Allergic Asthma Management: A Case Study of Tegan Smith

This case study focuses on Tegan Smith, a six-year-old child presenting with symptoms suggestive of allergic asthma following a move to Alpine Resort. The analysis delves into the likely diagnosis of allergic asthma, considering the familial history of allergies and the new environmental exposure. It e...Read More

Type of Asthma.
Tegan smith, a six years old has developed signs that are suggestive of asthma. In view of the
circumstances that have led to the condition, it is most likely an allergic asthma. Asthmas can be
categorized according to the triggers. It may be non-allergic, exercise triggered or even
occupation triggered. Tegan has developed these symptoms after they moved to Alpine Resort.
Non allergic asthma occurs devoid of any allergies but occurs following an infection triggered by
a flu or cold. A change in climate may result into such. However, in this case, Tegan developed
about a year after they moved to Alpine resort. This rules out the possibility of this type of
asthma.
The asthma is most likely allergic in nature. There is a familial history of an allergy from the
mother, sinusitis and nasal polyps. There is a very high likelihood of asthma and allergy
developing in the child if it is passed (Mahmoudi, 2016). Asthma and allergy can develop at any
particular time in life. An allergy is a hypersensitive reaction by the body against a harmless
antigen. In this situation, Tegan may have been exposed to a new environment and new allergens
that has triggered a response.
When the body encounters an antigen for the first time, the body immune system recognizes it as
foreign. The first encounter does not prompt the production of many IgE antibodies. But
subsequent exposures may lead to a more severe reaction that will lead to the presentation of
signs and symptoms of asthma (Malone, 2016). It took some time to develop after exposure.
Pathophysiology.
Asthma involves a series of events that eventually lead to its presentation. According to
Kaufman (2011), these events include: inflammation of airway, obstruction and hyper

responsiveness. The body immune system takes a central role in the course of asthma. The body
recognizes an allergen through the antigen presenting cells. They present the antigen to the B
cells an T cells. B cells differentiate into plasma cells, producing antibodies against the antigen.
T helper memory cells are also formed. in the subsequent reactions, the onset of production of
antibodies will be faster when the memory cells are activated. IgE antibodies are formed and are
found on the surface of mast cells. An encounter with an antigen that results in cross matching of
two IgE on the same mast cell degranulation. This leads to an inflammatory response at the site.
An inflammatory response is characterized by increased eosinophil infiltration and increased
secretion of fluid and mucus into the airway lumen (Killeen& Skora, 2013). This results in
obstruction of the airway resulting in labored breathing and wheezing. Insufficient oxygenation
of blood is associated with a feeling of fatigue due to insufficient oxygen delivery to the brain.
The increased agitation is also a neurological manifestation associated with decreased oxygen
supply. The presence of mucus in the bronchiole triggers a cough reflex to clear it from the
airway. The heart rate and respiratory rate rise as a consequence increased carbon dioxide levels
in blood. All these symptoms result due the changes attributed to asthma.
Treatment options for Asthma.
Asthma is essentially managed rather than treated. The management plan is formulated based on
the age of the patient and the pattern of the condition. The two main categories of drugs used are
relievers and preventers. Some corticosteroids such as prednisone are used in severe flare ups
The initial treatment is based on the presenting symptom at the time of diagnosis. Adjustment is
made later on the basis of severing a preventing flare ups. Relievers are a standard medication
for any asthma patient (Chung et.al, 2013). They are used to offset the presenting symptom.

In adults and adolescents, all have a reliever medication to offset symptoms such as wheezing.
Most patients require a small dose of an inhaled corticosteroid as a preventer. These patients
must satisfy some requirement. They have had symptoms of asthma twice in the past month,
woken up by symptoms or has had a severe flare up that necessitated him to visit a general
practitioner in the last 12 months. Combined therapy is sometimes implemented by using another
drug such as a bronchodilator with the corticosteroid. Bronchodilator may short acting or long
acting beta agonists. The level of the preventer is dependent on severity of asthma.
For children at the age of 6 years and above, the preventers may need to be taken more often
especially if they will require to take more than twice in a week. Also this may apply for those
having flare ups more often. Preschool children may do not need preventer unless the wheezing
is preventing proper breathing (Leung et.al, 2015)
Standard asthma management education.
Before discharging asthma patient, they or their care providers should be educated on how to
manage this condition. In the case of Tegan Smith, she and her parents should be educated.
Management goals should be discussed after conducting a diagnosis that confirms the condition.
Choosing the initial treatment is based on the presenting symptom. The action plan should be
written down to emphasize on the important goals.
They should be educated on the triggers of asthma (cabana et. al,2014). They should completely
avoid some such as smoking. For those others they should aim at reducing them though it may be
impossible. This is part of changing their lifestyle to accommodate the changes. They should
avoid all causes of allergy. good nutrition including mostly fruits is recommended. They are also
encouraged to participate in physical activities. They should avoid some drugs which may induce

asthma such as aspirin. Co-morbidities such as allergic rhinitis should be managed. Influenza and
pneumococcal vaccines are recommended.
They should be educated on the correct usage of medication. They should be advised on the
correct inhaler technique (Hamdan et. al, 2013). There are three inhaler types: standard
pressurized metered dose inhaler, breath activated pressurized metered dose inhaler and dry
powder inhalers. When using a metered dose inhaler, they should use a spacer. Sometimes a
spacer and an age appropriate face mask are used to enhance on the delivery.
They should be informed and encouraged to practice maximum adherence in taking the drugs to
ensure their effectiveness as either relieving or preventive.
References.
Mahmoudi, M. (2016). Allergy and Asthma.
Malone, M. A. (2016). Allergy Primer for Primary Care, An Issue of Primary Care: Clinics in
Office Practice, E-Book (Vol. 43, No. 3). Elsevier Health Sciences.
Kaufman, G. (2011). Asthma: pathophysiology, diagnosis and management. Nursing Standard
(through 2013), 26(5), 48.
Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma
in the adult. Nursing Clinics, 48(1), 11-23.
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P.
(2013). International ERS/ATS guidelines on definition, evaluation and treatment of severe
asthma. European Respiratory Journal, erj02020-2013.

Leung, D. Y., Szefler, S. J., Akdis, C. A., Sampson, H., & Bonilla, F. A. (2015). Pediatric
allergy: principles and practice. Elsevier Health Sciences.
Hamdan, A. J., Ahmed, A., Abdullah, A. H., Khan, M., Baharoon, S., Salih, S. B., ... & Al-
Muhsen, S. (2013). Improper inhaler technique is associated with poor asthma control and
frequent emergency department visits. Allergy, asthma & clinical immunology, 9(1), 8.
Cabana, M. D., Slish, K. K., Evans, D., Mellins, R. B., Brown, R. W., Lin, X., ... & Clark, N. M.
(2014). Impact of physician asthma care education on patient outcomes. Health Education &
Behavior, 41(5), 509-517.