Case Study on The Pathogenesis of Asthma

Running head:CASE STUDY
Case Study
Name of the Student
Name of the University
Author Note

1CASE STUDY
Answer 1
Asthma is a fairly common chronic disorder that is caused due to inflammation of
airways. The pathogenesis of asthma is complex and depends on many factors and the
patients present with a vast variety of underlying processes. The basic underlying
pathophysiology is represented via inflammation of upper and lower airways. However, a
series of events lead to such inflammation and asthmatic episodes (Russell & Brightling,
2017). The pathogenesis of asthma initiates when the patient is exposed to allergens. The
inhaled allergen then binds to IgE antibody present on the mast cells. This stimulates
degranulation of the mast cells. This stimulates the release of inflammatory mediators such as
histamine, prostaglandins as well as D2 and platelet aggravating factors. This in turn
increases the permeability of the blood capillaries and enters the blood vessels, causing them
to swell. Thus is known as vasodilatation. These causes formation of openings in the
junctions of the cells. This allows the allergen to penetrate below the epithelial surface. When
the allergen penetrates below the epithelial surface, it results in bronchospasm, congestion of
the vessels, and secretion of mucus and impairment of muco-ciliary function. The walls of the
airway thicken and smooth muscles of the bronchi contracts which is actually the cause of
bronchospasm. This contraction causes impairment of the exhalation and inhalation process.
The airway of the patient becomes hyper-responsive. Certain tissues are remodelled in the
airway, leading to inflammation. This is because the air gets trapped and causes
hyperinflation of the tissues. As a result, the gas pressure rises in the alveoli and intrapleural
area. As a result, decreased perfusion of the alveoli occur, that is, lesser amount of blood
enters the alveoli. Since ventilation (flow of air into the alveoli) is related to perfusion, a
significant mismatch occurs (Powers & Dhamoon, 2020). This leads to hypoxemia, that is,
the oxygen concentration in the blood becomes lower. This process finally leads to hypoxia,

2CASE STUDY
where the body is deprived of adequate amount of oxygen. This presents the clinical
manifestations of asthma.
In the case of Poppy, the clinical manifestation is severe. She is presented with
hypoxia, which is apparent by her SpO2 Level being 87%. Any level below 90% is considered
to be hypoxia, which is the major symptom (Jubran, 2015). She is presented with violent
cough as well as wheezing. This is caused by the contraction of the smooth muscles, which
leads to bronchospasm as directed in the pathogenesis. Bronchospasm leads to unproductive
coughing and wheezing of the patient.
She is presented with tachypnea (shallow breathing) which is very likely caused due
to the low oxygen level in the blood due to ventilation-perfusion mismatch. This low oxygen
level causes the increase in carbon dioxide in the blood, leading to the patient having to take
low and shallow breathes, that is tachypnea. Hence her respiratory rate is much higher than
normal (42 bpm). On a similar note, the patient is also experiencing a shortness of breath, that
is, dyspnea. Her heart rate is abnormally high as well, presenting at 160 while the normal is
100.
The patient is showing limitations of expiratory flow, which is very much related to
the shortness of breath and increased respiratory rate. This is a classic clinical manifestation
of asthma as it is caused due to the inflammation of the airways. The hyperinflation of the
airway traps the air or does not let it escape. Hence, Poppy is having decreased expiratory
flow which is leading to the inspiratory and expiratory wheezing. The arterial blood gas level
shows respiratory acidosis, which also shows that she cannot remove enough air by
exhalation. This is causing an increase in the blood carbon dioxide level, finally leading to
the lowered SpO2 level of the patient.

3CASE STUDY
Answer 2
1. Poppy is positioned in a High Fowlers position. The Fowlers position is a half-
sitting or upright position which is usually recommended for the patients experiencing
respiratory distress. Patients of asthma are often sat in a semi-fowlers position. The High
Fowler’s position helps in reducing the pressure on the chest that occurs due to gravity. The
high fowler’s position allows the patient to stay in a 90 degree position and helps accessory
muscle movement (Najafi, Dehkordi, Haddam, Abdavi & Memarbashi, 2018). This helps to
pull on the ribs of the patient and helps them take the air in. This will be very helpful for
Poppy as she is suffering from dyspnea and tachypnea. This will help Poppy take the air in
and increase the SpO2 value. Once Poppy has more oxygen and less carbon dioxide in her
system, it should help her symptoms.
2. In the case of Poppy, oxygen therapy is important. Oxygen must be delivered to her
using a high-flow nasal cannula as this device can deliver the required amount of oxygen to
the patient. Since this is an acute situation, Poppy must be given oxygen using this device as
this can guide her breathing patterns in an acute situation. This device has been chosen
because it is helpful in increasing the SpO2 in patients and the high flow of oxygen has been
observed to be very helpful in lowering the severity of asthma episodes. It leads to shorter
oxygen use time and significant improvements in SpO2. It is also safe for children (Martínez
et al., 2019).
For Poppy, providing supplementary oxygen will work as it will make the SpO2
higher and lower the concentration of carbon dioxide in Poppy’s system. This will lower her
need to breath as much and thus lower her respiratory rate, making it more stable. This will
also in turn lower her heart rate and take care of the respiratory acidosis that she is
experiencing (Baudin, Buisson, Vanel, Massenavette, Pouyau & Javouhey, 2017).

