Asthma Case Study

Introduction

Today, the world has approximately 334 million people living with asthma. . Currently, there is an increasing rate of asthma infections among the people living in the middle and low-income nations. In the United States, statistics published in 2012 indicated that approximately 19 million adults lived with asthma whereas 7 million children had the condition. In 2013, asthma accounted for approximately 3,630 deaths in the United States. Several factors increase the chance of developing Asthma (CDC, 2015). They include obesity, overweight, smoking and exposure , occupational triggers and having close relatives with asthma. Asthma is a respiratory condition that causes inflammation of the air passage and the lungs. The recurrent attacks cause wheezing and breathlessness whose frequency and severity vary depending with the individuals (Nanda, 2015).

Pathophysiology

Patients with this condition experience an attack when exposed to stimulating factors, such as dust, smoke, perfume, animals and pollen among others. The stimulus causes inflammation on the walls of bronchus, causing the secretion of mucus. The muscles of bronchus also respond by causing repetitive spasms that constrict muscles of the bronchioles in the lungs. Stress and panic during an

attack contributes to an increase in cortisol and adrenaline levels; thus increasing the sensitivity of pulmonary nerves in the lungs. On detecting the dust or smoke, the posterior pulmonary plexus, they relay the message to the spinal cord through the thoracic sympathetic chain. The upper thoracic spine receives and sends the information to the brain (Brown, et al., 2013). Consequently, the brain activates the vagus nerve, a move that contributes to the increment in the rate of bronchial spasm and mucus production. In a normal circumstance, pulmonary plexus nerves respond when the level of stimulation is high enough to threaten a patient’s life. However, neurological mechanisms control the rate of asthma attacks through managing the degree of stimulation. In a failed initiation of an asthma attack the spinal cord fails to send messages to the brain. Nevertheless, a series of unsuccessful initiations leads sensitizes the nerves in the lungs. Therefore, small intensity of stimulation generates life-threatening actions (Brown, et al., 2013).
Clinical presentation of asthma begins with the presentation of the patient’s medical history. In the course of assessment, a doctor evaluates the patient’s social history that includes the features of home and work environments, use of the illicit drugs, the prevalence of asthma, eczema and others forms of allergy among close relatives, smoking, and factors that may hinder adherence to medication. A physician assesses the patient to determine his or her knowledge of the condition and support systems that improve the coping mechanisms (Nanda, 2015).
High-pitched sounds, coughing and wheezing are the common symptoms of asthma. In severe cases, wheezing occurs during inspiration and expiration, whereas in mild form, the patient experiences wheezing during expiration. Such differences occur depending on the extent of bronchial constriction that limits the flow of air to the lungs. Nevertheless, the obstruction of small airways leads to an asthma attack without wheezing (Nanda, 2015). Therefore, doctors should not always rely on wheezing to diagnose this condition. Conversely, wheezing can symbolize other conditions, such as heart failure and fibrosis. With the cases of nocturnal and exercise-induced asthma, the patient develops nonproductive cough after midnight and early morning, and after physical training respectively. Furthermore, adults or children with these forms of asthma may have history of chest tightness and pain without other asthma symptoms. In children, parent should evaluate them to persistent colds accompanied with coughs, chest congestion, recurrent bronchitis and pneumonia (Brown, et al., 2013).
During physical examination, physicians ensure that the patient experiences obstructed airflow that is irreversible. Furthermore, they ensure the absence of alternative diagnosis to ascertain the accuracy of their diagnosis. Acute asthma episodes can depict looming respiratory arrest. Besides, they can also be severe, mild or moderately severe. With the mild episode, patients experience breathlessness after physical activities. Such a condition arises from increased rate of respiration without the use of muscles, such as the heart that respond to respiration. In most of the cases, children with imminent respiratory attacks depict signs, such as confusion and drowsiness. However, these symptoms are present in adolescents with severe respiratory failure. The presence of diaphoresis accompanied by hypoventilation signifies increasing severity of the condition (Nanda, 2015).
Patients with moderate severe episodes have increased respiratory rate.

In children, doctors assess them for nasal flaring accompanied by intercostals and supraclavicular retraction. The heart rate increases to 120 beats per minute. Apart from the abdominal breathing, the patients also experience loud wheezing during expiration. Adults with this condition remain breathless as they talk, whereas the infants encounter feeding problems together with softer cries. Unlike other cases, patients with severe strains of asthma remain breathless when inactive, lack appetite, experience speech difficulties and are agitated easily. The heart rate also increases in addition to wheezing when breathing (Nanda,

2015).
With time, lung function and symptoms may worsen; thus characterizing the disease’s progression. Inflation of the airways alters their function by causing thickening of the reticular basement membrane. Besides, epithelial fragility, hyperplasia and hypertrophy of the smooth muscles, and hypertrophy of the glands that secrete mucus characterize airway remodeling. Both the adults and infants experience an increment in the number of inflammatory cells that include lymphocytes, eosinophils, and neutrophils. Neutrophil cells are common in patients with viral wheezing while eosinophil inflammation occurs in patients with other forms of allergies (Brown, et al., 2013).
Current Trends and Cultural Sensitive Care
The management of asthma assumes a combination of medications and other therapeutic methods. Currently, beta-2 and inhaled corticosteroids are the critical medications used for the prevention of exacerbations. The bronchodilatory abs anti-inflammatory effects of the two drugs battle multiple causes of asthma. With the patients who use inhalers, physicians recommend those that contain a combination of fluticasone and albuterol. Bronchial thermoplasty is an emerging therapy that involves the use of a flexible bronchoscopy to distribute of radio frequency energy in the airways to prevent constriction of the smooth muscles. Furthermore, doctors consider combining oligonucleotides and an allergen to reduce the chances of responding to allergen-induced asthma (Nanda, 2015). The method is superior to immunotherapy as oligonucleotides activate the Th1 cells significantly. Currently, doctors combine medication with patient education to equip the patients with adequate information concerning their condition; hence proper management of the acute symptoms (Brown, et al., 2013). Currently, most of the researchers focus on the evolution of the cytokine networks. Such a revolution accounts for the changes in the potential targets for antihistamine therapy. Therefore, the current research and topics evaluate different multiple preclinical trials and inflammatory cascades. The researchers also evaluate the changes in stimulating factors among other issues that affect efficient management of asthma. The physician asthma care education (PACE) and the CCHMC asthma homecare program are two groups that provide culturally sensitive care to the patients. Apart from reviewing the prescribed treatment, they advise the patient on what to eat and the practices to observe to improve their self-management skills (Brown, et al., 2013). Due to education barriers Hispanic and Asian populations can be noncompliment to Asthma care and regiments.
Conclusion
Although asthma can be either episodic or chronic condition, it places a significant economic burden on the patient and the health care system in general. The respiratory condition affects millions of people in the entire world. Apart from early and accurate diagnosis and treatment, people should avoid exposure to the risk factors that contribute to a flare.smoking, some agricultural and hairdressing chemicals, and obesity among others. Besides, people whose close relatives live with the condition must visit a physician regularly for checkups as they are