Pathogenesis of Asthma and Medication Management

This study material provides an in-depth understanding of the pathogenesis of asthma, including bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling. It also discusses the medication management for asthma, focusing on the use of Salbutamol, Hydrocortisone, and Ipratropium Bromide. Learn about the mechanisms of action, nursing considerations, and expected clinical responses for each medication. Find expert insights and recommendations for effective asthma management.

NURSING

TABLE OF CONTENTS
QUESTION 1..................................................................................................................................3
Pathogenesis................................................................................................................................3
QUESTION 2..................................................................................................................................4
High Flowers position for acute asthmatic patient......................................................................4
Titrate oxygen..............................................................................................................................4
QUESTION 3..................................................................................................................................4
Explanation of Medication..........................................................................................................4
REFERENCES................................................................................................................................7

QUESTION 1
Pathogenesis
The inflammation of the airway paths leads to the formation of asthmatic patients i.e. the
limitation of the airflow which can be caused by a variety of changes. These are:
Bronchoconstriction: In acute exacerbation of asthma, the exposure to different allergens or
irritants leads to narrowing down of airways and causes allergy induced asthma. Sometimes
aspirin and other anti- inflammatory drugs can also lead to development of asthma where the
evidence indicates that mediator release from the airways cells can cause such stimuli.
Inflammation of acute airway causes regulation of the airways and this leads to cause of asthma
(Jartti & Gern, 2017). Stress and enhanced production of pro- inflammatory cytokines are
additional mechanisms lead to formation of asthmatic prognosis in a patient.
Airway Edema: With the persistence of the disease the inflammations progresses and the limit to
the airflow further deepens in the airway. The formulation of insipissated mucus plugs, hyper
secretion, inflammation, edema etc. are some of the structural challenges that arises in the
patients. It can be observed in Poppy as well that after the identification of the asthma in age 2, it
has further worsened where the infrequent and intermittent asthma has now turned out to be
acute exacerbation of asthma. Now the patient might not easily respond to the usual treatment
methods as easily.
Airway hyper responsiveness: This is termed as exaggerated or hyper responsiveness of the
bronchoconstrictor to a wider range of stimuli can be termed as the airway hyper responsiveness.
The degree of such airway hyper responsiveness might not be categorised as a undue feature of
the asthmatic symptoms but yet it can be termed as a major or reason behind asthma (Caperell &
et.al., 2019). The inflammation, neuroregulation dysfunctionality, structural changes etc. are the
multiple factors that can get affected by the hyper responsiveness and can lead to asthmatic
increased impact in the patient. In order to reduce inflammation, the treatment can be used to
reduce this and consequently the airway inflammation and hyper responsiveness can also be
cured effectively leading to better control on the asthmatic symptoms. But in this scenario, the
patient currently, this is not the case as the inflammation has increased to a level where it is not
decreasing but rather developing and the child is not able to speak a whole sentence clearly.
Airway Remodelling: People who are suffering from asthma might tend to limit their airflow
with the limitation to it being partially reversible. The certain changes in the structural become
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irreversible and the progressive loss in the lung function becomes significant. The consequent
changes that arise tend to become permanent and the activation of the structural changes also
leads to such reversal. In such cases the repair as well as the remodelling process is not very well
established and sub- basement membrane tends to get thickened. The nature of this tends to make
the disease more permanent or steady in an individual and the therapeutic response becomes
limited (Fanta & Hockberger, 2019). The current patient Poppy is showing similar symptoms of
airway remodelling.
Thus these comprise of the clinical manifestations of the pathogenesis of asthma.
QUESTION 2
High Flowers position for acute asthmatic patient
Placing Poppy in High Flowers Position can help in alleviating the respiratory distress as it
relaxes the tension of abdominal muscles and allows improved breathing. Especially in children,
this positions leads to alleviation in the chest compression due to the force of gravity and
ultimately the respiratory status of the child gets improved drastically.
Titrate oxygen
Device that I will be using for the oxygen delivery would be HFNC i.e. high- flow nasal
cannula as it is already proved to be much safer and effective technique in asthma management
in children (Denlinger & et.al., 2020).
Since the SpO2 level in Poppy is as low as 87%, only HFNC can lead to effective increase
in the expiratory flow and also increase the ventilation or perfusion ratio thus improving the
SpO2 level in Poppy.
The use of HFNC will fulfil the need for extra oxygen thus improving the saturation value
and also reducing the acidosis of Poppy simultaneously.
QUESTION 3
