Asthma Case Study: Diagnosis, Treatment, and Management

This assignment presents a case study of a patient, Tegan Smith, potentially suffering from allergic asthma. The analysis begins with a diagnosis based on the patient's symptoms and family history, highlighting the role of genetics in allergic asthma. The assignment then delves into the pathophysiological changes affecting airflow limitation in asthma, including bronchoconstriction, airway edema, hyperresponsiveness, and remodeling. It further explores treatment options, such as reliever and preventer medications, including the use of inhalers and corticosteroids. Finally, the assignment outlines standard asthma management education for parents and children before discharge, focusing on skill training for inhaler use, adherence to medications, and the provision of a written action plan. The assignment incorporates relevant references to support the analysis.

Running head: ASTHMA 1
Asthma
Name
Institution

ASTHMA 2
Asthma
Question 1
From the provided case study, it is evident that Tegan Smith could possibly be suffering
from allergic asthma. Allergic asthma is the most common type of asthma and it is usually very
severe among adults who are diagnosed with it during adulthood. This type of asthma tends to
run in the family and thus genetics play a role in whether an individual will have allergic asthma
if one of their family members has it (Mukherjee & Zhang, 2011). From the scenario that we are
presented with, we are informed that Tegan’s mother, Christine Smith has a history of sinusitis,
nasal polyps and allergy. This implies that Tegan must have inherited this condition from her
mother.
Allergic asthma has several symptoms that include shortness of breath, coughing,
wheezing, and tightness in the chest. In addition, Tegan also displays other symptoms that
include watery eyes, stuffy nose, and postnasal drainage (Mukherjee & Zhang, 2011). Normally,
these symptoms start showing when an individual inhales allergens which in Tegan’s case, had
been a week earlier. Furthermore, she is has dyspnea and agitations despite treatments an
indication that the condition has become severe.
We can also notice that her respiratory rate increases to 35 breaths per minute which is
higher than the normal rate. This could be an indication of tachypnea which can be described as
rapid shallow breaths. She also has an abnormally high heart rate of 125 bpm and her pulsus
paradoxus also increases to 30 mmHg which are other characteristics of allergic asthma.
Question 2

ASTHMA 3
Several pathophysiological changes affect the airflow limitation in asthma. Some of these
changes include bronchoconstriction, airway edema, airway hyper-responsiveness, and airway
remodeling. Bronchoconstriction is described as the contraction of the bronchial smooth muscles
thus leading to narrowing of the airway which in-turn interferes with airflow (Murphy &
O’Byrne, 2010). Bronchoconstriction occurs rapidly to narrow the airway as a result of an
exposure to allergens and other irritants. Allergen-induced bronchoconstriction results from the
release of mediators such as histamine, leukotriene, tryptase, and prostaglandins which directly
leads to the contraction of the airway smooth muscle.
Airway hyperresponsiveness can be described as an exaggerated bronchoconstriction in
response to several stimuli and irritants. It is a major contributing factor in asthma. The clinical
severity of asthma, in most cases, determines the degree to which the hyperresponsiveness of the
airway can be defined due to contractile responses to methacholine challenges (Murphy &
O’Byrne, 2010). Mechanisms such as inflammation, structural changes, and dysfunctional neuro-
regulations affect the hyper-responsiveness of the airways.
Airway remodeling, on the other hand, can be described as the activation of the structural
cells which consequently leads to permanent changes in the airway thus increasing the
obstruction to airflow and may make the patient become less responsive to therapy. This
permanent change of the airway structure may be associated with the gradual loss of the lung
function (Bara, Ozier, De Lara, Marthan & Berger, 2010). Changes might involve sub-epithelial
fibrosis, dilation and proliferation of the blood vessels, hypersecretion of the mucous glands, and
thickening of the sub-basement membrane. Finally, airway edema further limits airflow as the
disease becomes more severe.

