Case Study on Asthma

This case study discusses the causes, symptoms, and treatment options for asthma. It covers the various pathological conditions involved in asthma, the role of T helper cells in its development, and the medications used to treat it. The case study also includes a discussion on emergency care for acute severe asthma.

Running head: CASE STUDY ON ASTHMA
Case Study on Asthma
Name of the Student
Name of the University
Author Note

1CASE STUDY ON ASTHMA
Response to question 1.
Asthma refers to a complex disorder that is characterized by the obstruction in the paroxysmal
airways that is the condition where the sensitivity of the airways is increased due to the
inhalation of the eosinophilic inflammatory filtrate and spasmogens. In Asthma , various
pathological condition is involved for example, bronchial inflammation long with the airway
constriction , shortness of the breath , wheezing, coughing. Asthma mainly affects the trachea,
bronchioles and bronchi. Edema, bronchospasm, excessive amount of mucous in the airway
track and along with this damage of smooth muscle and epithelial cell damage can also leads to
the condition of bronchoconstriction and ultimately results in Asthma. Bronchospasm refers to
the sharp contraction of the bronchial smooth muscles and it results in constriction in the airways
.In edema of the airways track there occurs microvascular leakage and it blocks the airway. In
this condition, there occurs vasodilation of the airway capillaries and that causes more secretion
of the mucous and causes blockage of the airways (Kudo, Ishigatsubo & Aoki, 2013). Asthma is
also associated with the increasing level of IgE and also eosinophilic inflammation in the
airways. After inhalation of various allergens like dust, pollens, fungi, animal dander, the T
helper cells( Th2) are proliferated and along with this Th2 cytokines, Interleukin ( IL)-5, IL-3
and IL-4 are also produced and released (Lambrecht & Hammad, 2015). The inflammation in the
airways is the major reason of this disease. The inflammation is mainly induced by the chemical
mediators released by those inflammatory cells. This causes inflammation of the airways and
thickening of the airway wall. This thickening of the airways causes narrowing of the trachea and
asthma is developed. In this case study of Smith, in x-ray it is seen that, he had a
hyperinflamated lungs and it is mainly due to the blockage of the airways. Smith had been
diagnosed with asthma when he was just 2 years old and also he had very low respiratory rate

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than a healthy individual. Hyperinflamated lungs are mainly seen in the patients of chronic
ophthalmic pulmonary disease ( COPD). Smith had severe dyspnoea and he could not even
speak a sentence in one breath. The breath shortness is due to his obstruction in the tracheal
airway. The allergen is taken up by the dendritic cells and after processing they are presented to
the T helper cells. The activation of allergen specific T helper cells plays a major role in
developing Asthma. In recent times, it is seen that Th17 and Th9 are also responsible for
occurrence of this disease (Übel et al., 2014). The Th17 cells is responsible for the production of
IL-17A, IL-22 and IL-F. The released cytokines is responsible for the airway inflammation and
IL-17A is directly associated with the increased contraction of the airway smooth muscle ( ASM)
(Chesné et al., 2015). In this case it can be assumed that, patient Smith had developed his
Asthma due to the constriction of the tracheal airways and the excessive mucous plugging is also
another key reason for the development of Asthma as he had hyperinflamated lungs observed in
the chest x-ray. In this excessive mucous, the mucous mainly contains lymphocytes,
inflammatory cells, cell debris of the necrotic pathway of epithelial cells and mucin. In the case
of Smith the main reason behind the breath shortness is the limitation of airflow to lungs due to
constriction in the airway due to increased contractility of the ASM. The contraction of the ASM
is associated with the influx of calcium ions from extracellular to intracellular environment and
ions are entering through a voltage-dependent calcium channel . This increased concentration of
the Calcium ion in the intracellular environment will cause stimulation of the G-protein coupled
receptor pathway and result in activation of the Phospholipase C ( PLC). Activated PLC then
helps in production of IP3 and IP3 stimulates the release of Calcium ions from the sarcoplasmic
reticulum (SR). Released calcium ions then activates MLC kinase ( MLC K) by forming calcium
calmodulin complex. MLCK then phosphorylates the regulatory MLCs to phosphorylated MLCs.

