Case Study:
An 18-year-old college student reports a history of episodic attacks of shortness of breath, dry cough, and wheezing for the last 5 years. These symptoms usually occur during a change of weather or whenever she “catches a cold”. Symptoms also reported to worsen during night and early morning. Accompanying symptoms of recurrent sneezing, runny nose, and itchy eyes.
The patient reports she was prescribed some inhaler medications by her practitioner two years ago for use as needed. She stopped the meds as she was concerned over inhaler dependence. Intermittently she takes cough syrup during “attacks” with some help.
PMH: No diagnosed chronic illnesses
SH: College student, single, lives with parents. Father is smoker in the home, use dry wood in the home in fireplace
ROS:
Constitutional: Denies fever, denies weight loss
Respiratory: Denies hemoptysis, reports mostly dry cough
Cardiovascular: Tightness in chest at times
ENT: Denies ear pain, mild rhinorrhea reported, scratchy throat intermittently
Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information.
Discussion Questions:
- Based on the history provided, the health care provider suspects asthma with varying frequency and intensity. Describe whether this condition is restrictive or obstructive and support with evidence.
- Describe the pathophysiologic process that occurs with asthma and support with evidence from the literature.
- Explain what confirmatory testing is evidence based practice for diagnosing asthma and how this information can guide the treatment plan.
- Based on the history provided, the health care provider suspects asthma with varying frequency and intensity. Describe whether this condition is restrictive or obstructive and support with evidence
Lung disease can be categorized as restrictive or obstructive; however, in both, shortness of breath is common. Restrictive lung disease ensues when there is the stiffness of the chest walls and weakening of the muscles constraining the lungs’ inhalation capacity while obstructive lung disease is characterized by difficulty in breathing due to obstruction in the air passages due to the narrowing of airways in the lungs, thus making the exhaled air move out slowly. (Martinez, 2016). Asthma is a chronic obstructive disease that causes inflammation of the airways, bronchial hyperresponsiveness, and its allied with a dry cough, wheezing, shortness of breath, and chest tightness. Asthma triggers include ”medications, allergens, and environmental factors such as occupational exposure and smoke(Bargagli & Carleo, 2019).In the case study scenario, the patient is experiencing wheezing, dyspnea, and coughing, which are symptoms of an obstructive lung disease hence not restrictive because the problem is not related to difficulty in lung expansion but rather a difficulty in exhaling.
- Describe the pathophysiologic process that occurs with asthma and support with evidence from the literature
Pathophysiology of asthma is related to the deterioration of breath due to irritant exposure and physical condition, and it is a disease caused by diverse endo- and phenotypes. Allergens, exercise, or infections can elicit it, and an individual’s immune system responds by creating an inflammatory reaction that leads to narrowing and swelling of the airways and more production of mucus (McCance & Huether, 2018). Muscles around the airways can lead to bronchospasms, making it tough for an individual to breathe. Moreover, asthma can be due to an inflammatory reaction of the bronchial mucosa, which causes compression of the airways, hyperresponsiveness, and obstruction of variable airflow. The inflammatory reaction is due to cellular elements that lead to airway hyperresponsiveness, including T helper two lymphocytes, B lymphocytes, eosinophils, basophils mast cells, and obstinate inflammation of the bronchial mucosa. The two asthmatic response is an early asthmatic response, which alps at 30 minutes and can resolve within 3hours, and late asthmatic response, which instigates at around 4 to 8 hours after early response. The obstruction that ensues in asthma patients decreases flow rates and increases airflow resistance, leading to air trapping, hyperinflation distal to obstructions leading to difficulty in breathing (Yokoyama,2018). Ongoing air leads to alveolar gas pressures, thus a decline in alveoli perfusion, causing hyperventilation, and the patient in the case study is experiencing allergic asthma due to airway obstruction following environmental allergens.
- Explain what confirmatory testing is evidence-based practice for diagnosing asthma and how this information can guide the treatment plan
History of recurrent episodes, cough, dyspnea, allergies, and wheezing supports asthma diagnosis through a thorough physical exam, medical history, and lung function assessment, which is vital. Asthma can be diagnosed through an objective measurement of the lung function using pre and post-bronchodilator spirometry. In the case of an acute flare, immediate administration of oxygen, inhaled beta-agonist bronchodilators, and inhaled corticosteroids must manage acute asthma (Hangaard et al.,2019). Other tests used include; FeNO test, which checks inflammation of the lungs by measuring the level of nitric oxide, and peak flow test, which measures how debauched one breathes out. After these tests, one must undergo some allergy tests to check if an allergy activates the symptoms. Managing asthma aims to control symptoms to avoid an exacerbation, thus reducing mortality and morbidity risks. On the other hand, as providers, we must reassure our patients and fortify teaching to reduce the frequency and severity of asthma episodes, hence improving life’s eminence.
References
Bargagli, E., & Carleo, A. (2019). Oxidative Stress in Obstructive and Restrictive Lung Diseases. Oxidative Stress in Lung Diseases, 213-222. doi:10.1007/978-981-32-9366-3_9
Haugaard, S., Kronborg, T., Stausholm, M. N., Cichosz, S. L., & Hejlesen, O. (2019). Using the pre- bronchodilator spirometry curvature to improve the estimation of post-bronchodilator airflow obstruction. Monitoring airway disease. doi:10.1183/13993003.congress-2019.pa2644
Martinez, F. D. (2016). The Childhood of Adult-Onset Asthma and the Asthma/Chronic Obstructive Pulmonary Disease Overlap. Barcelona Respiratory Network, 2(3). doi:10.23866/brnrev:2016- m0024
McCance, K. L., & Huether, S. E. (2018). Study Guide for Pathophysiology – E-Book: The Biological Basis for Disease in Adults and Children. St. Louis: Elsevier Health Sciences
Yokoyama, A. (2018). Advances in Asthma: Pathophysiology, Diagnosis and Treatment.