Pediatric Asthma and Allergy Research

This assignment provides a detailed review of 14 academic articles related to pediatric asthma and allergy research. The papers cover topics such as severe childhood asthma, inflammation in pediatric asthma, airway remodeling in asthma, lactate and lactate dehydrogenase in transient tachypnea of the newborn, and more. Each article is summarized, providing a comprehensive understanding of the current research in this field.

Running head: CASE STUDY
Case study explaining the pathophysiology of asthma
Name of the Student
Name of the University
Author Note

1CASE STUDY
Table of Contents
Introduction......................................................................................................................................2
Discussion........................................................................................................................................2
Pathophysiology of the illness/disease........................................................................................2
Two signs/symptoms...................................................................................................................5
Conclusion.......................................................................................................................................7

2CASE STUDY
Introduction
Asthma refers to a chronic inflammatory disease that occurs in the airways and is a
common inflammatory disease that affects the airways of the lungs. This condition is primarily
characterized by recurring and variable symptoms such as, bronchospasm, reversible airflow
obstruction, chest tightness, coughing, and shortness of breath. These episodes are found to occur
several times per day or week. Depending on the physiological condition of the individual
suffering from it, these symptoms often worsen at specific time of the day (Bonini and Usmani
2015). Although, childhood asthma and wheezing are non-synonymous terms, they most often
create similar outcomes among children. This report will discuss a case study on the occurrence
of paediatric asthma in a child, Jessica, aged 5 years old. It will also elaborate on the
pathophysiology of the disease and illustrate the common signs and symptoms, thereby relating
them to the case study.
Discussion
Pathophysiology of the illness/disease
Asthma is a direct manifestation of chronic inflammation that occurs in the conducting
region of the airways. This inflammation commonly occurs in the bronchi and the bronchioles.
This subsequently leads to an elevation in contractibility of the smooth muscles that are present
near and around the airways. The aforementioned factors often contribute to bouts of airway
narrowing, which in turn contributes to symptoms related to wheezing (Mahr, Malka and Spahn
2013).

3CASE STUDY
Airway hyperresponsiveness state is a characteristic functional abnormality of paediatric asthma
and leads to narrowing of the airways due to a stimulus. Hyperresponsiveness most often occurs
due to a viral infection and consists of an elevated sensitivity of the airways, to an external agent
(Price et al. 2013). In this case scenario, it is evident Jessica’s family have three pets, two long-
haired dogs and one short-haired cat.
Pet dander and hair are composed of even microscopic particles and flecks of dead skin,
shed by the dogs, cats or other animals with feathers and furs. These skin and hair bits act as
triggers and lead to hypersensitivity in the airways. According to research evidences, higher rates
of allergies to cats are reported by individuals (Huang et al. 2013). The breathing allergens often
decline the ability of the lungs to function in an appropriate manner, which in turn worsens the
respiratory symptoms (Konradsen et al. 2014).Exposure to endogenous and exogenous factors
such as, allergens and the increased viscosity of the mucus that lines the epithelium is found to
modulate function of the cilia. Thus, the fact that Jessica has three pets can be attributed to onset
of mechanisms that influenced the airway hyperresponsiveness and caused inflammation of her
airways.
Bronchoconstriction can be defined as the dominant physiological event that leads to
subsequent interfering with the airways. In cases of acute exacerbation of paediatric asthma, the
smooth muscles of the bronchi contracts rapidly to narrow the airways, thereby responding to
exposure to a range of stimuli (Carraro et al. 2013). Jessica’s diagnosis to seasonal asthma can be
attributed to her shift to the suburbs. This made her more susceptible to exposure to a range of
external agents such as, pollen, dust or fumes that might have resulted in an increase in the
population of T helper 1 and 2 cells. In addition, generation of Th2 cytokines were also triggered
by the allergens that lead to IgE overproduction, increase in eosinophil and bronchoconstriction.

4CASE STUDY
Furthermore, exposure to a range of allergens in the household and the new locality to which the
patient Jessica shifted to, might have contributed to mast cell activation that releases
bronchoconstrictor mediators, such as, histamine, prostaglandin D2, and cytokines (Boulet and
O’Byrne 2015). Inflammatory cell infiltration has a probability of intraepithelial and
subepithelial cell inflammatory cell accumulation (Manuyakorn, Howarth and Holgate 2013).
The innate and adaptive immune systems play a considerable role in the onset and
regulation of inflammation in the airways. In particular, research studies have found strong
relation between inflammation and an imbalance between the Th1 and Th2 cytokines (Yuan et
al. 2013). Furthermore, onset of paediatric asthma can be related to an increase or shift towards
Th2 cytokine-like disease. This occur either in the form of an underexpression of Th1 or
overexpression of Th2. In addition, the airway inflammation in the patient Jessica might also
represent a loss of balance between the two opposite populations, composed of Th lymphocytes
(Th 1 and Th2) (Farahani et al. 2014). Furthermore, the allergic inflammation that resulted in the
onset of paediatric asthma might have been mediated by the family of cytokines by Th2 cells.
This statement can be further validated by the fact that the immune system of infants and
children are skewed towards generation of Th2 cytokines (Cho and Norman 2013).
Two signs/symptoms
Wheezing sounds during auscultation- Upon conducting an auscultation of the patient
Jessica, with the help of a stethoscope, wheezing sounds were heard from her heart and lungs.
This procedure was performed with the aim of examining the respiratory and circulatory system
of the patient. Hence, the major symptom can was presented by Jessica in the form of whistled,
or high-pitched sounds that were produced, during breathing. The sounds were most commonly
heard when she exhaled. This continuous, coarse sound was produced due to narrowing of the

