Asthma: Pathophysiology, Clinical Manifestations, and Management

This presentation provides an overview of asthma, including its pathophysiology, clinical manifestations, and management. It discusses the role of inhaled corticosteroids in treating asthma and explains the pharmacokinetics of these medications. The presentation aims to enhance understanding of asthma and its treatment options.

Asthma
student’s Name
Institution Affiliation

Overview
Lucy Doe is a 39 year old female who owns and
works in a bakery, and is within a healthy weight
range. She does not regularly engage in physical
exercises and used to smoke in her early 20s. She
does not take alcohol. She lives with her daughter,
who occasionally helps her with some activities in
the bakery. She has one year asthma history and
experiences episodic symptoms such as wheeze,
breast shortness, cough, and edema. Her mother
and brother have been diagnosed with asthma.
She utilizes an inhaled long-acting bronchodilator
every day to manage her condition

Pathophysiology of Asthma
Asthma results from an immune response in bronchial
airways
Contraction of bronchial smooth muscles
(brochoconstriction) is a major pathological change
that occurs on respiratory tract during asthma attack
It is the prevailing physiological occurrence in asthma
It involves rapid airway narrowing and subsequent
interference of airflow
Brochoconstriction can be triggered by different
stimulus such as irritants and allergens (Reinhold &
Earl, 2014).
During asthma attack, inflamed airways react with
stimulus leading to narrowing of airways
Bronchoconstriction induced by allergens arises from
IgE-dependent production of nediators from mast cells
that cause contraction of airway smooth muscle
Non-steroidal inflammatory drugs, including aspirin,
can also cause acute airflow obstruction by triggering
a non-IgE dependent response (Reinhold & Earl,
2014).
When the different types of cells and mediators
interact an inflammation results in the airway followed
by airflow limitation (Reinhold & Earl, 2014).
As a consequence, smooth muscles tighten resulting in
recurrent episodes of coughs, shortness of breath, and
wheeze manifest as the clinical symptoms of asthma

Cough as a Clinical Manifestation of Asthma
Cough is a common clinical manifestation of asthma
Asthma triggers cough through
 stimulation of airways secretion,
 eosinophillic inflammation, and
 bronchial hyperactivity (Ali, Summer, & Levitzky, 2010)
airway narrowing from cellular infiltrates leads to limitation of airflow,
causing cough (Bonagura & Twedt, 2009) .
Constriction of smooth muscles also causes airway narrowing and cough
Stimulation of mechanoreceptors can also trigger cough.
 Since improper airway smooth muscle contraction is essentially
associated with inflammation, cough results.
For airway edema, it results from increased microvascular permeability
microvascular permeability is a consequence of released mediators
induced by allergens and irritants (Geiger-Bronsky & Wilson, 2008).
Thus, increased narrowing of airways increases capillary permeability,
an event that leads to edema of mucous membranes (Cooper & Gosnell,
2018)

Mechanism of Action of Inhaled Corticosteroid in
Management of Asthma
Inhaled corticosteroid is a common drug used in
the management of asthma.
These medications suppress inflammation
primarily by inhibiting synthesis of genes
They function by turning off the numerous
inflammatory genes activated
They do this by repealing and overturning
acetylation of histone through conscription of
histone deacetylase 2 (Barnes, 2010).
As a consequence, synthesis of the genes is
prohibited
More precisely, when the corticosteroid goes
through the cell cytoplasm it combines with the
inactive glucocortid receptor complex (Ye, He, &
d’Urzo, 2017).
As a result, the activated glucocorticod receptor
combines with DNA leading to transactivation
and thus promotion of production of anti-
inflammatory proteins (Raissy, et al. 2013).
Transcription and production of numerous pro-
inflammatory cytokines is prohibited
(tranrepression)
When airway inflammation is suppressed, inhaled
corticosteroids are able to alleviate
hyperesponsiveness
As a result, asthma symptoms are controlled

Pharmacokinetics of Inhaled Corticosteroids
The anti-inflammatory impacts of inhaled
corticosteroids are primarily topical at the deposition
location in the airways , but it can act systemically if it
is swallowed
The aim of inhaled corticosteroid therapy is to
accomplish maximum anti-inflammatory impacts in the
vicinity of the airway mucosa with little or no
redundant local and systemic effects (Ye, He, &
D’Urzo, 2017).
The portion of the drug that reaches systemic
circulation undergoes absorption from the airway,
surface of alveolar, and gut following swallowing of
oropharyngeal deposits (Ye, He, & D’Urzo, 2017). .
The ideal characteristics of an inhaled corticosteroid
that offers a high therapeutic index include
• High serum protein binding levels for the portion that is
systemically absorbed
• High affinity for the glucocortid response
• Protracted retention in the lungs
• Fast and absolute system inactivation, and
• Little or no bioavailability
To ensure that Lucy’s condition is appropriately
managed she must take the inhaled corticosteroids as
directed by her doctor even when the symptoms of
asthma are not manifesting, when she is feeling well.
Doing so will help prevent occurrence of asthma flare
up or protect against worsening of symptoms
Also, the patient should ensure that the inhalers are
rinsed with water after every inhaled steroids’ dose.

References
Ali, J., Summer, W. R., & Levitzky, M. G. (2010). Pulmonary pathophysiology: A
clinical approach. New York: McGraw-Hill Medical.
Barnes P. J. (2010). Inhaled Corticosteroids. Pharmaceuticals (Basel,
Switzerland), 3(3), 514–540.
Bonagura, J. D., & Twedt, D. C. (2009). Kirk's Current Veterinary Therapy XIV - E-
Book.
Cooper, K., & Gosnell, K. (2018). Adult health nursing. Amsterdam : Elsevier
Geiger-Bronsky, M., & Wilson, D. J. (2008). Respiratory nursing: A core
curriculum. New York: Springer Pub.
Raissy, H.H., Kelly, W.H., Harkins, M., & Szefler, S. (2013). Inhaled corticosteroids
in lung diseases. American Journal of Respiratory and Critical Care Medicine.
187(8).
Reinhold, J. A., & Earl, G. (2014). Clinical therapeutics primer: Link to the
evidence for the ambulatory care pharmacist. Burlington, MA: Jones & Bartlett
Learning. Retrieved from
https://books.google.co.ke/books/about/Clinical_Therapeutics_Primer.html?id=Yze
ak_jixTcC&printsec=frontcover&source=kp_read_button&redir_esc=y#v=onepa
ge&q&f=false
Ye, Q., He, X. & D’Urzo, A. (2017). A review on the safety and efficacy of inhaled
corticosteroids in the management of Asthma. Pulmonary Therapy. 3(1), 1-18.
Retrieved from https://link.springer.com/article/10.1007/s41030-017-0043-5