RUNNING HEAD: ASTHMA
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ASTHMA
Students name
Institutional affiliation
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Introduction
The current paper is a case study analysis of a patient, Tegan Smith, a 6-year-old girl with
asthma. The case study will be analyzed in order to better understand the asthma disease process
and management. The pathophysiology of asthma, and treatment in the Australian context will
be discussed. Lastly, the standards of asthma education offered to parents and children will be
analyzed in the Australian context.
Type of asthma.
The asthma subtypes are due to the different presentations in different people and depend
on the pathogenesis, age, and occupation and include allergic asthma, non-allergic asthma, cough
variant asthma, occupational asthma, exercise-induced asthma, and nocturnal asthma (Mukherjee
& Zhang, 2011). Tegan Smith has presentation suggestive of allergic asthma. Her symptoms
suggest atopy, a range of conditions including eczema, allergic conjunctivitis, allergic
rhinosinusitis, and asthma. Symptom suggestive of allergic conjunctivitis is watery eyes while
nasal discharge is highly suggestive of allergic rhinosinusitis (Van Aalderen, 2012). There is a
familial history of atopy. Atopy is defined as a genetic predisposition to allergy and is hereditary.
Tegan’s mother had a history of atopy including symptoms of nasal polyposis that follows
chronic rhinosinusitis, and allergy. Since atopy is hereditary, Tegan could have inherited his
allergic predisposition from his mother (Guibas, Mathioudakis, Tsoumani, & Tsabouri, 2017).
Tegan and his family moved to the highlands recently and this corresponded to onset of
symptoms. This could be due to exposure to new allergens for example pollen supporting the
idea that it is allergic asthma. Allergic asthma has environmental triggers including animal
danders, pollen and foods (Janssens & Ritz, 2013).
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Pathophysiology of allergic asthma
Asthma is a heterogenous, chronic, inflammatory lung disease characterized by: airway
narrowing that is partially or completely reversible, increased airway responsiveness to a variety
of stimuli, symptoms of cough, wheezing, dyspnea, and chest tightness that occur in paroxysms
and are usually related to specific environmental triggering events (Kumar, Abbas & Aster,
2015). After exposure to an allergen the body mounts a Th2 mediated immune response with
production of IgE antibodies. On re-exposure to the same allergens there is crosslinking of the
antibodies that bind to surface of mast cells leading to mast cell degranulation with release of
inflammatory mediators and histamine (Bonsignore et al, 2015). This is a common pathway in
most type 1 hypersensitivity reactions of which asthma is one. (Kumar, Abbas & Aster, 2015).
There are two phases of reaction, an early phase and a late phase. Mast cell degranulation and
release of cytokine drive the early phase with mucosal hyperstimulation leading to excess mucus
production, vessel dilatation and the direct effect of mediators on vagal receptors causes
bronchoconstriction. The late phase occurs due to recruitment of T lymphocytes, neutrophils and
eosinophils that will mediate acute and chronic inflammation (Bonsignore et al, 2015).
Inflammation in the wall of the respiratory tree leads to smooth muscle hypertrophy and
deposition of collagen with gland hypertrophy. This is termed airway remodeling (Kumar, Abbas
& Aster, 2015). This underlying pathology will present clinically as wheezing due to blockage of
airflow and cough due to the hyperresponsiveness of the airway with excess mucus production
(Lødrup & Pijnenburg, 2015).
Treatment
The treatment of asthma involves the use of medications in a systematic step wise manner
with clear regard for the severity of Asthma and symptomatology (Queensland Health, 2015).
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The category of asthma according to the symptoms is assessed so medication can be given in a
step wise manner (National Asthma Control Council of Australia, 2018). In Tegan’s case, this is
her initial diagnosis and no prior records of asthma control are available. The initial treatment
requires the prescription of a reliever that is taken in case of a flare up and a controller that is
taken daily as a preventive measure (National Asthma Control Council of Australia, 2018).
