Vodcast Presentation on Asthma: Symptoms, Pathophysiology and Pharmacological Management

This vodcast presentation provides an overview of asthma, its types, symptoms, and pathological changes during an asthma attack. It also covers the pharmacological management options available, including the mechanism of action of salbutamol and its administration routes. The presentation also includes educational advice on the correct use of inhalers, appropriate adherence methods to asthma medications, and the right behavioral strategies to prevent incidents of status asthmaticus.

Asthma

Client details
Name: Stephen Adler
Gender: Male
Age: 27 years old
Health condition: Asthma
Healthy Weight range: Normal
Exercise: 1- 2 times a week
Occupation: Clerk
Living status:Stephen lives with his parents and one younger brother
Family history: Nothing relevant
Pregnant: NA
Smoker: Chain Smoker
Alcohol: enjoys alcohol intake occasionally
Medications: Salbutamol

Asthma overview
Asthma is restrictive respiratory condition where inhalation (part
of respiration cycle) becomes restricted. It occurs due to
bronchospasm triggered by certain intrinsic or extrinsic factors.
Both psychological factors and inhalation of allergens play a very
vital role in development of an asthmatic attack (Lambrecht &
Hammad 2015).
Asthma can be of three types :-
Exercise-induced asthma – because of strenuous activity.
Occupational asthma – caused by gases, chemical and dust
Allergy-induced asthma – can be caused due to allergens such as
dust particles mold spores, pollen grains.

SYMPTOMS OF ASTHMA
Picture link :https://www.vectorstock.com/royalty-free-vector/asthma-symptoms-with-
coughing-cartoon-person-vector-21042472

Pathological Changes occur during
asthma attack
Bronchial smooth muscle contraction – in asthma, there
is bronchospasm which is the bronchial inflammation due
to over-secretion of activating inflammatory cells,
recruited inflammatory cells, inflammatory mediators,
like T-lymphocytes or mast cells (Akinbami Simon &
Rossen, 2016). . There is repetitive bronchospasms and
the muscle mass of the bronchial smooth muscle is very
increased (Mannino, 2017). The matrix proteins
(extracellular) deposition is plays a very important role in
pathogenesis of the asthmatic attack.

PATHOPHYSIOLOGY OF ASTHMA
Increased mucus production – there is an increased mucus
production due to over-activity of the mucous producing glands
in asthma. In the patient, chain smoking has led to mucus stasis,
over activity of secretory cells and functional disruption of the
airway surface fluid leading to increased mucus production
(Pavord et al., 2018).
In the patient, smoking and reduced physical activity (due to
very low exercise and sedentary lifestyle) has led to further
deterioration or aggravation of the asthma symptoms in Stephen.
 picture link - http://adultemergencymedicine.blogspot.com/
2014/11/asthma-pathophysiology-and-clinical.html

Clinical Manifestation
 Wheezing
 Dyspnoea
 Chest tightness
 Squealing sound when exhaling
 Trouble sleeping caused by shortness of breath, coughing or
wheezing
 The two specific manifestations of asthma are :-
 Hypoxia: is caused by blockage of oxygen supply and decreased
amount of oxygen perfusion to the tissues.
 Dyspnea: intense situations of shortness of breath triggered by
allergens and resultant bronchospasms.
 In the case study, the symptoms of Asthma includes dyspnea and
chest tightness.
picture link : https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-2-21/figures/2

Pathophysiology in advanced stage
In the advanced stages of Asthma – there is permanent
damage and remodelling to and of the respiratory tissues
which occurs by these three processes :
1. hypertrophic growth of the smooth muscle
And thickened basal membrane
Collagen deposition
This is followed by oedema, obstruction and partial recovery
and again the repetition of the processes.

• The pharmacological treatment of asthma is symptomatic
and focusses on preventing the airway obstruction, recurrent
inflammations and preventions of the vigorous exacerbations
related to asthma.
• Glucocorticoids and Beta2-adrenoceptor agonists are
considered as the most effective drugs.
• Anticholinergics, Leukotriene, theophylline receptor are
third line of drugs used in the pharmacological management
of asthma (Terl et al.,2017).
• The overall medication (or pharmacological management) is
targeted increasing the bronchodilation and reducing the
development of exacerbation (Nair et al., 2017).
Pharmacological management
Stephen will be using salbutamol over
inhaled corticosteroids as the latter has side
effects like cough, sore throat and oral
thrush.

