Asthma Case Scenario Pathophysiological Mechanisms

Asthma Case Scenario

Pathophysiological Mechanisms

One could argue that asthma is always a chronic condition as it is a chronic, difficult to control, inflammation of the airways of an individual. One of the main features of asthma is that it is characterized by inflammatory cell infiltration which contributes to "airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity; in some patients, persistent changes in airway structure occur, including sub-basement fibrosis, mucus hypersecretion, injury to epithelial cells, smooth muscle hypertrophy, and angiogenesis; gene-by-environment interactions are important to the expression of asthma" (nih.gov, 2013). In fact, it's worth noting that viral respiratory infections are one of the most overwhelming causes of asthma exacerbation and can also contribute to the evolution and development of asthma (nih.gov, 2013).

With both conditions there are three overwhelming factors which the individual generally experiences: bronchoconstriction, airway edema and hyperresnsiveness of airways (nih.gov, 2013). The overwhelming dynamic which occurs in both chronic and aggravated asthma is that the airways become narrowed. "In acute exacerbations of asthma, bronchial smooth muscle contraction (bronchoconstriction) occurs quickly to narrow the airways in response to exposure to a variety of stimuli including allergens or irritants" (nih.gov, 2013). Thus, when a child or adult suffers from asthma, a variety of stimulants can cause this narrowing of the airways: cold air, exercise, irritants, stress, etc. (nih.gov, 2013). With certain cases of chronic asthma and with aggravated forms of the disease which experience more persistent and progressive forms of inflammation, factors like edema, inflammation, mucus hypersecretion and certain structural changes (nih.gov, 2013). The hyperresponsiveness of the airways is a major factor and can be influenced the inherent inflammation which occurs with asthma or the defunct neuroregulation or overall structural changes (nih.gov, 2013).

When it comes to arterial gases, the changes in these patterns are most distinct when the disease progresses from mild to extreme (MEE, 2012). For instance, when an asthma attack commences, "the normal PaO2 of 100 mm Hg falls (e.g. To 60mm Hg), the PaCO2 of 40 mm Hg falls (e.g. To 30 mm Hg) and the pH of 7.40 rises (e.g. To 7.50)" (MEE, 2012). One must not forget this is indeed a progressive disease; thus as it worsens and the pH gets higher, "the PaO2 and the PaCO2… for example, the PaCO2 reaches 20 mm Hg and the pH reaches 7.60" (MEE, 2012). Thus, the lungs gets to a progressively worse state where they're unable to get rid of excess carbon dioxide; the PaCO2 elevates and pH plummets as well, but the PaO2 also plummets; as an asthma attack worsens the rock-bottom level PaCO2 and the elevated pH start to fall again (MEE, 2012).

In the case scenario that we're examining, the patient's factor of age could have a direct impact on how the disease is manifests. Childhood allergies could mean that the disease progresses more rapidly, and that the child is more vulnerable to certain irritants. Children might not quite understand how to regulate stress in their lives and how to make themselves more protected from stressors or how to use de-stressing techniques with discipline and success.