4CASE STUDY
Answer 3
Salbutamol via nebuliser
Salbutamol is a beta2-receptor agonist that acts on the adrenoreceptors of the
bronchial muscle to stimulate bronchodilation (Pubchem.ncbi.nlm.nih.gov., 2020).
Poppy is receiving this medication in response to her bronchospasm that is caused due
to smooth muscle contraction.
This medication can often have side effects such as tachycardia, anxiety and others.
The nurse must listen for the lung sounds before administration.
Since it has a very fast reaction, the expected outcome is lowered symptoms in Poppy,
easing her spasms and preventing another asthma attack.
The patient’s vitals must be checked including SpO2, respiratory rate as well as others.
It may cause high heart rate as a side effect, so it should be monitored (Cai, Lin & Liang,
2020)
Hydrocortisone IV
Hydrocortisone is a corticosteroid which has anti-inflammatory properties and thus
will decrease the inflammation in the airways by controlling the biosynthesis of
prostaglandins.
Poppy is receiving this medication to reduce the inflammation of airways due to her
asthma. It is useful in acute asthma (Alangari, 2014)
The nurses should consider that this medication may be contraindicated in certain
infections.
It has a clinical effect in 2-4 hours and works up to 8 hours after administration. This
will ensure that the inflammation in the airways is controlled for that period of time.

5CASE STUDY
The patient should be checked time to time for the side effects such as nausea, as well
as if any of the symptoms persist.
Ipratropium Bromide via nebuliser
Ipratropium bromide is a medication that is anticholinergic and works via blocking
the receptors of acetylcholine. This leads to muscle relaxation around the airways which
enables the patient to breathe easier.
Poppy is receiving this medication in response to the hyperinflation of her airways
that is preventing her from breathing properly.
As for nursing considerations, the solution should be protected from light and a
nebulizer mask should be used for the patients. The patient should also be hydrated enough.
This medication works within fifteen minutes and lasts for around three to five hours.
This will ensure that Poppy remains stabilized.
The patient should be monitored for the side effects which include increased heart
rate. So the patient’s heart rate should be checked from time to time (Saab & Aboeed, 2020).

6CASE STUDY
Reference
Alangari A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic
medicine, 9(4), 187–192. Doi: https://doi.org/10.4103/1817-1737.140120
Baudin, F., Buisson, A., Vanel, B., Massenavette, B., Pouyau, R., & Javouhey, E. (2017).
Nasal high flow in management of children with status asthmaticus: a retrospective
observational study. Annals of intensive care, 7(1), 55. Doi:
https://doi.org/10.1186/s13613-017-0278-1
Cai, Z., Lin, Y., & Liang, J. (2020). Efficacy of salbutamol in the treatment of infants with
bronchiolitis: A meta-analysis of 13 studies. Medicine, 99(4), e18657. Doi:
https://doi.org/10.1097/MD.0000000000018657
Jubran A. (2015). Pulse oximetry. Critical care (London, England), 19(1), 272. Doi:
https://doi.org/10.1186/s13054-015-0984-8
Martínez, F. G., Sánchez, M. I. G., del Castillo, B. T., Moreno, J. P., Muñoz, M. M., Jiménez,
C. R., & Fernández, R. R. (2019). Treatment with high-flow oxygen therapy in
asthma exacerbations in a paediatric hospital ward: Experience from 2012 to
2016. Anales de Pediatría (English Edition), 90(2), 72-78. Doi:
https://doi.org/10.1016/j.anpede.2018.06.008
Najafi, S., Dehkordi, S. M., Haddam, M. B., Abdavi, M., & Memarbashi, M. (2018). The
Effect of Position Change on Arterial Oxygen Saturation in Cardiac and Respiratory
Patients: A Randomised Clinical Trial. JOURNAL OF CLINICAL AND
DIAGNOSTIC RESEARCH, 12(9), OC33-OC37. Doi:
10.7860/JCDR/2018/36282.12130

7CASE STUDY
Powers, K., & Dhamoon, A. (2020). Physiology, Pulmonary, Ventilation and Perfusion.
Retrieved 27 March 2020, from https://www.ncbi.nlm.nih.gov/books/NBK539907/
Pubchem.ncbi.nlm.nih.gov. (2020). Salbutamol. Retrieved 27 March 2020, from
https://pubchem.ncbi.nlm.nih.gov/compound/Salbutamol
Russell, R. J., & Brightling, C. (2017). Pathogenesis of asthma: implications for precision
medicine. Clinical Science, 131(14), 1723-1735. Doi:
https://doi.org/10.1042/CS20160253
Saab, H., & Aboeed, A. (2020). Ipratropium. Retrieved 27 March 2020, from
https://www.ncbi.nlm.nih.gov/books/NBK544261/