case report. Case Reports in Internal Medicine. 2(2).
p.p60.
Hasegawa, K. and et.al., 2015. Sex differences in hospital length of stay in children and adults
hospitalized for asthma exacerbation. Annals of allergy, asthma & immunology: official
publication of the American College of Allergy, Asthma, & Immunology. 115(6). p.533.
Hasegawa, K. and et.al., 2015. Children and Adults With Frequent Hospitalizations for Asthma
Exacerbation, 2012-2013: A Multicenter Observational Study. The Journal of Allergy and
Clinical Immunology: In Practice.
Jensen, M.E. And et.al., 2015. Caregiver's functional status during a young child's asthma
exacerbation: A validated instrument. Journal of Allergy and Clinical Immunology.
Moreno‐Valencia and et.al., 2015. Detection and characterization of respiratory viruses causing
acute respiratory illness and asthma exacerbation in children during three different seasons
(2011–2014) in Mexico City.Influenza and other respiratory viruses. 9(6). pp.287-292.
Nair, S.M., Pinto, V., Hirebile, V.K. and Maroli, R., 2015. Spontaneous pneumomediastinum
and subcutaneous emphysema in asthma exacerbation: An unusual presentation.Saudi
Journal of Medicine and Medical Sciences. 3(1). pp.58.
Nyenhuis, S.M. And et.al., 2015. Impact of Self-Identified Race and Genetic Ancestry on
Airway Inflammation in Asthma. Journal of Allergy and Clinical Immunology. 135(2).
pp.AB86.
O'Byrne, P.M. and Tworek, D., 2015. Timing is everything: Targeting IgE to reduce asthma
exacerbation risk. The Journal of allergy and clinical immunology. 136(6). pp.1486.
Online
Rance, K.S., 2011. Helping patients attain and maintain asthma control: reviewing the role of
the nurse practitioner. [Online] Available through:
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155860/>. [Accessed on 5th January 2016].
Fireman, P., 2003. Understanding asthma pathophysiology. [Online]. Available through:
<http://www.ncbi.nlm.nih.gov/pubmed/12776439>. [Accessed on 5th January 2016].
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Dougherty R.H. And Fahy J.V., 2009. Acute Exacerbations of Asthma: Epidemiology, Biology
and the Exacerbation-Prone Phenotype. [Online]. Available through:
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730743/>. [Accessed on 5th January 2016].
Nelson, J., 2013. 6 types of asthma and how they're treated. [Online]. Available
through:<http://www.mnn.com/health/allergies/stories/6-types-of-asthma-and-how-theyre-
treated>. [Accessed on 5th January 2016].
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