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Asthma
Symonpeter Ndungu
Walden University
NURS 6501N-16
Instructor: Dr. Catherine Carpenter
October 6th, 2018
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Introduction
According to Huether& McCance (2017), Asthma is a chronic inflammatory disease that
is characterized by reversible airflow obstruction and airway hyperresponsiveness. Asthma
occurs in all ages and its prevalence is increasing. In the united states, there are approximately
6.8 million asthma cases in children and an approximate 18.7 million cases among adults (p.
698). According to Sims (2006), 40% of asthmatic adults visit an emergency department (ED)
every year and asthma is the sixth leading cause of hospitalization (p. 264). In this paper, the
writer will describe the pathophysiological mechanism of chronic asthma and acute asthma
exacerbation. This paper will also explain how ethnicity as factor might impact the
pathophysiology of both acute and chronic asthma disorders. Two mind maps, one for chronic
asthma and one for acute asthma exacerbation will be included in this paper too.
Pathophysiology of Chronic Asthma and Acute Asthma Exacerbation
Asthma is characterized by a process that involves airway inflammation, bronchospasm
and increased mucous production. For individuals who are sensitized, an acute asthma
exacerbation starts when the individual is exposed to an antigen which then triggers both an
innate and adaptive immune response. The early asthmatic response involves acute inflammatory
response from the mast cells that line the airway. Exposure to the antigen leads to the
degranulation of the mast cells which then releases inflammatory agent that include histamine,
bradykinins, leukotrienes and prostaglandins and interleukins. This response contributes the
narrowing of the airways and obstruction of airflow due to mucosal edema, increased mucous
production and bronchospasm (Huether& McCance, 2017, Sims, 2006).
The late asthmatic response begins four to eight hours after the early response and
involves inflammatory agents like eosinophils, neutrophils and lymphocytes which again cause
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bronchospasm obstruction to airflow due to excessive mucous secretion. Release of mediators
like leukotrienes and bradykinins leads to vasodilation and bronchial muscle constriction that
causes further bronchospasm, inflammation and permeability in the airway. This process leads to
a situation where excessive mucous further narrows the already constricted airways. Airway
obstruction leads to increased resistance to airflow which decreases flow rates, especially
expiratory flow and thereby causing air trapping, hyperinflation to areas distal to the obstruction
and increased work of breathing. This leads to early hypoxemia without CO2 retention. Further
hypoxemia increases hyperventilation which causes decrease in Paco2 and pH to increase
thereby causing respiratory alkalosis. If the situation is not treated, it leads to a decrease in tidal
volume, increased CO2 retention, a decrease in Pao2 and decrease in serum pH which indicates
respiratory acidosis and impaired gas exchange. If this inflammation continues without
treatment, it can lead to a long-term airway damage that is irreversible, known as airway
remodeling(Huether& McCance, 2017, Sims, 2006).
Asthma and Ethnicity
According to Carroll (2013), there is a marked racial difference in asthma prevalence and
morbidity. Carroll (2013) states that compared to non-Hispanic white children, Non-Hispanic
Black and Puerto Rican children have higher incidences of asthma of 1.6 and 2.4 respectively.
This higher rate of asthma is as a result of disproportionate access to preventive care and overuse
of the emergency care rather than primary care offices due lack of insurance which is
compounded by lack of medications such as corticosteroid inhalers needed for long-term
management of asthma (Carrol, 2013).
Diagnosis and Treatment
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According to Huether& McCance (2017), the evaluation of an acute asthma attack
requires rapid assessment of arterial blood gases and expiratory flow rates and a search for the
underlying triggers. To make a diagnosis of asthma, the advanced nurse practitioner (NP) needs
to quickly assess the patient’s history of allergies, assess any recurrent episodes of wheezing,
dyspnea, cough or exercise intolerance and do further evaluation of the patient’s spirometry and
a study of the patient’s chest x-ray (Huether& McCance (2017).