ASTHMA 4
Question 3
One of the most common treatment options for asthma is the reliever medication that is
administered by the use of an asthma spacer device. One of the reliever medications is the
inhaled short-acting beta2 that is normally very effective as a first aid medication for asthmatic
patients (Asthmaaustralia.org.au, 2018). Patients diagnosed with allergic asthma, like is the case
with Tegan are prescribed reliever medications for emergency purposes. This reliever medication
commonly comes in a device known as the metered-dose inhaler. This device is used to deliver a
specific dosage of medication to the lungs to help with airflow (Asthmaaustralia.org.au, 2018).
The relievers are available in most pharmacies in Australia without prescription.
Another available treatment option may be the use of preventer medication such as an
inhaled corticosteroid. This medication should be taken on a daily basis in combination with
relievers in case any symptoms are available. This medication is appropriate for patients who
have had any symptoms of asthma in more than once in the past one month (Bosnjak,
Stelzmueller, Erb, & Epstein, 2011). Preventer medication may sometimes involve a second
medicine in addition to the inhaled corticosteroid. This according to the Australian guidelines is
referred to as combined therapy.
Inhaled corticosteroid reduces the inflammation of the airways thus lowering an
individual’s risk of suffering a severe flare-up of asthma. It is normally administered in a low
dose to help in achieving good control for the symptoms of asthma (Lazarus, 2010). The
preventer is taken every day even in the absence of symptoms unless otherwise stated by the
doctor to avoid asthma flare-up.
Question 4

ASTHMA 5
Some of the standard asthma management education for the parents and their children in
moments preceding discharge is as described below.
Skill Training for an Appropriate Use of the Inhaler
It is important that the parent and the child are educated on the appropriate use of the inhaler to
enhance an efficient control of the symptom and avoid exacerbations. To ensure effective usage,
the doctor should choose the most suitable device for their patient before the prescription
(Ginasthma.org, 2018). It is further important to check the inhaler technique and use a physical
demonstration to show the patient the effective use of the device.
An Improved Adherence to the Medications
Most patients rarely take their medication as prescribed by the doctor. Non-adherence to
medication is another leading cause of poor control of asthmatic symptoms. Poor adherence may
be unintentional or non-intentional (Boulet, Vervloet, Magar & Foster, J2012). It is important to
engage the parents in a shared decision-making for the choice of dose and medication.
Additionally, reducing the complexity of the regimen could help in improving the adherence to
medication. Furthermore, it is important to perform a comprehensive education on the symptoms
of asthma and the management techniques.
A Written Action Plan
The patient should be provided with a written action plan that describes their asthmatic condition
to help them in the control and manage asthma by recognizing worsening asthma and
appropriately responding to them (Ginasthma.org, 2018). This action plan should have the

ASTHMA 6
asthma medications that are normally used by the patient, the procedure of increasing medication
if the need arises, and the way to access medical care if the symptoms persist.

ASTHMA 7
References
(2018). Asthmaaustralia.org.au. Retrieved 1 May 2018, from
https://www.asthmaaustralia.org.au/ArticleDocuments/1594/Asthma%20Schools
%20Guidelines%20Victoria%202017.pdf.aspx
(2018). Ginasthma.org. Retrieved 1 May 2018, from
http://ginasthma.org/wp-content/uploads/2016/01/GINA_Pocket_2015.pdf
Bara, I., Ozier, A., De Lara, J. T., Marthan, R., & Berger, P. (2010). Pathophysiology of
bronchial smooth muscle remodelling in asthma. European Respiratory Journal, 36(5),
1174-1184.
Bosnjak, B., Stelzmueller, B., Erb, K. J., & Epstein, M. M. (2011). Treatment of allergic asthma:
modulation of Th2 cells and their responses. Respiratory research, 12(1), 114.
Boulet, L. P., Vervloet, D., Magar, Y., & Foster, J. M. (2012). Adherence: the goal to control
asthma. Clinics in chest medicine, 33(3), 405-417.
Lazarus, S. C. (2010). Emergency treatment of asthma. New England Journal of
Medicine, 363(8), 755-764.
Mukherjee, A. B., & Zhang, Z. (2011). Allergic asthma: influence of genetic and environmental
factors. Journal of Biological Chemistry, 286(38), 32883-32889.
Murphy, D. M., & O'byrne, P. M. (2010). Recent advances in the pathophysiology of
asthma. Chest, 137(6), 1417-1426.