Pathophysiology of Asthma | Case Study

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

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CASE STUDY
PATHOPHYSIOLOGY OF ASTHMA
The patient in the case study is grasped with a disease called asthma which has
occurred due to exercise and also because of allergic response in the body. Asthma is a type
of chronic pulmonary disorder mainly caused due to the inflammation primarily in the
respiratory tract along with tightening of the smooth muscles present in the respiratory
airways (Quirt et al., 2018). The disease can be categorized in mainly into two types, these
are non-allergic asthma and allergic asthma, however it has other types as well such as drug
induced asthma, occupational asthma and exercise induced asthma (Papi et al., 2019). The
atopic asthma or the allergic asthma is mediated by type 1 Immunoglobulin E mediated
hypersensitivity along with allergen sensitization that is observed since childhood. It is also
governed by genetic factor such as history of asthma present in the family and positive skin
test. The non-atopic asthma happens due to non-allergic sensitization of the body, virus
infection occurred in the body and the skin test is negative. The drug induced asthma is
caused due to sensitive reaction of certain drugs towards the body such as aspirin
(Warrington, Silviu-Dan & Wong, 2018). Occupational asthma is caused due to stimulus that
effects and triggers the asthma condition, the stimulants are fumes, chemical dusts such as
cotton, woods, organic materials, gas like toluene (Liccardi et al., 2018). Exercise induced
asthma is caused after mild or vigorous exercises that worsens that condition in cold climate.
Bronchoconstriction is a common factor in all the types of asthma. It is a basically a type of
narrowing that occurs in the airways of the lungs due to contraction of the surrounding
smooth muscle of the lungs which results in wheezing consequent coughing and breathing
shortness. The patient in this case has a symptom of exercise-induced bronchoconstriction.
Exercise typically follows a usual form of bronchodilation. The constriction sets in during
exercise which reaches at peak at about 10 to 15 minutes and the condition resolves by 1
hour. During this period of time the level of few inflammatory mediators rises in a huge

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amount (Aggarwal, Mulgirigama & Berend, 2018). The mediators that are raised above the
normal condition are histamine, leukotrienes and interleukin. The TH2-type lymphocytes that
are activated which increases the Bcells expressing the CD 23 and T-cells that is expressing
the CD25 that is interleukin-2R overall increasing the production of immunoglobulin E. This
condition resolves after one or three minute. The patient with suffering from exercise-induced
asthma the condition lasts up to a refractory period of four hours or less than that. The
bronchoconstriction is less stressed if exercise is repeated during this period of time. This
happens due to the release of prostaglandins. The original cause of this type of
bronchoconstriction seems to be the enormous bulk of dry air, cool air that is drawing in
during strenuous exercise. The allergic asthma is a type of autoimmune disorder also known
as hypersentivity type1 (Lambrecht & Hammad, 2015). The vascular abnormality such as
angiogenesis, plasma exudation, vasodilation results to the narrowing of airways of the lungs.
Enlarged quantity of blood flow is essential for removing the inflammatory mediators from
the lungs. The normal function of the body is maintained by autonomic nerves system
somewhere the parasympathetic nerve is chiefly stimulated by the stimuli and creates
impulses which is supplementary passed by the vagal nerves in to the brain which in turn
carried into the airways. Acetylcholine that is discharged by efferent nerves produced inositol
triphosphate which begins the bronchoconstriction and restriction of muscles. Asthma is also
caused because of sleep disorders and gastrointestinal disorders (de Freitas Dantas Gomes &
Costa, 2015).
SIGNS AND SYMPTOMS OF ASTHMA
The patient in this case study has a medical history of asthma condition and also has a
complain of respiratory traction infection. The symptoms that the patient was having are
breathing shortness, wheezing and unresolved coughing which can be regarded as the main
observatory symptoms of asthma exacerbation. The child also had symptoms of exercise-

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induced asthma, which lead him withdrawal from sports and physical activities (Caggiano et
al., 2017). The child experienced a sudden asthma attack, which resulted in sudden rise of
respiratory rate 30 beats per minute and also a high pulse rate of 110 beats per minute. The
reason for increasing the heart rate in drastic rise in heart rate is due to condensed pumping
efficiency of the left side of the heart, which results in the build-up of more fluid in the lungs
known as pulmonary oedema (Wang et al., 2017). This fluid accumulation results in the
development of coughing and wheezing which in turn raises the pressure in the body. The
reason for high respiratory rate in the body is due to the lower level of oxygen supply in to
the lungs, which in turn because of short level of PaCO2 resulting in bronchospasm caused
due to hyperventilation resulting to cause hyperinflation. The patient had a spo2 level of 94%
at the time of admission and spo2 level of 90% after 30 minutes of admission. This indicates
that the is spo2 level is dropping in the patient. This state of the body is known as hypoxemia,
which occurs when the level of oxygen in the blood falls below normal. It may give rise to
symptoms such as breathing shortness and headaches (Pandya & Sharma, 2019). This
condition has a risk of anaemia. The patient’s shortness of breathing can be due to muscle
swelling in the lungs airways along with secretion and accumulation of mucus that build up
in the airways of the lungs as a result the lungs are unable to hold up adequate amount of air.
The patient was also having a whistling sound during breathing. The sound takes place
because of the inability of air or difficulty of air to pass through the narrow and inflamed
pathways resulting in a breathing difficulty (Gossman, Alghoula & Berim, 2019). The
condition also gives rise to respiratory tract infection. The patient was a having a body
temperature of 38.4 degree centigrade which means that the child was having high fever
during this attack. This also indicates that the child was having a sign of infection especially
cold along with asthma which also contributed in the development of airway narrowing and
inflammation. This also triggers the condition of asthma in children.

