Chronic and Acute Asthma

Overview
According to Vasileiadis, Alevrakis, Amepelioti, Vigionas, Rovina, and Koutsoukou (2019), asthma happens to be rather common. Although it could be deemed a minor health concern amongst some people, the condition could be life-threatening for others – especially in relation to asthma attacks. It should be noted, from the onset, that “an acute asthma attack occurs in the midst of the chronic disease of asthma” (U.S. National Library of Medicine, 2019). Asthma does not have a cure. This effectively means that for those with the condition, the relevance of working closely with a qualified medical professional in tracking (and responding to) symptoms cannot be overstated.
Discussion
According to Lynn (2015), there are various physiologic factors involved in as far as asthma is concerned. From a general perspective, at the time of the asthma exacerbation (i.e. an asthma attack), the inflammation as well as swelling of the airways becomes apparent. While this occurs, the bronchial/breathing tubes narrow as a consequence of the contraction of the muscles around the airways as well as the production of excess mucus. It is the constriction of muscles as well as inflammation of bronchiolar that presents as wheezing, breath shortness, as well as coughing episodes (Lynn, 2015).
In acute asthma, the airway obstruction mechanism that appears inherently predominant is acute bronchoconstriction. However, in chronic asthma, it should be noted that “the acute smooth muscle contraction producing narrowing of airways is complicated by the development of edema and cell infiltrates in the bronchial wall and by retention of abnormally viscid sputum” (Austen and Lichtenstein, 2013, p. 177).
To a large extent, it is the exposure to certain riggers that results in the swelling and inflammation of bronchial tubes as a result of an immune system that happens to be overly sensitive. Different persons have different triggers. For this reason, there are a wide range of triggers that could include, but they are not limited to; tobacco smoke, infections of the upper respiratory system, dust mites, pollen, etc. The inhalation of some dry or cold air could also be a trigger among some individuals.
In as far as asthmatic attacks are concerned, symptoms tend to vary from one person to another. The general symptoms, however, are: wheezing and coughing; chest pain and tightness; and shortness of breath. Acute asthma could be diagnosed on the basis of diagnostic tests (such as PEF, BD, and pulmonary function tests) and a physical exam. On the other hand, chronic asthma could be diagnosed on the basis of medical history.
In seeking to evaluate how severe an asthma attack is, an arterial blood gas (ABG) could be obtained. Key quantitative information could be obtained from measurements on this front. According to Higgins (2003), during asthma exacerbation, initial findings could be inclusive of hypocapnia and hypoxemia. Hypercapnia, in the words of the author, is in most instances “a later finding that reflects increasing airflow obstruction and fatigue because of the increased work of breathing; it may indicate impending respiratory failure... mechanical ventilation is required in fewer than 10 percent of patients who present with hypercapnia” (Higgins, 2003).
In as far as the treatment of asthma is concerned, the overall goal is often close monitoring as well as trigger aversion. Routinely, the doctor and the asthmatic patient will draw up a treatment plan that clearly indicates the course of action that ought to be adopted in case of a flare-up. In as far as acute asthma is concerned, the level of severalty is mostly used to determine the most appropriate response.
In the case of chronic asthma, control medicines could be prescribed. Typically, these are taken on a daily basis and they are meant to aid in the alleviation of symptoms. This they do by way of ensuring that the airways are not narrowed and minimizing the inflammation of airways. Some of the medications that could be prescribed in this case include, but they are not limited to, mast cell stabilizers and corticosteroids.
In the case of acute asthma, short-term relief medicines could be prescribed. These could be inclusive of short-acting anticholinergics and corticosteroids (IV or oral). To assist in breathing, in severe cases, oxygen therapy could be given.
Factor
One of the patient factors that could impact the pathophysiology of both acute and chronic asthma is behavior – especially in as far as exposure to certain environmental factors is concerned. According to the National Heart, Lung, and Blood Institute – NHLBI (2019), in as far as susceptibility to asthma is concerned, “environmental exposures, including those at work, may increase the risk of developing asthma or making asthma symptoms worse.” These factors include, but they are not limited to, exposure to certain chemical irritants and related particles at the workplace. In such a case, an individual could develop chronic asthma. On the other hand, in as far as acute asthma is concerned, poor quality of air (mostly as a consequence of the presence of dust, pollen, etc.) could result in an asthmatic attack. Thus, in as far as treatment is concerned, control medicines (i.e. daily medicines) could be used in chronic asthma. On the other hand, when poor quality of air is the cause of an asthmatic attack, the avoidance of risk factors and the utilization of Inhaled Short-Acting Beta2-Agonists (SABAs) which are quick-relief medications is key in the control of acute asthma.
References
Austen, F. & Lichtenstein, L.M. (Eds.). (2013). Asthma: Physiology, Immunopharmacology, and Treatment. New York, NY: Elsevier.
Higgins, J.C. (2003). The ‘Crashing Asthmatic’. Am Fam Physician, 67(5), 997-1004.
Lynn, S. (2015). Understanding Asthma Pathophysiology, Diagnosis, and Management. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/07/ant7-Asthma-622.pdf
National Heart, Lung, and Blood Institute – NHLBI (2019). Asthma. Retrieved from https://www.nhlbi.nih.gov/health-topics/asthma
U.S. National Library of Medicine (2019). Allergic Asthma. Retrieved from https://ghr.nlm.nih.gov/condition/allergic-asthma#genes
Vasileiadis, I., Alevrakis, E., Amepelioti, S., Vigionas, D., Rovina, N. Koutsoukou, A. (2019). Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology. J Clin Med., 8(4), 563-567.