Chronic asthma and acute asthma exacerbation essay example

Chronic asthma and acute asthma exacerbation essay example

To Prepare

Review “Asthma” in Chapter 27 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.
Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. chronic asthma and acute asthma exacerbation essay example.
Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation chronic asthma and acute asthma exacerbation essay example.

To Complete

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Write a 3-page paper that addresses the following:

Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation. chronic asthma and acute asthma exacerbation essay example.
Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.
Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your chronic asthma and acute asthma exacerbation essay example paper.

Pathophysiology of Asthma

Asthma is “an inflammatory disease of the airways that causes airway hyper responsiveness, mucosal edema, and mucus overproduction, production characterized by coughing, wheezing and dyspnea.” The pathophysiology of asthma is characterized by three major components: airway inflammation, airway hyperresponsiveness, and airway obstruction. Asthma may present in acute from or in chronic manifestation (Mims, 2015). This paper will discuss the pathophysiology of both acute and chronic asthma, and discuss the effect of genetic factors in the pathophysiology, diagnosis and the treatment of the condition, presented as mind maps for the two forms of asthma.

Pathophysiology

Acute asthma begins when the patient is exposed to environmental allergies, cold, or exercise. The cells that are involved in the inflammatory response include; mast cells, activated T lymphocytes, eosinophil, epithelial cells, endothelial cells, goblet cell. Th1 lymphocytes produce interleukin-2 cytokines and interferon alpha. Th2 lymphocytes, when activated, produce interleukin-5, IL-6, IL-9and 13. Fibroblast, endothelial cells, and cell-derived mediators produce structural changes that include; hypertrophy and hyperplasia of the smooth muscles surrounding the airways, formation of new blood vessel along the airways and growth of the airway epithelium (Agarwal, Dhooria, Aggarwal, Maturu, Sehgal, Muthu, & Jindal, 2015). chronic asthma and acute asthma exacerbation essay example.

In addition, in acute asthma, the pathophysiological progress is characterized by; bronchial smooth muscle constriction causing bronchospasm, increased mucus secretion by the goblet cells, and airway edema. Smooth muscle spasms are mediated by the immunoglobulin E dependent response, increased mucus hypersecretion is triggered by exposure to allergens. These changes reduce the airway diameter, reducing the rate of airway inhalation and the rate of exhalation as well.  Consequently, the neurological response causes an increase in the rate of breathing, thus increasing the work of breathing (Becker & Abrams, 2017).

On the other hand, chronic asthma is characterized by structural changes that occur weeks after the inflammatory response has begun. The structural changes involved are an increase in the size and the number of the smooth muscle cells surrounding the airway through hypertrophy and hyperplasia, respectively. Additionally, fibrosis in the sub epithelial area along the length of the airway (Horak, Doberer, Eber, Horak, Pohl, Riedler & Studnicka, 2016).

The progressive airway constriction and results in uneven airway distribution. As a compensatory mechanism, the bronchi hyperventilate, causing the corresponding hyperinflation of the lung alveoli, therefore preventing further stages of hypoxia. The increase in the partial pressure of carbon dioxide is prevented by hypoventilation of the airway. Additionally, hypercarbia is prevented by the ready diffusion in of the carbon dioxide gas from the pulmonary capillaries through the capillary and alveoli membrane into the alveolar space and therefore exhaled. However, due to the interference in the ability of the airways to ventilate sufficiently, there is a resultant mismatch in the perfusion ventilation ratio. chronic asthma and acute asthma exacerbation essay example. Vasoconstriction of the blood vessels in the pulmonary vascular bed prevents the further and worsening imbalance between the ventilation and the perfusion (Szefler, Holguin, & Wechsler, 2017).

The progression of pathophysiological events and changes occurring in both acute asthma and chronic asthma forms cause disturbances to the arterial carbon dioxide levels. In the acute form, the body responds to the increased airway obstruction by alveolar hyperventilation.  The hyperventilation causes the excessive exhalation of carbon dioxide from the blood circulation. The result is reduced amount of carbonic acid, in relation to the constant amount of bicarbonate in the circulation, therefore causing respiratory alkalosis during which the blood PH increases above 7.45 and the partial pressure of carbon dioxide falls below 38mmHg. The response by increasing the excretion of bicarbonate ions and hydrogen ion retention. In the chronic manifestation of asthma, due to irreversible structural changes in the airway, the airway obstruction leads to retention of carbon dioxide chronic asthma and acute asthma exacerbation essay example. Therefore the amount of carbonic acid is higher relative to the number of bicarbonate amounts in the blood circulation to levels above 42mmHg and the pH falls below 7.35, therefore causing respiratory acidosis. The body responds to the respiratory acidosis by increasing the excretion of the hydrogen ions and retention of bicarbonate ions in the kidney (Mims, 2015). chronic asthma and acute asthma exacerbation essay example.

Role of Genetics

The presence of the gene that codes for the platelet activating factor is associated with susceptibility to asthma. Additionally, the genetically determined response to asthma is dictated by environmental exposure. Certain medical disorders, specifically; hepatitis A and Mycobacterium tuberculosis are associated with an increase in the inflammatory response to allergens prompting asthmatic responses. In addition, minimized use of antibiotics and earlier exposure to the environmental exposures lead to increased production of Th2 lymphocytes. Subsequently, the relatively increased Th2 lymphocyte production precludes the production and secretion of immunoglobulin E. Immunoglobulin E causes increased response to the allergens leading asthmatic response in susceptible individuals. chronic asthma and acute asthma exacerbation essay example. Based on these factors, the diagnosis of the patient can be done through detailed history taking concerning the history antibiotics use, history of mycobacterium infection or history of asthma in the family. Additionally, the blood analysis of blood for the presence of increased levels of inflammatory mediators can be a diagnostic criterion. Based on the effect of genetics on the pathophysiology of asthma, the occurrence of asthma is managed by preventing exposure to the susceptible individuals based on the family history of asthma. Advising patients to reduce the use of antibiotic medication helps in improving immune response to asthma (Zhu, Yan, Zhai, Yang, & Li, 2017) chronic asthma and acute asthma exacerbation essay example.

Mind Map; Acute Asthma

Mind Map; Chronic Asthma

 

References

Agarwal, R., Dhooria, S., Aggarwal, A. N., Maturu, V. N., Sehgal, I. S., Muthu, V., … & Jindal, S. K. (2015). Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations. Lung India: official organ of Indian Chest Society, 32(Suppl 1), S3.

Becker, A. B., & Abrams, E. M. (2017). Asthma guidelines: the Global Initiative for Asthma in relation to national guidelines. Current opinion in allergy and clinical immunology, 17(2), 99-103.

Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., … & Studnicka, M. (2016). Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines. Wiener Klinische Wochenschrift, 128(15-16), 541-554. chronic asthma and acute asthma exacerbation essay example.

Mims, J. W. (2015). Asthma: definitions and pathophysiology. In International forum of allergy & rhinology (Vol. 5, No. S1).

Szefler, S. J., Holguin, F., & Wechsler, M. E. (Eds.). (2017). Personalizing Asthma Management for the Clinician. Elsevier Health Sciences.

Zhu, Y., Yan, X., Zhai, C., Yang, L., & Li, M. (2017). Association between risk of asthma and gene polymorphisms in CHI3L1 and CHIA: a systematic meta-analysis. BMC pulmonary medicine, 17(1), 193. chronic asthma and acute asthma exacerbation essay example.

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