Exploration of Pharmacology Case on Asthma in a Five-Year-Old Child

Exploration of Pharmacology Case
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Introduction:
Asthma is a chronic inflammatory and allergic disease associated with symptoms like
insufficient breathing, coughing and wheezing. Childhood asthma is more prevalent and
nocturnal cough is the most prominent symptom of it. Patient in this case, Jessica is having
asthma. She is five-year child and she is showing symptoms like cold, nasal discharge, nocturnal
cough and breath shortness. Risk factors responsible for the occurrence of asthma are cold air,
exercise, pollen and viruses. It can also occur due to medications like aspirin and β blockers.
Genetic factors also play major role in the occurrence of asthma. Type 1 hypersensitivity
reactions occur in asthma. In this paper different aspects of asthma in Jessica are discussed.
These aspects include pathophysiology, treatment and symptoms related to the asthma.
Pharmacology:
Constriction is a prominent feature of asthma. Constrictions of the airway can lead to the
constriction of muscle surrounding chest which results in the tightness of the chest. Breathing
problem in the asthma patients results in the lowered oxygen saturation in asthma patients which
results in the diminished supply of oxygen to muscles and cells. Deficiency of oxygen can lead
to development of fatigue in asthma patients. Patients with progressive and worsening asthma
exhibit nocturnal asthma which results in insomnia and fatigue in the daytime (Krishnan et al.,
2012; S124-35).
Bronchoconstriction produces shortness of breath in Jessica. Hence, bronchodilator such as
salbutamol was being administered to her. Salbutamol in the form of inhalation is useful as
bronchodilator in asthma patients. Inhaled salbutamol exhibits peak plasma concentration at 3 –
4 hours after inhalation. Hence, Jessica can get relieved from the breathlessness after 3 – 4 hours
after its administration. Inhaled salbutamol exhibits average plasma half-life of 4 – 6 hours.
However, literature indicate that salbutamol can exhibit bronchodilation within five minutes of
its administration, irrespective of the plasma concentration. Hence, inhaled salbutamol can
exhibit its efficacy upto approximately 20 hours because concentration of drug become
approximately negligible after 4 half-lives. Salbutamol metabolism occurs through phase II
metabolism and it produces glucuronide and sulphated conjugates. Approximately 85 % of the
inhaled drug can be detected in the urine after 48 hours. It indicates that there is not complete
elimination of drug in Jessica after 48 hours. Hence, there can be bronchodilation and
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improvement in breathing in Jessica within five minutes of its administration and it can lasts upto
4 – 6 hours.
Inflammation is the main mechanism responsible for the occurrence of asthma. Henceforth, to
reduce this inflammation, anti-inflammatory medication such as prednisone is being
administered to Jessica. Prednisolone exhibits peak plasms concentration at around 1 – 3 hours.
Hence, it exhibits maximum anti-inflammatory effect at around 3 hours. From the literature, it is
evident that there is no correlation exists between the plasma concentration of prednisolone and
clinical response. However, it can be considered that alternate day administration with
fluctuating plasma concentrations can be considered as the most effective regimen for the
administration of prednisolone. However, in case Jessica, STAT dose of prednisolone is advised
because she is exhibiting breathlessness. Breathlessness can occur in Jessica due to
bronchoconstriction as a result of inflammation and its medicators. Hence, emergency
administration of prednisolone is advised in Jessica. Plasms half-life of prednisolone is 2.1 to 3.5
hours. Hence, it can exhibit its effect upto 10 – 12 hours (Bergmann et al., 2016).
Ipratropium inhalation can be used as broncholytic agent in asthma patients. It can be useful to
open the congested respiratory tract in asthma patients. Bioavailability of ipratropium is between
1 – 6 %. Half-life of inhaled ipratropium is 2 hours. Hence, this drug can produce its effect upto
approximately 6 hours after its administration. Ipratropium can be excreted in urine and feces as
unchanged and as metabolites. It produces eight metabolites, however none of the metabolites
are active as anticholinergic drug. It gets metabolized in inactive ester hydrolysis products.
Ipratropium bromide is being given to Jessica for three times with 20 minutes apart duration
(Norris & Ambery, 2013). Hence, it can be useful in maintaining required concentration for
exhibiting broncholytic effect in Jessica.
Symptoms:
Jessica is showing symptoms line coughing and wheezing. Coughing is the most common
symptom of asthma. In asthma patients, cough can be of two types like dry cough and wet cough.
In children of Jessica’s age, there can be augmented intensity and frequency of cough at the night
time. It is called as nocturnal cough (Ng & How, 2014; 36-41). Cough have categorized into
productive and nonproductive cough. In productive cough, phlegm can be expelled; hence
bacteria and other particles can have eliminated from the respiratory tract. Henceforth, it is
considered as one of the defense and protective systems of the body. However, majority of the
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