Recommended relievers include salbutamol 2 -4 puffs (100 mcg per puff) via a pressurized
metered dose inhaler or terbutaline for children over 6 years, 1-2 puffs (500 mcg per puff) via a
breath- actuated powder inhaler (National Asthma Control Council of Australia, 2018). Usind
controllers depends on the level of asthma severity. The levels include infrequent intermittent
asthma, frequent intermittent asthma and frequent sever asthma. In infrequent intermittent
asthma, a controller is not needed and treatment of flare ups is recommended. In frequent to
severe asthma, however, controllers are needed. They include an inhaled corticosteroid,
Montelukast, and sodium cromoglycate (National Asthma Control Council of Australia, 2018).
Treatment follows the stepwise manner, either step up or step down. This is done by regular
assessment and if the asthma is well controlled with no flare ups then the dose of controllers can
be gradually reduced to a therapeutic level (step-down). Also, if the Asthma flares-up despite the
prescribed medication then it can be slowly increased to the required level (step-up) (National
Asthma Control Council of Australia, 2018).
Asthma management education.
According to the National Asthma Control Council of Australia, (2018), the
recommended education for parents and children involves information on asthma and its
management strategies. The parents should be told about the pathology associated with it
including information that is a chronic condition with causes and treatment options available.
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The medication terminology is explained as relievers that treat acute attacks and preventers that
are taken regularly to prevent attacks. The adverse effects of medications is explained including
the inhaled corticosteroids that have the worst side effects. Asthma management devices and
how to use them is explained. They include inhalers, spacers and puffers. The cleaning and care
of these devices is also demonstrated and to assess if the information has been retained, the
parents and children have to demonstrate what was taught. Finally the educators should help the
asthma patient and parents come up with a written actin plan that contains treatment goals,
medication used, dosages and clear guidelines on what to do in different clinical situations.
(National Asthma Control Council of Australia, 2018).
Conclusion
In conclusion, Tegan has allergic asthma due to his symptoms and family history of
atopy. Allergic asthma is a chronic condition that is characterized by airway narrowing that is
partially or completely reversible, increased airway responsiveness to a variety of stimuli,
symptoms of cough, wheezing, dyspnea, and chest tightness that occur in paroxysms and are
usually related to specific environmental triggering events. The treatment options for asthma
include reliever medication and preventer medication and avoidance of trigger allergens. Asthma
discharge education to help in self-management of this lifelong condition is given to parents and
children.
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References
Bonsignore, M. R., Profita, M., Gagliardo, R., Riccobono, L., Chiappara, G., Pace, E., &
Gjomarkaj, M. (2015). Advances in asthma pathophysiology: stepping forward from the
Maurizio Vignola experience. European Respiratory Review, 24(135), 30-39
Guibas, G. V., Mathioudakis, A. G., Tsoumani, M., & Tsabouri, S. (2017). Relationship of
Allergy with Asthma: There Are More Than the Allergy “Eggs” in the Asthma “Basket”.
Frontiers in Pediatrics, 5(92).
Janssens, T., & Ritz, T. (2013). Perceived Triggers of Asthma: Key to Symptom Perception and
Management. Clinical and experimental allergy: journal of the British Society for Allergy
and Clinical Immunology, 43(9), 1000-1008.
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease.
(Ninth edition.). Philadelphia, PA: Elsevier/Saunders
Lødrup Carlsen, K. C., & Pijnenburg, M. W. (2015). Monitoring asthma in childhood. European
Respiratory Review, 24(136), 178-186.
Mukherjee, A. B., & Zhang, Z. (2011). Allergic Asthma: Influence of Genetic and
Environmental Factors. Journal of Biological Chemistry, 286(38), 32883-32889.
National Asthma Control Council of Australia. (2018). Australian asthma handbook. Melbourne,
Australia: National Asthma Council Australia
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Queensland Health, (2015). Chronic Conditions Manual: Prevention and Management of
Chronic Conditions in Australia. (1st Ed.). The Rural and Remote Clinical Support Unit,
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Van Aalderen, W. M. (2012). Childhood Asthma: Diagnosis and Treatment. Scientifica, 2012, 18