Clinical Scenario Interpretation: Asthma Case Study Analysis Report

This assignment presents a clinical scenario involving a patient with symptoms of dyspnea and chest tightness, leading to a diagnosis of allergic asthma. The analysis delves into the supporting data for the diagnosis, identifying triggers such as pollen and dog fur, and exploring the exacerbating factors like occasional smoking and the presence of a roommate with a dog. The assignment examines the pathophysiologic concepts, including the effects of beta-blockers and NSAIDs on the condition, and describes the early events causing the pathogenesis of the disorder, such as bronchoconstriction and airway inflammation. It further explains the mechanisms leading to chronic airway inflammation and hyperresponsiveness, as well as the pathologic mechanisms behind wheezing. The assignment predicts pulmonary function test results and identifies potential complications, such as status asthmaticus, that require monitoring. The analysis is supported by references to relevant medical literature.

Running head: Clinical Scenario Interpretation 1
Clinical Scenario Interpretation
Name:
Institution:

Clinical Scenario Interpretation 2
Clinical Scenario Interpretation
Questions
1. The clinical scenario is most consistent with which diagnosis?
 Allergic Asthma
2. What data in the clinical scenario supports your diagnosis?
 Her symptoms of dyspnea and chest tightness are intermittent but are more severe in
spring when the trees begin to flower.
 The patient's symptoms have worsened and lasted longer in the past three months,
which is consistent with the moment the roommate moved in with the dog and
triggered her asthma from the fur.
 The patient presents with end-expiratory wheezing.
 The patient is an occasional smoker.
 Her father has a history of asthma.
3. What may be triggering this patient’s exacerbation of the disorder identified in
question 1?
 The symptoms tend to be worse during spring months when there is hay fever from
pollen.
 Dog’s fur
4. Describe the key pathophysiologic concepts (complete sentences, 1-6 sentences)
a) What two medication drug classes may trigger an exacerbation of dyspnoea
in a person with the disorder identified in question 1?
Beta-blockers are known to worsen dyspnoea, as they can cause a more significant
increase in airways resistance, and hence, should be carefully reviewed in patients with
asthma (Weinberger, 2020). Unless there is a compelling indication for their use, the beta-

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blockers should be withdrawn slowly, and another alternative drug provided (Weinberger,
2020).
Non-steroidal anti-inflammatory drugs (NSAIDs) can bring severe consequences in
asthmatic patients. For instance, ketorolac can lead to the acute development of dyspnoea
(Fernandes et al., 2017). Also, asthmatic patients react severely to aspirin or other NSAIDs
by developing severe nasal congestion and severely watery nose accompanied by a
shortening of breath and rapidly progressing to bronchial obstruction (Makowska et al.,
2015).
b) Describe the early events responsible for the pathogenesis of the disorder
identified in question 1.
The woman presented with dyspnea. Dyspnea, as a result of bronchoconstriction, could
have caused the narrowing of the airway and consequently interfered with airflow (Cockcroft,
2014). One possible cause of bronchoconstriction is allergens such as hay fever from pollen
and dog fur, which the woman may have been exposed to and reacted to either or both of
them. Also, she is an occasional smoker, and smoking can influence asthma occurrence by
causing airway inflammation and airway hyperresponsiveness (Chatkin & Dullius, 2016;
Borak & Lefkowitz, 2015).
c) How does this result in chronic airway inflammation and airway
hyperresponsiveness?
Bronchoconstriction resulting from the response to stimuli such as dog fur and hay
fever causes airway hyperresponsiveness - a feature of asthma. The mechanisms that
influence chronic airway hyperresponsiveness comprise inflammation, as well as structural
changes (such as swelling of airway), and inflammation critically affects the extent of airway
hyperresponsiveness (Borak & Lefkowitz, 2015). The patient smokes occasionally, and this
habit is related to airway inflammation in asthmatic individuals that smoke (Thomson, 2017).

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d) Describe the pathologic mechanism that is responsible for this patient’s
wheezing.
Bronchoconstriction and airway obstruction led to the patient’s wheezing. Wheezing is
normally heard while exhaling since airways are often narrow throughout this point of
breathing (Gong Jr, 1990, p. 204).
e) What might you expect the results of her pulmonary function tests to be?
Why?
I expect abnormal pulmonary function tests (PFT) results with the two most common
PFTs: spirometry and methacholine challenge tests. The asthmatic patient will get dyspneic
with inhalation of methacholine aerosol and also experience difficulty in doing spirometry as
her airway gets constricted (Bohadana et al., 2018). Also, her wheezing will persist from the
start of the methacholine challenge test till the end (Bohadana et al., 2018).
5. For what actual or potential complications related to the diagnosis in question 1,
does she need to be monitored?
 Status asthmaticus

Clinical Scenario Interpretation 5
References
Bohadana, A. B., Rokach, A., Wild, P., & Izbicki, G. (2018). Asthma-like symptoms
induced by the methacholine challenge test: Do they predict a negative-to-positive
switch in the test result?—case report. Journal of Thoracic Disease, 10(10), E716-
E720. https://doi.org/10.21037/jtd.2018.09.63
Borak, J. B., & Lefkowitz, R. Y. (2015). Bronchial hyperresponsiveness. Occupational
Medicine, 66(2), 95–105.
https://academic.oup.com/occmed/article/66/2/95/2750597
Chatkin, J. M., & Dullius, C. R. (2016). The management of asthmatic smokers. Asthma
Research and Practice, 2(1). https://doi.org/10.1186/s40733-016-0025-7
Fernandes, V., Regateiro, F., Baptista, J., Alfaro, T., & Matos, M. (2017). Severe
ketorolac-induced asthma diagnosed by chest CT. Allergy and immunology.
https://doi.org/10.1183/1393003.congress-2017.pa4034
Gong Jr, H. (1990). Wheezing and Asthma. In Clinical Methods: The history, physical,
and laboratory examinations (3rd ed., p. 204). Butterworth-Heinemann.
Makowska, J., Lewandowska–Polak, A., & Kowalski, M. L. (2015). Hypersensitivity to
aspirin and other NSAIDs: Diagnostic approach in patients with chronic
rhinosinusitis. Current Allergy and Asthma Reports, 15(8).
https://doi.org/10.1007/s11882-015-0552-y
Thomson, N. C. (2017). Asthma and smoking-induced airway disease without
spirometric COPD. European Respiratory Journal, 49(5), 1602061.
https://doi.org/10.1183/13993003.02061-2016
Weinberger, S. E. (2020). Treatment of Hypertension in Asthma and COPD. Evidence-
Based Clinical Decision Support at the Point of Care | UpToDate.

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