5CASE STUDY
respiratory airways (Bener et al. 2014). Obstruction of certain parts of the respiratory system
might have contributed to such sounds in the patient. This symptom can be correlated to the
manifestation of asthmatic conditions due to the fact that mucus accumulation, airway
inflammation and tightening of the muscles can lead to a narrowing of the airways, thereby
leading to the production of wheezing sounds.
Upon getting exposed to a range of asthmatic triggers, such as pollutants, allergen, and
pet dander, hypersensitive reactions are seen in the sensitive airways. These in turn get red and
inflamed, thereby contributing to tightening of the air muscles (Esposito et al. 2014). This is
often manifested in the form of excess mucus or phlegm production that narrows the bronchi and
makes it difficult for an asthmatic individual to breathe. Wheezing has been associated with
asthma in children who have been suffering from the health abnormality for a prolonged period
of time (Tapiainen et al. 2016). Thus, the audible wheezes in the upper zone can be attributed to
blockage of the upper part of the respiratory system. The audible wheezes that are heard can also
be accompanied due to chest tightness and shortness of breath, the most common symptoms of
asthma. Hence, the turbulent flow of air through the narrowed segments of the extrathoracic
airways is responsible for producing a whistling noise. Airflow through the compressed or
narrowed regions of the bronchi and bronchioles become turbulent, which in turn leads to
vibrations in the walls of the airways (Silvestri et al. 2015). This vibration leads to the production
of wheezing sounds, the primary symptom presented by Jessica.
Increased respiratory rate- The typical respiratory rate for a healthy individual, aged 6
years is approximately in the range of 18-25 breathes per minute. However, upon admission, the
patient Jessica showed elevated respiratory rate, 36 bpm. This condition suggests presence of
symptoms that pertain to tachypnea. This symptom was presented in the form of abnormal

6CASE STUDY
breathing. This breathing condition refers to a physiological state where the breathing is fast and
often shallow, due to accumulation of excess carbon dioxide in the body (Ozkiraz et al. 2013).
Bronchial asthma, the disorder presented by Jessica occurred due to obstruction of the breathing
pathways. This in turn was mediated by several allergens (Nievas and Anand 2013). The fact that
the patient was susceptible to exposure to a range of pollutants, allergens and animal hair, she
was at an increased likelihood of suffering from tachypnea, which increased the breathing rate.
Presence of prolonged asthma can be associated with loss of adventitious breath sounds, thereby
contributing to rapid breathing, in addition to high-pitched wheezing sounds (Kim et al. 2014).
Hence, an inflammation of the respiratory tract, in association with release of
inflammatory cytokines might have resulted in rapid breathing in the patient. This symptom is
indicative of respiratory problem, persistent in the patient. Hence, it can be stated that the
respiratory distress caused due to inflammation and narrowing of the airways are primarily
responsible for tachypnea/rapid breathing symptoms in Jessica.
Conclusion
To conclude, the discussions presented above help in confirming the occurrence of
asthma in the patient Jessica. The patient reported several signs and symptoms that are directly
related to the inflammation of the airways. A reduction in the diameter of the bronchial tubes
caused adventitious lung sounds that occur due to airflow through compressed airways. The
immune system of the patient played a major role in the pathogenesis of the condition, by
controlling the release of Th1, Th2 and other cytokines. Furthermore, hyperresponsiveness to pet
dander, and other external agents in the suburbs, such as, pollen and pollutants, increased the
susceptibility of the patient to suffer from asthma. These factors acted as major triggers that led

7CASE STUDY
to the development of paediatric asthma symptoms. Furthermore, inflammation of the skin, and
development of learning and cognitive disabilities were also related to the asthmatic symptoms
in the patient Jessica.

