The pathophysiology of both acute and chronic and asthma has similarities and differences. One similarity between the two conditions is that they both cause symptoms through obstruction of airflow. They both manifest by affecting the respiratory system. Another similarity is that in both, there is a characteristic bronchial hyperresponsiveness in an attempt to compensate for airway obstruction (Murphy & O’Byrne, 2010). One difference between the two conditions is that, in acute asthma, an attack is triggered by sudden inflammatory responses, as a result of exposure to allergens while chronic asthma is a result of persistent changes in the structure of the airway. Another difference is that, in the two conditions, there are varying degrees of lymphocytes, adhesion molecules, and cell-driven mediators. For example, T-Lymphocytes regulates airway inflammation, while the other cells of the airway, like mast cells contribute highly to the chronicity of the disease.

The three main components in the pathophysiology of asthma are airway inflammation, airflow obstruction and bronchial hyperresponsiveness (Murphy & O’Byrne, 2010). An exposure to allergens leads to trigger off a cellular mediated response, which leads to release of cytokines, which in turn mediate and inflammatory response. The inflammation leads to airway obstruction by causing airway edema, bronchoconstriction, chronic plug formation and remodeling of the airway. The airway obstruction causes a resistance to airflow, triggering bronchial hyperresponsiveness (Murphy & O’Byrne, 2010). Since the airflow obstruction is uneven, this results in ventilation-perfusion mismatch, presenting with hypoxia, hypercarbia, wheezing, coughing and shortness of breath. Such persistent episodes in acute attacks lead to permanent changes in airway structure, smooth-muscle hypertrophy, injury to epithelia cells, angiogenesis and mucus hypersecretion, leading to chronic asthma (Holgate, 2011).

During the asthmatic attacks, the arteria blood gases change in that the ventilation-perfusion mismatch leads to hypoxia. The increased alveolar ventilation and diffusion of carbon dioxide across the alveolar-capillary membranes prevent hypercarbia. In acute attacks, patients experience hypoxemia. The hypoxic drive due the hyperventilation leads to a decrease in PACO_2. However, if the obstruction worsens, there is a likelihood of carbon dioxide retention due to continued ventilation-perfusion mismatch (Curie & Baker, 2012).

How the patient factor affects the pathophysiology of both conditions:

The patient factor selected is age. Although asthma ca affect a person of any age, it is more common in young children and the very old persons. In relation to pathophysiology, the young children experience asthma due to the high responsiveness of their bronchus. Thus, if exposed to allergens, they are more likely to develop an asthmatic attack than an adult. In relation to older people, their lung function is highly decreased. Due to the decreased function of the lungs in adults, allergens, viruses, smoking and some illnesses easily induce asthma in adults (Curie & Baker, 2012).

Diagnosis and Treatment in relation on Patient Factor:

The patient factor, age, will be important in the diagnosis of asthma. Although the physician will be keen to note the age of the patient, the other risk factors that play a role in the development of asthma will be considered. The physician, will thus ask the patient, or a parent in the case of a child, about the symptoms of the disease (Holgate, 2011). the physician will then take the past medical history of the client, which will help in determining any risk factor for asthma. Additionally, the physician will do a physical exam on the patient. Further, the patient will undergo  the tests for allergies, or other specialized tests, such as lung function tests, in the case of adults, to determine the functioning of the lungs. In adults also, the physician will consider that many adults might have taken a lot of non-steroid anti-inflammatory drugs in their lives, which would predispose them to asthma (Curie & Baker, 2012).

The  three major aspects of managing asthma are patient education, desensitization and pharmacologic management (Holgate, 2011). The health care provider teaches the patient about the disease and encourages the patient to avoid the triggering allergens. Additionally, the patient is taught on how to sense the increasing symptoms using a flow meter. Pharmacological management is also helpful in treating asthma, although some patients do not respond to inhaled steroids.

MIND MAPS:

1. Acute Asthma

 

Asthmatic medications/avoid exposure

Allergen, inflammatory response

Asthmatic exacerbation

 

Clinical Manifestation

Shortness of breath                                                                                                                  Older people(50-60)

Family/medical history

Physical exam

ABG values

 

Young Persons (7 million)

Greater in females before puberty

1. CronicAsthma

 

Individual plan      weight reduction

Inhalers                                             corticosteroids

Permeable vasculature, inflammatory response

Asthmatic exacerbation/IgE  activation/Interleukins

-race-obesity -genetics -Allergen exposure -dyspnoea

Clinical Manifestation

Older Adults

Older Adults

Older Adults

Young Persons (<5 years) prevalent in young boys than in Prevalent industrialized countries

References

Curie, P. G., & Baker, F. W. (2012). Asthma. Oxon, OX: Oxford University Press.

Holgate, T. S. (2011). Pathophysiology of asthma: what has our current understanding taught us about new therapeutic approaches? Journal of Allergy and Clinical Immunology, 128(3), 495-505.

Murphy, M. D., & O’Byrne, M. P. (2010). Recent advances in the pathophysiology of asthma. CHEST Journal, 137(6), 1417-1426.

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