Understanding Asthma: Etiology, Diagnosis, Pathogenesis, Treatment and Prevention

Running head: HEALTH VARIATION
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Name of the Student
Name of the University
Author Note

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Question 1
Jackson smith is an 18 years old male, having a history of asthma and who had been
admitted in to the ED with severe breathlessness. The signs and the symptoms of asthma
involves productive cough, chest tightness,, acute airway obstruction due to the narrowing of
the airway and the formation of the mucus plugs and wheezing due to the narrowing of the
airways.
The underlying pathophysiology behind the bronchoconstriction, airway hyper-
responsiveness and airway obstruction is the inflammation in the airways causing several
anatomical modifications in the airways (Brannan & Lougheed, 2012). The constriction is
mainly due to the contraction of the bronchial smooth muscle in response to a variety of
allergens.
Allergen induced bronchoconstriction is brought by the release of the IgE dependant
mediators from the mast cells which includes prostaglandins, leukotriene, histamines and
tryptase that contracts the muscles of the airways (Bonini & Usmani, 2015). Obstruction of
the airways gives rise to sounds of wheezing limiting the flow of air through the airways.
This is the main cause of the symptom of chest tightness in Mr. Smith. Wheezing is a kind of
musical sound that that is produced due to the limited airflow through the airways (Melen &
Pershagen, 2012).
Airway remodelling is the permanent changes that might occur due to inflammation.
Hypertrophy and hyperplasia of the airway smooth muscles can cause this change in the
airways and can be related to the progressive loss of the lung function that cannot be
reversible by the current therapy (Brannan & Lougheed, 2012). Furthermore the regulation,
repair and the remodelling process is still not well established. Airway hyper-responsiveness

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is also caused due to inflammation, dysfunctional neuro-regulation and the structural
changes.
The vital signs of Jackson Smith displays that he had a low oxygen saturation level,
which is a common symptom during an asthmatic attack. Low oxygen saturation can be
related to fact that less amount of oxygen reaches the blood for being carried to the cells.
Acute dyspnoea is also a common manifestation during the asthma exacerbations.
Jackson Smith was also found to be suffering from acute dyspnoea that is chest
tightness that was preventing him to talk. The intensity of the dyspnoea depends upon the
severity of the asthma, bronchoconstriction, dynamic hyperinflation, respiratory drive and
other physiological factors (Antoniu, 2010). According to a study Antoniu, (2010) chest
tightness was found to be associated with the mild bronchoconstriction and is attributed to the
vagal stimulation due to the increased resistance of the airways but not to the hyperinflation.
The respiratory rate of Mr. Smith was also found to be higher than the normal range, which
implies that the person has to take more breaths to meet the oxygen demand.
A diminished breath sound in asthma manifests the fluid or air accumulation round
the lungs or the thickening of chest walls, over inflation of the parts of the lungs or lessened
flow of the air flow in to the lungs (Melen & Pershagen, 2012). The chest x-ray displayed a
hyper-inflated lungs in asthmatic patients. Lung hyperinflation can be caused by the blockage
of the airway that resists the expulsion air from the lungs. However lung hyperinflation is
more common for the COPD patients and mild or moderate hyperinflation in the asthmatic
patients. A rise in the serum lactate levels can be found in the asthma patients (Melen &
Pershagen, 2012). This is due to the fact that when the oxygen level is low in the blood, the
carbohydrate breaks down for producing energy with a subsequent production of lactic acid.
As a result the lactate levels in the blood gets higher. Again it has been noticed that the

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administration of the Beta – agonist during the asthma treatment can also cause an abrupt
increase the concentration of the lactate in the blood (Rodrigo, 2014). Finally, the rapid pulse
rate of Jackson Smith is mainly due to the fact that the heart has to pump more quickly for
sending blood to different parts of the body due to the less oxygen concentration. Some
psychological factors comes in to play during asthmatic attacks that can be responsible for the
elevated pulse rate.
Question 2
Two high priority nursing interventions for managing the asthma attack in Jackson
Smith
 One of priority intervention is to increase the oxygen saturation level of Jackson Smith.
Since the oxygen saturation level of Jackson is not below 90 %, hence application of
oxygen therapy might not be helpful. It is necessary to assess the exacerbation by
monitoring the peak expiratory flow rates and forced expiratory volume as taken by the
respiratory therapist. Helping Jackson Smith to do a pursed lip breathing might increase
the oxygen saturation level.
 Rationale: Oxygen saturation refers to the fraction of the oxygen saturated haemoglobin
relative to the total haemoglobin present in the blood. The peak flow measure enables a
nurse to measure the airway obstruction and the severity of the exacerbations (Sue Jordan,
2011). Pursed lip breathing helps in increasing the oxygen saturation level by increasing
the probability of the entry of oxygen in the lungs.
 Another priority nursing strategy is the effective clearance of the airways. In Jackson
Smith it is necessary to clear the hyper-secreted mucus to get a clear airways. The
interventions include assessment of the respiratory rhythm, depth and rate, assessing for