8CASE STUDY
References
Bener, A., Ehlayel, M.S., Bener, H.Z. and Hamid, Q., 2014. The impact of Vitamin D deficiency
on asthma, allergic rhinitis and wheezing in children: An emerging public health
problem. Journal of family & community medicine, 21(3), p.154.
Bonini, M. and Usmani, O.S., 2015. The role of the small airways in the pathophysiology of
asthma and chronic obstructive pulmonary disease. Therapeutic advances in respiratory
disease, 9(6), pp.281-293.
Boulet, L.P. and O’Byrne, P.M., 2015. Asthma and exercise-induced bronchoconstriction in
athletes. New England Journal of Medicine, 372(7), pp.641-648.
Carraro, S., Giordano, G., Reniero, F., Carpi, D., Stocchero, M., Sterk, P.J. and Baraldi, E., 2013.
Asthma severity in childhood and metabolomic profiling of breath condensate. Allergy, 68(1),
pp.110-117.
Cho, C.E. and Norman, M., 2013. Cesarean section and development of the immune system in
the offspring. American Journal of Obstetrics & Gynecology, 208(4), pp.249-254.
Esposito, S., Galeone, C., Lelii, M., Longhi, B., Ascolese, B., Senatore, L., Prada, E., Montinaro,
V., Malerba, S., Patria, M.F. and Principi, N., 2014. Impact of air pollution on respiratory
diseases in children with recurrent wheezing or asthma. BMC pulmonary medicine, 14(1), p.130.
Farahani, R., Sherkat, R., Hakemi, M.G., Eskandari, N. and Yazdani, R., 2014. Cytokines
(interleukin-9, IL-17, IL-22, IL-25 and IL-33) and asthma. Advanced biomedical research, 3,
p.127.

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Huang, C., Hu, Y., Liu, W., Zou, Z. and Sundell, J., 2013. Pet-keeping and its impact on asthma
and allergies among preschool children in Shanghai, China. Chinese Science Bulletin, 58(34),
pp.4203-4210.
Kim, M.J., Yoo, J.H., Jung, J.A. and Byun, S.Y., 2014. The effects of inhaled albuterol in
transient tachypnea of the newborn. Allergy, asthma & immunology research, 6(2), pp.126-130.
Konradsen, J.R., Nordlund, B., Onell, A., Borres, M.P., Grönlund, H. and Hedlin, G., 2014.
Severe childhood asthma and allergy to furry animals: Refined assessment using molecular‐
based allergy diagnostics. Paediatric Allergy and Immunology, 25(2), pp.187-192.
Mahr, T.A., Malka, J. and Spahn, J.D., 2013, May. Inflammometry in paediatric asthma: a
review of fractional exhaled nitric oxide in clinical practice. In Allergy and asthma
proceedings (Vol. 34, No. 3, pp. 210-219). OceanSide Publications, Inc.
Manuyakorn, W., Howarth, P.H. and Holgate, S.T., 2013. Airway remodelling in asthma and
novel therapy. Asian Pacific journal of allergy and immunology, 31(1), p.3.
Nievas, I.F.F. and Anand, K.J., 2013. Severe acute asthma exacerbation in children: a stepwise
approach for escalating therapy in a pediatric intensive care unit. The journal of pediatric
pharmacology and therapeutics, 18(2), pp.88-104.
Ozkiraz, S., Gokmen, Z., Boke, S.B., Kilicdag, H., Ozel, D. and Sert, A., 2013. Lactate and
lactate dehydrogenase in predicting the severity of transient tachypnea of the newborn. The
Journal of Maternal-Fetal & Neonatal Medicine, 26(12), pp.1245-1248.
Price, M.M., Oskeritzian, C.A., Falanga, Y.T., Harikumar, K.B., Allegood, J.C., Alvarez, S.E.,
Conrad, D., Ryan, J.J., Milstien, S. and Spiegel, S., 2013. A specific sphingosine kinase 1

10CASE STUDY
inhibitor attenuates airway hyperresponsiveness and inflammation in a mast cell–dependent
murine model of allergic asthma. Journal of Allergy and Clinical Immunology, 131(2), pp.501-
511.
Silvestri, M., Franchi, S., Pistorio, A., Petecchia, L. and Rusconi, F., 2015. Smoke exposure,
wheezing, and asthma development: A systematic review and meta‐analysis in unselected birth
cohorts. Pediatric pulmonology, 50(4), pp.353-362.
Tapiainen, T., Aittoniemi, J., Immonen, J., Jylkkä, H., Meinander, T., Nuolivirta, K., Peltola, V.,
Salo, E., Seuri, R., Walle, S.M. and Korppi, M., 2016. Finnish guidelines for the treatment of
laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatrica, 105(1), pp.44-49.
Yuan, Y., Yang, B., Ye, Z., Zhang, M., Yang, X., Xin, C., Lin, M. and Huang, P., 2013.
Sceptridium ternatum extract exerts antiasthmatic effects by regulating Th1/Th2 balance and the
expression levels of leukotriene receptors in a mouse asthma model. Journal of
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