Explanation of Medication
Salbutamol via nebuliser
The mechanism of action of the Salbutamol basically leads to relaxation of the smooth
muscles and the beta- adrenergic receptors present in lungs gets activated. It causes opening of ht
airways effectively.
Since Poppy has lower SpO2, tracheal tugs and her muscles need to be relaxed;
Salbutamol is more effective and will lead to resolution of these problems consecutively.
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The nursing consideration that is required for the use of Salbutamol is:
 Lung sounds need to be accessed and, PR and BP also noting their rate before
administering rug and then when the medication is at peak.
 Meals for minimizing gastric irritation
 Whole tablet of extended release should be swallowed.
 Mouth rinse with water after every inhalation.
The clinical responses include the relief from asthma related disease, improvement in the
SpO2 levels, wheezing cure and also reduces the use of accessory muscle for respiration thus
assisting in giving relief to Poppy in her existing condition (Islam & et.al., 2016).
Common side effects of Salbutamol are tremor, anxiety, muscle cramps, headache, drier
mouth etc. Some adverse symptoms might be flushing of skin, tachycardia, myocardial ischemia
etc. It can even lead to disturbance in the behaviour and the sleep.
Hydrocortisone IV
The mechanism of the action includes decrease in the vasodilatation, permeability of
capillaries and further also leads to decreased leukocyte migration leading to inflammation. The
hydrocortisone also binds to the glucocorticoid receptor and mediates changes that might occur
in the gene expression that can cause multiple effects of down streaming impact that can remain
for hours. Lower doses of it can cause and anti- inflammatory effect and thus benefit the patient.
Since Poppy is suffering from hyperinflation in both lungs and also suffers from
inflammation of bronchus thus making the use of this dosage extremely effective in reduction of
the inflammation (Cronin & et.al., 2016).
There are various nursing considerations that need to be kept in mind while administering
this drug and these are:
 Monitoring the signs of thrombophlebitis regularly and thromboembolis as well where the
different aspects such as swelling, warmth, chest pain, shortness of breath etc. are noted.
 Monitoring signs of hyper sensitivity reactions and includes pulmonary symptoms, skin
reactions as well.
 The muscle or joint pain needs to be regularly assessed and any persistent pain needs to be
immediately reported.
 Children can face increased intracranial pressure or shift in moods that also need to be
assessed.
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 Measuring BP, muscle strengths etc. regularly.
Clinical responses that can be expected in Poppy are reduced inflammation in the airways,
increase in the SpO2 level and reducing the wheezing sounds (Kassisse & et.al., 2017).
The continuing clinical observation also would be in relation to nausea, heartburn, trouble in
sleeping, headache etc. In case these effects persist or even become more realistic, then the steps
should be taken immediately because it weakens the immune system of a patient.
Ipratropium Bromide via nebuliser
The mechanism of action involved in this is that it acts as the antagonist against the
muscarinic acetylcholine receptor and ultimately leads to inhibition of parasympathetic nervous
system in airways thus inhibiting their function as well.
Poppy is suffering from asthma thus casing higher chances of narrowing of the pathways
and therefore the constriction can be stopped using Ipratropium bromide which will reduce the
bronchodilation and also increases the SpO2 level (DeBaun & Strunk, 2016).
The different nursing considerations required are:
 Checking the nebuliser technique.
 Ensuring patients can correctly use delivery device for medication.
 Administering nebuliser through mouthpiece and adjusting according to length of
equipment.
 Caution while using Atrovent
 Evaluation of the therapeutic response.
Clinical response will be increased SpO2 level, reduced secretion and bronchodilation
(Paget & Webber, 2020).
Clinical observation for bladder pain, cloudy or bloody urine, difficulty in breathing, lower
back pain, shortness of breath etc. are the main aspects that will be required to be considered.
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REFERENCES
Books and Journals
Caperell, K., & et.al., (2019). Provider Prediction of Disposition for Children With an Acute
Exacerbation of Asthma Presenting to the Pediatric Emergency Department. Pediatric
emergency care. 35(2). 108-111.
Cronin, J. J., & et.al., (2016). A randomized trial of single-dose oral dexamethasone versus
multidose prednisolone for acute exacerbations of asthma in children who attend the
emergency department. Annals of emergency medicine. 67(5). 593-601.
DeBaun, M. R., & Strunk, R. C. (2016). The intersection between asthma and acute chest
syndrome in children with sickle-cell anaemia. The Lancet. 387(10037). 2545-2553.
Denlinger, L. C., & et.al., (2020). Exacerbation-prone asthma. The Journal of Allergy and
Clinical Immunology: In Practice. 8(2). 474-482.
Fanta, C. H., & Hockberger, R. S. (2019). Acute exacerbation of asthma in adults: Emergency
department and inpatient management. UpToDate. Waltham, MA: UpToDate.
Islam, M. R., & et.al., (2016). A Prospective, Randomized Controlled Trial of Noninvasive
Ventilation in Acute Exacerbation of Asthma in Children.
Jartti, T., & Gern, J. E. (2017). Role of viral infections in the development and exacerbation of
asthma in children. Journal of Allergy and Clinical Immunology. 140(4). 895-906.
Kassisse, E., & et.al., (2017). Open randomized study of children with acute exacerbation of
asthma and treated with inhaled steroids. Revista Cubana de Pediatría. 89(2). 165-176.
Paget, S. P., & Webber, C. (2020). Variation in the management of acute exacerbations of
asthma in New South Wales.
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