Case Study asthma wk5.docx - 1 Case Study Asthma Wilfredo...

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1 Case Study: Asthma Wilfredo Concio NRP/511: Advanced Pathophysiology July 7, 2020 Thomas Falletta, MS ANP-BC
2 Case Study: Asthma Introduction The scenario follows Nancy Smith, a 35-year-old female who is suffering from exacerbation of asthma that started 2 weeks ago. She had asthma since childhood. Last urgent care visit was 4 months ago where she was prescribed inhaled steroid that was never filled, oral steroid and albuterol inhaler which she was using 4 to 5 times a day. Besides having a history of asthma, she also suffers from eczema where she had allergy shots before. Symptoms consist of shortness of breath when climbing stairs or short distance walking, orthopnea, and coughing spells at night. Spirometry result reveals FEV1: 61%, FVC: 88%, FEV1/FVC ratio: 69%. Oxygen saturation on room air is 93%. Overall Pathophysiology and Disease Process The Global Initiative for Asthma defines asthma as follows: "Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation." ("Asthma quest," 2019) and The National Asthma Education and Prevention Program (NAEPP) with evidence- based guidelines, defined the core defects of asthma as a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation . A cardinal feature of asthma is variable airway obstruction , a variation in airway caliber over the time frame of minutes to days; it is due to bronchoconstriction, mucosal inflammation, and luminal secretions, and results in increased airflow resistance and work of breathing. Bronchoconstriction occurs in airways that contain contractile airway smooth muscle. Enhanced parasympathetic
3 cholinergic tone occurs in nocturnal asthma and can cause contraction of airway smooth muscle, increased mucus production, and increased airway obstruction. Factors associated with mucus overproduction and inflammation (allergen exposures, viral or bacterial infections) can also increase obstruction (McCracken, Veeranki, Ameredes, & Calhoun, 2017). Airway hyperresponsiveness , an exaggerated reduction in airway caliber after a stimulus, has been recognized as a hallmark of asthma from the time of Claudius Galen, a physician in about AD 150. Airway hyperresponsiveness may be induced by allergens (e.g. pollen, animal dander), chlorine, pollutants (e.g. sulfur dioxide), diesel exhaust particulates, and viral upper respiratory tract infections. Sympathetic control in the airway is mediated via β2-adrenoreceptors expressed on airway smooth muscle, which are responsible for the bronchodilator response to albuterol used in diagnosis and symptom relief and for longer-term bronchodilation facilitated by long- acting β2-agonist controller agents. Cholinergic pathways may further contribute to airway hyperresponsiveness and are the basis for the efficacy of anticholinergic therapy. The

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