Case study of asthma management and medication escalation in a 63-year-old patient

¶ … Asthma:

As a 63-year-old, John has had asthma since childhood, a medical condition that has been controlled with the various types of medications for the disease. While the medication frequency and doses have increased in the past five years, John's wife died within the same period and he hasn't been taking care of himself. The patient presented to the hospital with exacerbation of asthma from an upper respiratory tract infection or influenza virus. However, he had not had the influenza vaccine though it was recommended by his general practitioner. Through physical examination, it was revealed that he had decreased breath sounds among other conditions. As a result of the condition, he could only speak in short sentences while coughing and producing sputum.

Different Forms of Asthma Medication:

Based on this case, there are various types of asthma medication that are used to control or treat the condition. According to Bass (2010), asthma medication is classified into two major categories i.e. controller asthma medication and rescue or quick relief asthma medication. The rescue or quick-relief medication treats acute asthma symptoms like cough, chest tightness, wheezing, and shortness of breath. On the contrary, controller asthma medication tries to prevent these similar symptoms though all the medication is inhaled. The controller medications are also known as the long-term asthma control medications since they are taken consistently to control symptoms and prevent attacks ("Asthma Medications: Know Your Options," 2011).

There are several types of asthma inhalers with each of them having different purposes. In most cases, patients choose from inhaler devices based on the doctor's advice or personal preference. As revealed in John's case, asthma medication basically includes relievers, symptom controllers, and preventers. Through taking other types of pharmaceutical drugs, some asthma patients usually experience an increase in symptoms. The different types of asthma medications include & #8230;

Relievers:

These medications are normally in blue or grey delivery devices and provide instant relief from the condition through relaxing muscles around the airways for four hours. In most cases, relievers are the only medication to use in an asthma attack to control the disease.

Preventers:

They are in orange, white, brown or yellow delivery devices and make the airways less sensitive to triggers and minimize inflammation within the airways ("Asthma Medications," 2011). Preventers are taken daily to keep the individual well necessitating the need to keep taking them even if the person is feeling better.

Symptom Controllers:

In addition to being green delivery devices, symptom controllers are long-acting relievers that assist in relaxing the muscles around the airways for approximately 12 hours. While they shouldn't be taken to control an asthma attack, the symptom controllers are taken on a daily basis and should be combined with a preventer.

Combination Medication:

The combination asthma medication includes both the preventer and symptom controller in a single delivery device. Unless it's prescribed by a doctor, these medications shouldn't be taken to manage an asthma attack though they should be taken daily.

Pathophysiology of Upper Respiratory Tract Infections vs. Asthma:

Respiratory alkalosis and hypoxaemia were discovered in John's condition after an urgent arterial blood gas was conducted. In addition, John had an influenza virus that was presented with exacerbation of asthma induced from an upper respiratory tract infection. However, the pathophysiology of upper respiratory tract infections and asthma are quite different.

The upper respiratory tract infection is the most common type of severe illness evaluated in the outpatient setting. This type of illness includes self-limited, mild, catarrhal syndrome of the nasophranyx, and life-threatening conditions like epiglottitis. Even though viruses are the most common causes of upper respiratory infections, bacterial primary infection requires targeted therapy. In contrast, asthma is a common chronic disease across the globe and the most common cause of children's hospitalization in America. This is because it's an airway disease that contributes to airway thickening and is caused by scarring and inflammation making it to pathologically associated with over-developed mucus glands.

The pathophysiology of asthma basically involves airway inflammation, bronchial hyper-responsiveness, and intermittent airflow obstruction because its complex. There is a difference in the mechanism of inflammation in asthma since it's acute, sub-acute, or chronic (Morris et. al., 2011). Airflow obstruction and bronchial reactivity are caused by mucus secretion and the presence of airway edema. Bronchial hyper-reactivity and airway hyper-responsiveness in asthma are exaggerated responses to several exogenous and endogenous stimuli. The extent of the airway hyper-responsiveness is generally proportional with the medical severity of asthma. Direct stimulation of airway smooth muscle and indirect stimulation through active substances are the mechanisms involved.

In order to establish the diagnosis for asthma, there is need to acquire spirometry with post-bronchodilator as the basic test whereas patients with acute asthma should undergo pulse oximetry measurement. For many patients with symptoms of the illness, the chest radiograph is still the initial imaging evaluation while exercise spirometry is the common method for evaluating patients with exercise-induced bronchospasm. The pharmacologic management of asthma includes the use of control and relief agents just like John took relievers, preventers, and symptom controllers to manage the disease.

In contrast, upper respiratory tract infections are direct attacks of the mucosa lining the upper airway. Most of these illnesses are caused by person-to-person spread of the virus resulting in inoculation by viruses or bacteria that begin when secretions are transferred. Generally, patients with suboptimal humoral and phagocytic immune function have higher chances for contacting these illnesses and increased probability of prolonged or severe course of disease (Meneghetti et. al., 2011). For instance, John had decreased breath sounds in both lung fields, oxygen saturations and anxiety, pursed lip breathing, expiratory wheeze, and small tidal volume. This contributed to the application or use of an oxygen mask and nebulised salbutamol resulting in the decrease of the ventilator rate of the patient.