3CASE STUDY ON ASTHMA
This ultimately results in activation of myosin-actin cross bridges and smooth muscles
contractions (Kudo, Ishigatsubo & Aoki, 2013).
Response to question 2.
In the case of Jackson smith it is seen that, he had a 90 % SpO2 in the room air and that is lower
than the normal level ( 94-100% SpO2). As he had acute severe asthma, he should be given
emergency care so that, he can get relief from his condition as soon as possible. In this case,
nurses should emergency care and that should help Smith to get relief. Firstly, nurses should try
emergency medicines that can result relief in Asthma. In this case of Asthma management,
nurses should can start the medication with the nebulized salbutamol that is a beta agonist
drug(Patel et al., 2015). The inhalation of this drug should be done via face musk. Along with
this, the drug also can be delivered with oxygen (Gotera et al., 2013) as Smith has severe
problem in breathing. In this case, oxygen should be treated as a medicine for Smith also. In
addition to this, inhalation of ipratropium bromide can be used as an add-on therapy for Smith
(Nakawah, Hawkins & Barbandi, 2013). With consideration of Smith’s acute severe asthma,
Corticosteroids can be helpful for Smith as it downregulates the formation of the
proinflammatory cytokines and ultimately reduces inflammation of the airway (Barnes , 2013).
In another strategy, nurses can use the nurses can measure the peak flow to measure the airflow
of the lungs. It is mainly used to see the expiratory rate of the air flow and it is known as peak
expiratory flow ( PEF). After monitoring the PEF they can decide that what amount of air
pressure can be given to Smith in order to give him relief (Lalloo et al., 2013).

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Response to question 3.
3. a) In this case, nebulized salbutamol, nebulized ipatropium bromide (4/24) and IV
Hydrocortisone 100mg (6/24) is used to treat Jackson. Nebulized salbutamol acts on beta-2
adrenoreceptors and covalently binds at the active site of the receptor. The conformational
changes in the receptor will cause conversion of the ATP to c-AMP. This results in decreased
concentration of intracellular Ca+2 level. As a result, vasodilation occurs and air can travel to the
alveoli. This will relief asthma as there is a vasoconstriction in the trachea (Cazzola et al., 2013).
Nebulized ipratropium bromide works via the action of c-GMP on the intracellular calcium ions
and this causes lowering of the smooth muscle’s contractility and reliefs the acute asthma.
Ipratropium mainly blocks the muscarinic cholinergic receptor and it blocks the receptor without
any specificity and that ultimately results in decrease in production of c-GMP (Meurs et al.,
2013). Hydrocortisone mainly reduce the release of mucous by lowering the secretion of
macrophages and secrtagogue. It ultimately causes reduction of inflammation, swelling and
allow the patients of Asthma to get more relief as there is severe mucous secretion in the asthma
and reduction of mucous secretion will help the patients (Lohia, Schlosser & Soler, 2013).
3. b) During the administration of salbutamol a nurse should observe that whether there is any
anxiety, palpation muscular cramp or not. In severe condition myocardial ischemia, tachycardia
may occur. In this condition, nurses should immediately stops the drug and take action according
to the symptoms. Positive effect should also be noted in case of positive response. In case of
hydrocortisone nurses should note if there is any symptoms of mood swing, weakness, acne
upset stomach or not. In such condition, medicines should be changed.In case of ipratropium
bromide , nurses should be watchful to note any kind symptoms like of nausea, dizziness or more
difficulty in breathing in the patient.

