Pathophysiology of Asthma or RSV

Pathophysiology-Respiratory Alterations
The pathophysiology of Mrs. Teel’s 7-month-old infant’s alteration is a persistent, lingering cough that has lasted for several months. The infant coughs mostly at nights and has had an allergic reaction to amoxicillin in the past. Aside from this, the infant appears healthy, the child’s breathing is clear to auscultation. The cough worsens when the baby cries but other than that the cough does not seem particularly bad. The mother is worried that it may be respiratory syncytial virus (RSV) but the pathophysiology of the infant’s symptoms does not align with RSV as the child demonstrates no lethargy or signs of fever. The most likely cause of the cough is an allergen and the child is simply having an allergic reaction, just as the infant had to amoxicillin. In the nighttime, the air cools off and pollen that is in the air settle back down to the ground where it is breathed in and can cause a cough in a child with allergies. The allergy could very well also be a food allergy that has gone unnoticed. In any event, there are no signs of infection or of RSV and this may easily be ruled out as the problem.
The factors of genetics and behavior may be impacting the child’s cough. Since the child has already demonstrated an allergy to amoxicillin, it is evident that the child does have allergies that need to be noted. The family history of the child should be considered when diagnosing the child’s cough. If the mother, father, brothers, sisters, grandparents, and so on have any history of allergies that this should be made known to the physician as it will help to make a determination on the likelihood of genetics being a factor in the child’s symptoms.
However, as Campbell, Boyle, Thornton and Prescott (2015) show, “allergic disease can be viewed as an early manifestation of immune dysregulation. Environmental exposures including maternal inflammation, diet, nutrient balance, microbial colonization and toxin exposures can directly and indirectly influence immune programming in both pregnancy and the postnatal period” (p. 844). In other words, allergies may be determined by a number of different variables and while genetics can be one factor to help explain onset, it is by no means the only factor to be investigated—and that is why the behavior of the infant is also important to discuss. Things to know include: what is the infant eating (what foods are part of his daily diet), is the children getting all of his essential nutrients, what is the child’s environment like—is the child in an environment with a high pollen count, etc. These types of questions can help to answer many questions about why the child is developing a cough that is persistent but that is not severe enough to be considered worrisome or that indicates a need for hospitalization. The child’s cough, on the other hand, indicates that the body is uncomfortable with something that it is coming into contact with—and this could be something in the air or something that the child is eating. It could stem from a genetic effect that was passed on from the parents, or it could be caused by an immune system dysregulation.
Subbarao, Anand, Becker et al. (2015) show that “early life physical and psychosocial environments, immunological, physiological, nutritional, hormonal and metabolic influences interact with genetics influencing allergic diseases, including asthma” (p. 998). The child’s cough could stem from the interaction of these variables with the child’s genes, causing the cough to flare up as the result of the development of asthma, which is impacted by allergens with which the child comes into contact—either through air in the child’s environment on by way of the child’s diet, depending on what the child is eating. The mother could try introducing new foods in substitution for some that may typically be an allergen for infants and see what the impact is, or the mother could consider the environment and take care to keep windows closed and use a high grade filter in the furnace to catch pollen and other allergens that could be giving the child trouble. As “prenatal and postnatal environments, diverse biological samples and rigorous phenotyping, will inform early developmental pathways to allergy, asthma and other chronic inflammatory diseases” (Subbarao et al., 2015, p. 998), it is important to consider both the family history and the environment as well as the child’s own behavior when assigning a cause to the cough.
McCance and Huether (2015) also point out that childhood asthma can result from “a complex interaction between genetic susceptibility and environmental factors, including early exposure to allergens (e.g., air pollution, dust mites…)” and so on (p. 716). The pathophysiology of asthma in children is like that in adults and the symptoms may be operational on an ongoing basis, as is the case with the infant. The allergens that have impacted the child may be happening because of a development of asthma which would explain the persistent cough as well.
In conclusion, Mrs. Teel need not worry that the child is suffering from RSV as the pathophysiology of RSV does not match the symptoms displayed by the infant. Rather what the infant is displaying aligns more closely with the pathophysiology of asthma and the child may be having an allergic reaction to something in the air, whether it is pollen or dust mites or cat hair or some other substance that commonly causes an allergic reaction in people. Depending on the child’s family history and the child’s behavior, these factors could be impacting the respiratory issue and leading the infant to cough more at night in response.
References
Campbell, D. E., Boyle, R. J., Thornton, C. A., & Prescott, S. L. (2015). Mechanisms of
allergic disease–environmental and genetic determinants for the development of allergy. Clinical & Experimental Allergy, 45(5), 844-858.
McCance, K. L., & Huether, S. E. (2015). Pathophysiology-E-Book: The Biologic Basis
for Disease in Adults and Children. Elsevier Health Sciences.
Subbarao, P., Anand, S. S., Becker, A. B., Befus, A. D., Brauer, M., Brook, J. R., ... &
Kozyrskyj, A. L. (2015). The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining developmental origins of allergy and asthma. Thorax, 70(10), 998-1000.