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Asthma is generally a type of chronic pulmonary disorder that causes a state of
inflammatory condition in the air pathway of the lungs, which in turn secretes unwanted
quantity of mucus. The condition makes breathing difficulty along with coughing, wheezing
and shortness of breathing. The common symptoms and signs of this condition vary from one
person to another and also depends upon age. The symptoms are lack of sleep, breathing
shortness, coughing and wheezing. Tightness in the chest while coughing or talking or pain in
chest, whistling sound in the course of exhalation is another two symptoms that are child was
having. The breathing problem that the child was having need quick medication as untreated
condition may result in permanent functional structural changes in the lungs airways which is
also known as airways remodelling (Bush, 2019).
MEDICATIONS AND MECHANISMS OF ACTION
The drug named Salbutamol can helpful in the treatment of asthma patient. Ventolin
is the brand name of the drug and it belongs to bronchodilators. The patient was prescribed to
consume prednisolone, which is also used in the treatment of curing allergic reaction such as
respiratory tract infection and asthma. Ipratropium is also another type of drug used to cure
asthma.
Salbutamol is given to uncover the massive and medium lung airways and thus
helping in curing the asthma condition, chronic pulmonary disease and bronchoconstriction.
The drug is also prescribed to treat and reduce the high potassium concentration that is
present the blood. It is taken by the help of inhaler, which is useful in lowering the condition
within a maximum time of 15minutes after taking the inhaler. It belongs to the group of beta
agonist, which is used in relaxing the muscles of the lungs airways. The drug is consists of
butyl group which is very much reactive with the beta-receptors which are the main
predominant receptors present in the smooth muscles of bronchus (Zamani et al., 2015). The

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activated receptors secretes adenylyl cyclase which converts the adenosine triphosphate in to
cyclic adenosine monophosphate which in turn activates the signalling cascade resulting in
the inhibition of the inflammation in the cells and also to stop the production of myosin
phosphorylation and cytokines that are highly essential for muscle contraction. It also
increases the channel sensitivity of sodium and potassium, which is helpful in having a
hyperpolarisation condition resulting in relaxation of muscles within the lung airways
(Ullmann, Caggiano & Cultrera, 2015).
Ipratropium belongs to the family of acetylcholine antagonist drug which works
together with cholinergic muscarinic receptor present in the body. The cyclic guanosine
production is decreased because of the blockage in the muscarinic receptor (Saab & Aboeed,
2019). The overall receptor functions to decrease the smooth muscle contraction of the
airways of lungs resulting in muscular dilation. The drug triggers parasympathetic response
of the body when taken through the nasal pathway resulting in less quantity of water
secretion from the musical glands of the body and thus improving the non-allergic and
allergic asthma condition (Saab & Aboeed, 2019).
The corticosteroid drug known as prednisolone, known as anti-inflammatory drug is
generally used in the treatment of allergic responses of the body and breathing problems. The
compound named prednisone is converted into prednisolone after consumption. The
corticosteroid binds to the receptor of the glucocorticoid and inhibits the inflammation of the
cells thereby supressing the inflammatory response (Schijvens et al., 2019).
Medications prescribed to the patient in the case study
The patient in the case study was advised to consume a dose of salbutamol 100ug
12puffs because it is helpful for delivering relief from instant asthma attack. It reduces the
symptom of wheezing and coughing. It is also given for the treatment of exercise induced

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asthma along with curing the allergic response of the body. The time of the drugs response
begins after consumption period of 4 to 6hours (Ullmann, Caggiano & Cultrera, 2015). Oral
prednisolone of 1mg/kg that was given helps in resolving the condition of inflammation by
reducing the autoimmune reaction that has occurred into the body. It is also used in the
treatment of respiratory tract infection and thereby reducing the allergic reaction. The child
was also administer 8puffs of ipratropium for reducing the condition allergy as it is a beta-
agonist that are used for a short period of time (Schijvens et al., 2019). The patient was also
given the combination of both salbutamol and ipratropium for to reduce the symptom of
breathing problem along with resolving the problem of tightness in chest, wheezing and pain.
Inhalers were given for this purpose as it helps in passage of the drug directly into the lungs
along with the airways thereby relaxing the sudden attack of asthma (Iramain et al., 2019).
Pharmacokinetics of the drugs
The ipratropium is drug that is usually prescribed to administer by the help of both
nasal pathway and oral pathway. The nasal mucosa helps in effectively transporting and
absorption into the systemic circulation. It is more effective because the oral drugs are not
usually absorbed into the systemic circulation and shows its affectivity after administration
period of 4 to 5hours. The reason behind using this drug in this patient because it helps in
resolving the sudden exacerbation of asthma. This drug reaches the pick after 3 hours of
consuming with the help of inhaler. The liver metabolise this drug and helps in its conversion
to salbutamol 4’O sulphate, after that the drug is excreted in form of metabolites from the
kidney. It also has the capacity to cross the blood brain barriers and its availability is more in
the plasma (Saab & Aboeed, 2019). Prednisolone is rapidly absorbed by the body and reaches
the peak after 1 to 3 hours. The kinetics of the drug depends upon its dose which in turn
depends upon the protein binding capacity. The action is dependent upon certain enzymes
along with phenytoin, corticosteroids and rifampicin (Schijvens et al., 2019).

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References
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