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1Chronic and Acute AsthmaLori ParkerNURS-6501N-25 Advanced PathophysiologyOctober 7, 2017
2Chronic and Acute Asthma$50.1 billion in direct care costs are attributed to asthma. One-third of hospital admission between 1995 and 2010 were asthma exacerbations in children 15 years and younger (Falk, Hughes, Rodgers, 2016, para. 2). The purpose of this paper is to explore chronic asthma and acute asthma exacerbation. Pathophysiological MechanismsChronic asthma Asthma is inflammation that narrows airways that can result in wheezing, shortness of breath, coughing especially at night and in the early mornings. Chronic asthma is a long-term persistent disease. Genetics may contribute to the development of asthma. When an individual who is sensitized to an allergen is exposed, inflammation occurs. Cells such as dendritic cells, Th2 lymphocytes, B lymphocytes, mast cells, neutrophils, basophils, and eosinophils play a part in the inflammatory process in either the early or late stage. In the early stage, antigen-specific IgE is produced linking to the antigen. Inflammatory mediators such as histamine and others are released causing mucosal edema and bronchial smooth muscle contraction, resulting in mucus production and airway narrowing. Four to eight hours after the early response, a latent reaction can happen. Cellular debris results in increased mucus production, along with prolonged smooth muscle contraction. Permanent subepithelial fibrosis and smooth muscle hypertrophy, referred to as airway remodeling can occur when inflammation goes untreated (Heuther & McCance, 2017, p. 698). Acute asthma exacerbation.An acute asthma exacerbation occurs when exposure to an allergen causes a hyper-responsive reaction resulting in bronchoconstriction. “The degree to which airway hyperresponsiveness can be defined by contractile responses to challenges with methacholine correlates with the clinical severity of asthma” (National Asthma Education and Prevention Program (National Heart, Lung, and Blood Institute). Third Expert Panel on the Management of
3Asthma, 2007, p. 11). Symptoms of asthma exacerbation can include shortness of breath coughing, wheezing, chest tightness, anxiety/agitation, tachypnea, tachycardia, use of accessory muscles and decreased peak respiratory flow (Camargo, Rachelefsky, & Schatz, 2009, p 357). Arterial blood gas analysis is essential for all patients experiencing a severe asthma exacerbation.ABG report may reveal the following: 1) PaCO2 (arterial CO2 pressure) is high or sometimes normal, i.e., 5 - 6 kPa. 2) l PaO2 (arterial O2 pressure) is < 8 kPa with or without administration of oxygen. 3) pH is low (Jain, Singal, Jain, Clark, & Chauhan, 2016, p. 320) indicating respiratory acidosis. PEF < 50% of predicted normal or best (Jain, Singal, Jain, Clark, & Chauhan, p. 319).Age as a Contributing FactorInflammation occurs as the result of exposure to a trigger or allergen; however, symptomsare typically intermittent in children, but more persistent in adults. Symptomatic asthma often subsides as children get older, whereas in adults symptoms usually persist (Sawicki, & Haver, 2017, para. 19.). Adults are four times more likely to die from asthma (“Asthma and Allergy