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Barnes, P. J. (2013). Theophylline. American journal of respiratory and critical care
medicine, 188(8), 901-906.
Cazzola, M., Page, C. P., Rogliani, P., & Matera, M. G. (2013). β2-agonist therapy in lung
disease. American journal of respiratory and critical care medicine, 187(7), 690-696.
Chesné, J., Braza, F., Chadeuf, G., Mahay, G., Cheminant, M. A., Loy, J., ... & Magnan, A.
(2015). Prime role of IL-17A in neutrophilia and airway smooth muscle contraction in a
house dust mite–induced allergic asthma model. Journal of Allergy and Clinical
Immunology, 135(6), 1643-1645.
Gotera, C., Lobato, S. D., Pinto, T., & Winck, J. C. (2013). Clinical evidence on high flow
oxygen therapy and active humidification in adults. Revista portuguesa de
pneumologia, 19(5), 217-227.
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4,
263.
Lalloo, U. G., Ainslie, G. M., Abdool-Gaffar, M. S., Awotedu, A. A., Feldman, C., Greenblatt,
M., ... & Otto, W. (2013). Guideline for the management of acute asthma in adults: 2013
update-Part 2: March 2013. SAMJ: South African Medical Journal, 103(3), 189-200.
Lambrecht, B. N., & Hammad, H. (2015). The immunology of asthma. Nature
immunology, 16(1), 45.
Lohia, S., Schlosser, R. J., & Soler, Z. M. (2013). Impact of intranasal corticosteroids on asthma
outcomes in allergic rhinitis: a meta‐analysis. Allergy, 68(5), 569-579.

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Meurs, H., Dekkers, B. G., Maarsingh, H., Halayko, A. J., Zaagsma, J., & Gosens, R. (2013).
Muscarinic receptors on airway mesenchymal cells: novel findings for an ancient
target. Pulmonary pharmacology & therapeutics, 26(1), 145-155.
Nakawah, M. O., Hawkins, C., & Barbandi, F. (2013). Asthma, chronic obstructive pulmonary
disease (COPD), and the overlap syndrome. The Journal of the American Board of
Family Medicine, 26(4), 470-477.
Patel, M., Pilcher, J., Hancox, R. J., Sheahan, D., Pritchard, A., Braithwaite, I., ... & Beasley, R.
(2015). The use of β 2-agonist therapy before hospital attendance for severe asthma
exacerbations: a post-hoc analysis. NPJ primary care respiratory medicine, 25, 14099.
References for Concept Map
Bohadana, A., Izbicki, G., & Kraman, S. S. (2014). Fundamentals of lung auscultation. New
England Journal of Medicine, 370(8), 744-751.
Castro, M., Zangrilli, J., Wechsler, M. E., Bateman, E. D., Brusselle, G. G., Bardin, P., ... &
Korn, S. (2015). Reslizumab for inadequately controlled asthma with elevated blood
eosinophil counts: results from two multicentre, parallel, double-blind, randomised,
placebo-controlled, phase 3 trials. The Lancet Respiratory Medicine, 3(5), 355-366.
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4,
263.
Leigh, D., & Marley, E. (2016). Bronchial asthma: a genetic, population and psychiatric study.
Elsevier.

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Polosa, R., & Thomson, N. C. (2013). Smoking and asthma: dangerous liaisons. European
respiratory journal, 41(3), 716-726.
Polosukhin, V. V., Richmond, B., Du, R. H., Ware, L. B., Lee, J. W., Miller, R. F., ... &
Blackwell, T. S. (2017). D98 INSIGHTS INTO ENVIRONMENTAL EXPOSURES IN
ASTHMA, COPD, AND CONSTRICTIVE BRONCHIOLITIS: Loss Of Multiciliated
Epithelium And Impaired Mucosal Immunity In Lungs Of Soldiers With Constrictive
Bronchiolitis. American Journal of Respiratory and Critical Care Medicine, 195.

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References
Übel, C., Graser, A., Koch, S., Rieker, R. J., Lehr, H. A., Müller, M., & Finotto, S. (2014). Role
of Tyk-2 in Th9 and Th17 cells in allergic asthma. Scientific reports, 4, 5865.