Asthma is a Chronic Lung Disease Case Study

Question: Describe about the Case Study for "Asthma is a chronic lung disease"? Answer: Pathophysiology Asthma is a chronic lung disease that causes obstruction and inflammation of airways. It is recognised to affect the breathing patterns followed by excess coughing and wheeziness. Patients suffer from airway obstruction. People with family history of asthma are sure to be affected in their life. Both environmental and genetic factors are responsible for it cause. In this study, a patient is diagnosed with asthma in the childhood. Medical reports of the patient give a brief detail of patients history, treatment plan and medication prescribed. This study shows the physical and social impact of the disease on the patient. In this case study Patient aged 44, married with no children is diagnosed as a child with asthma. Asthma can be of two types allergic that is caused by exposure to allergen and non-allergic that caused by cold and other irritants. Asthma in this patient is identified to be because of environmental factors that mostly include airborne allergens and respiratory tract infections (Meln and Pershagen 2012). Other factors include tobacco smoke, cooking gases, air conditioners, nitrogen dioxide, humidifiers, improper ventilation in a house, infection due to other asthma members in the house, use of electric heaters, etc. Several cases identified the increased asthma on air pollution (Theoharides et l. 2012). These factors together with viral respiratory infections are mainly responsible for the severe persistence of childhood asthma. Most children are affected with parainfluenza virus and rhinovirus during their early life (Bouzigon et al. 2015). Asthma is also manifested by an interaction of respiratory viruses with atopy. Family asthma experiences showed to be the major risk factor in several cases. In this case study patients family history shows atopy. Thus, genetic factors also help in the development of asthma. Therefore, an onset of early asthma is mainly due to history asthma, early exposure to risk factors for atopy and wheezing. Asthma patients commonly experience discomfort from multiple triggers (dust, cold weather) coughing, tightness in chest, shortness of breath and wheezing. Lung function test shows the thick layer of mucous in airways causing obstruction, edema and inflammation of lungs in these patients. Blood examination shows elevation in inflammatory cells such as eosinophils, mast cells, neutrophils, immunoglobulin E and basophils. Several studies revealed that allergens elevate immune response. Therefore, the high level of TH2, cytokines, chemokines and Ig E are observed (Theoharides et l. 2012). Mast cells cause an IgE-mediated release of hista mine and leukotrienes the key players in causing inflammation and bronchoconstriction. Inflammatory mediators disrupt airway epithelium. Dendritic cells interact with allergens and infiltrate the lymph nodes which results in elevated T cell response. Neutrophils are elevated during excessive smoking. Airway remodelling also occurs due to infiltrations of structural cells that leads to hyperplasia and hypersecretion of mucous. It is further accompanied by angiogenesis and subepithelial fibrosis. Bronchial inflammation is the manifestation of interaction between immune cells and other mediators that are mainly responsible for narrowed airways (Meln and Pershagen 2012). Although genetic factors are known to play the crucial role in asthma exact mechanism behind inflammation and airway obstruction through them is not yet understood. Asthma also has psychosocial effects. Patients suffer from anxiety, depression, slouching, unusual restlessness, lack of desire to work, etc. Low oxygen als o affects neurological functions. An uncontrolled cough sometimes increases fear of death. These makes life too stressful that apart anger, frustration, embarrassment becomes part of their everyday lives (Bouzigon et al. 2015). History taking and diagnosis History taking in medicine is corner stone which gives doctors clear evidence of the present patient condition. It includes past experiences of disease along with physical and psychosocial effects. The history taking starts with series of the questionnaire for a patient to obtain complete details. The history in the case of childhood asthma should involve information about exposure to passive smoking during early infancy, maternal use of corticosteroids and any other environmental factors discussed earlier. Deteriorated lung function causes prolonged persistence asthma symptoms. Several studies show that development of asthma in children before three years of age is mainly due to maternal smoking during pregnancy and have more frequent wheezing (Bickley et al. 2012). According to some studies, these children show decreased lung function by the age of 7 years. Therefore, intervention in asthma development in childhood prevents persistence of airflow obstruction in later years. In this case, patient study reports identified asthma only and no evidence of chronic obstructive pulmonary disease found. She also has a personal and family history of atopy. A detailed physical examination is required to check distressing symptoms, a presence of viral infection in upper respiratory tract and assessment of factors that cause inflammation (Schleich et al. 2014). Asthma in this patient is identified to be because of environmental factors that mostly include tobacco smoke, cooking gases, air conditioners, nitrogen dioxide, humidifiers, improper ventilation in a house, infection due to asthma members in the house, electric heaters, etc. Family asthma experiences showed to be the major risk factor in this case. Therefore, although suffering from a persistent cough since January 2015, could not go for the regular checkup. The patient kept on using sister's