Salbutamol – mechanism of action (systemic and topical)
Systemically, beta-2 adrenergic agonists primarily act on
layers of smooth muscle lining the vasculature, intestines,
bronchial tree and on liver stimulating the process of
glycogenolysis and consequent releasing glucose. (Bryant &
knights 2015; Broyles et al., 2017).
After inhalation, salbutamol acts on bronchial smooth
muscles, topically, releasing the bronchospasms.
This is the mechanism of action of salbutamol in Stephen.
Picture link: https://www.canadapharmacyonline.com/blog/
Salbutamol-Inhaler-for-Asthma.html

The administration route of Salbutamol is : -
1. Oral
2. Aerosol inhaler
3. Nebulizer
The three routes of the administration of
salbutamol depends on condition of patient
as in physical status and respiratory status.
In the case study Stephen takes salbutamol
during status asthmaticus or asthma attack.
Salbutamol- Administration Route
Picture link :http://iambixfabe.blogspot.com/2012/04/scary-
asthma-attacks-ventolin-nebule.html

Stephen should be taught about –
1. The correct use of inhalers
2.Appropriate adherence methods to
asthma medications
3.The right behavioral strategies to
prevent the incidents of status
asthmaticus.
4.The right pharmacological and non
pharmacological coping mechanisms.
5. Teaching the patient the right ways of
inhaler handling
Educational Advice
https://foodallergycanada.ca/food-allergy-basics/food-
allergies-101/food-intolerances-and-other-conditions/
asthma/

References
Akinbami, L.J., Simon, A.E. & Rossen, L.M., (2016). Changing trends in asthma prevalence among children. Pediatrics, 137(1), p.e20152354.
Broyles, B., Reiss, B.S., Evans, M.E., Mckenzie, G., Pleunik, S., & Page, R. (2017). Pharmacology in Nursing (2nd ed.). Cengage Learning Australia.
I used this Book to gain knowledge of medication for asthmatics.
Bryant, B., & knights, K. (2015). Pharmacology for health professionals (4th ed). Chatswood, NSW: Elservier.
I used this book to examine the medication which is use for asthmatics.
Lambrecht, B. N., & Hammad, H. (2015). The immunology of asthma. Nature immunology, 16(1), 45.
Mannino, D. M. (2017). Improving Outcomes in the Management and Treatment of Asthma. Journal of Managed Care Medicine, 20(1).
Nair, P., Wenzel, S., Rabe, K. F., Bourdin, A., Lugogo, N. L., Kuna, P., ... & Goldman, M. (2017). Oral glucocorticoid–sparing effect of benralizumab in severe asthma. New England Journal of Medicine, 376(25), 2448-2458.
Pavord, I. D., Beasley, R., Agusti, A., Anderson, G. P., Bel, E., Brusselle, G., ... & Frey, U. (2018). After asthma: redefining airways diseases. The Lancet, 391(10118), 350-400.
Terl, M., Sedlák, V., Cap, P., Dvořáková, R., Kašák, V., Kočí, T., ... & Zindr, V. (2017). Asthma management: A new phenotype‐based approach using presence of eosinophilia and allergy. Allergy, 72(9), 1279-1287.
Picture link :https://www.vectorstock.com/royalty-free-vector/asthma-symptoms-with-coughing-cartoon-person-vector-21042472
The asthma symptoms has been depicted.
picture link : https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-2-21/figures/2
The re-modeling of bronchioles has been shown, which is an important manifestation of Asthma.
picture link - http://adultemergencymedicine.blogspot.com/2014/11/asthma-pathophysiology-and-clinical.html
The narrowing of the bronchioles has been depicted.
Picture link: https://www.canadapharmacyonline.com/blog/Salbutamol-Inhaler-for-Asthma.html
The design of salbutamol inhaler has been shown
Picture link : https://foodallergycanada.ca/food-allergy-basics/food-allergies-101/food-intolerances-and-other-conditions/asthma - the inhalation technique of salbutamol is depicted in this picture
https://foodallergycanada.ca/food-allergy-basics/food-allergies-101/food-intolerances-and-other-conditions/asthma
Picture link :http://iambixfabe.blogspot.com/2012/04/scary-asthma-attacks-ventolin-nebule.html