According to Sims (2013), the goals of asthma treatment includes the following;(1.)
maintaining normal pulmonary function tests, especially peak flow; (2.) preventing or reducing
the number of exacerbations; (3.) identifying triggers; (4.) reducing exposure to possible triggers;
(5.) patient education; (6.)maintaining normal activity levels; (7.) relieving acute episodes; (8.)
preventing or reducing the number of ED visits; and (9.) improvingthe patient’s quality of life.
The NP will also need to make efforts to keep the patients oxygen saturation at greater than 90%
to 95% or maintaining a partial pressure of oxygen at 92 mm Hg. If need be, high-flow oxygen
may beadministered with a partial or complete nonrebreather mask (p. 266). To achieve these
goals, the NP should consider ordering the following medications: Bronchodilators e.g. Albuterol
that cause smooth muscle relaxation and thereby reliving the patient from spasm. Typically,
these medications are administered via a metered dose inhaler or via a nebulizer. For longer
acting maintenance treatment, the NP should consider prescribing salmeterol (Sims, 2013).
Conclusion
Without proper and immediate intervention, asthma can quickly cause death due to
respiratory failure. It is therefore critically important for the healthcare provider to educate
asthmatic individuals to always carry their prescribed asthma medication.
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References
Asthma and Allergy Foundation of America. (2015). Asthma. Retrieved from
http://www.aafa.org/asthma/
Carroll, K. (2013). Socioeconomic status, race/ethnicity, and asthma in youth. American Journal
of Respiratory and Critical Care Medicine, 188(10), 1180-1. Retrieved from
http://ezp.waldenulibrary.org/login?url=http://search.proquest.com/docview/
1462037662?accountid=14872
Clancy, J., & Blake, D. (2013). Pathophysiology and pharmacological management of asthma
from a nature-nurture perspective.EPrimary Health Care,E23(7), 34–41. Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?
direct=true&db=rzh&AN=104223888&site=ehost-live&sc623322ope=site
Hammer, G. G., & McPhee, S. (2014).EPathophysiology of disease: An introduction to clinical
medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017).EUnderstanding pathophysiology"(6th ed.). St. Louis,
MO: Mosby.
Sims JM. (2006). An overview of asthma.EDimensions of Critical Care Nursing,E25(6), 264–268.
Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/
login.aspx?direct=true&db=rzh&AN=106227803&site=ehost-live&scope=site
Chronic Asthma
Pathophysiology
Inflammation and narrowing of
the airways
Cells produce thicker mucus
Smooth muscle contractility
B cells to produce
immunoglobulin E
Tissue injury
Airway obstruction
Clinical Presentation
Coughing
Shortness of breath
Chest tightness
Wheezing
Complications
Signs and symptoms that interfere with sleep, work or recreational activities
Sick days from work or school during asthma flare-ups
Permanent narrowing of the bronchial tubes
Emergency room visits and hospitalizations
Side effects from long-term use of medications
Management
Prevention
Follow asthma action plan
Avoid triggers
Take medications as prescribed by a
doctor
Diagnosis
Family and medical history
Physical Assessment
Pulmonary function tests
Epidemiology
26 million people in the United States
7 million are children
Risk Factors
Having a blood relative with asthma
Having another allergic condition
OverweightSmoker
Exposure to secondhand smoke
Exposure to triggers
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Acute Asthma Exacerbation
Pathophysiology
Swollen and inflamed airways
Muscle contractility
Narrow bronchial tubes
Clinical Presentation
Shortness of breath
Chest tightness or pain
Coughing or wheezing
Complications
Asthma attacks can interrupt everyday activities and can disrupt the lives of those around you
Trips to the emergency room, which can be stressful and costly
A very severe asthma attack can lead to respiratory arrest and death
Management
Prevention
Follow asthma action plan
Avoid triggers
Take medications as prescribed by a
doctor
Diagnosis
Family and medical history
Physical Assessment
Pulmonary function tests
Epidemiology
26 million people in the United States
7 million are children
Risk Factors
Previous asthma attack
Use more than two quick-relief inhalers a month
Have other chronic health conditions
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