inhalers up to the month of September. It worsened the situation with multiple triggers (dust, cold weather) coughing, tightness in chest, shortness of breath and wheezing. Upon checkup lung function test and other clinical reports showed the low level of PEF-200 instead of normal range 400. She was recommended with PO Prednisolone 40 mg for five days, one per day. Clenil 100mcg was prescribed to take two puffs in the morning and evening. Salbutamol 100 mg one or two puffs were told to use for emergency. Several studies show that administering prednisolone even after obstructing airflow is the cause of disease severity. Asthma in this patient is recognised to be of a severe persistent category. More of salbutamol and antibiotics was prescribed to relieve symptoms. But other problems developed such as severe abdominal pain and excess menstrual bleeding, dark periorbital patches and faced turned paler. Pelvic and blood examination results showed reduced ferritin and haemoglobin level. Medication was changed, and new asthma plan was given. Ferrous fumarate and Norethisterone 5mg was prescribed along with Symbicort 100 two puffs daily morning and evening. The patient was asked to revisit in 6 weeks for review. Asthma care plan would not relieve the symptoms of anemia (Lommatzsch and Virchow 2014). So, the combination of ICS and LABA was given. Patient has improved and did not require further Salbutamol 100 but experiences a cough usually in the morning. Inhaler technique A correct inhaler technique is a major factor determining the asthma control. Inhalation is the major route of drug delivery in asthma. According to several studies efficacy of inhaled medication and its outcome depends on the patient behaviour on an intake of medicines as instructed (Price et al. 2013). Inhaler therapy aims to deliver a drug directly to lungs. Patient compliance correlates with benefits of inhaler therapy. Different inhalers are deposited to the different extent in lungs. Salbutamol deposits at a lower rate. When maximum drug reaches lungs, it prevents the adverse effects associated with deposition of a drug to some other region. Patients who do not comply with the instructed dosage or proper inhalation technique result in delayed drug delivery to target organ. Lack of education is found to be one of the main reason for noncompliance and inappropriate inhaler use. Adversity of incorrect inhaler use is not properly assessed thus; pharmacists teach inhaler technique t o patients at pharmacies. It led to positively influence asthma control (Giraud et al. 2012). A variety of inhalers is used out of which metered dose inhalers are mostly used in delivering bronchodilators such as salbutamol, corticosteroids. Initial use of meter dose inhalers needs to be properly primed and well shaken before use. Canisters must be well cleaned, and mouthpiece should be dry (Hamdan, et al. 2013). Spacer devices more efficiently deliver drugs to lungs. Patient must read package instruction properly. Dry powder asthma inhalers contain medicine as the dry powder. Unlike the former inhalers, this one needs to be forcefully inhaled. Therefore, they are not prescribed for an aged patient. In this case study, the patient was prescribed to take Symbicort. To use this inhaler firstly capsule is loaded after removing the cap and then breathed deeply keeping mouthpiece between the teeth. Before exhaling, breath is to be held for few seconds (Giraud et al. 2012). Assessment and management of acute asthma Assessment includes identification of symptom intensity and chances of exacerbations and management is the steps taken to forestall the adversity. According to guidelines of NAEPP EPR-3 severity of the patient, a condition is to be determined. Management should be goal directed to achieve positive results. The goal is to prevent symptoms and future risk of exacerbations. These guidelines include the set of instructions that is followed by physicians as per the patients disease scenario. It helps in decision making about asthma care. It instructs patients about dos and donts, assist in determining triggers, next appointment for review, how to communicate with physician and family about asthma attacks. It includes the plan for managing symptoms and asthma attack and emphasize on patient education. Comprehensive treatment is planned so as to resolve and reverse the inflammation (Simons et al. 2012). These guidelines are updated from time to time. If these guidelines are correctly implem ented, it can save both personal and financial loss of the patient. Patients need to give detailed information about the persistence of a cough, whether at night or in a morning, trouble in breathing and performing normal activities. Practioner should plan and ameliorate the symptoms within 2-3 weeks. The analysis should be done to comprehend the reason behind symptomatic frequencies. In this case, study patient was suffering from asthma since childhood. After using medicines for a prolonged period, she was found to be asymptomatic. But recently symptoms recurred. Asthma control plan involves continuous monitoring. She was given steroids, bronchodilators and antibiotics and alleviate medications Prednisolone, Clenil and Salbutamol. It helped relieve the intensity of symptoms and discomfort. She worsened the situation by discontinuing the visit as symptoms were not profound. Distress started to occur despite inhaling steroids. Patients should avoid negligence even if symptoms are resolved. However, later she continued the treatment, and Asthma Management Plan was changed as exacerbations triggered. Childhood asthma management includes administration of mainly nedocromil and theophylline as per NAEPP guidelines but rarely used (Kaya et al. 2014). Patients with allergic asthma require the different set of guidelines according to NAEPP. Mostly omalizumab is prescribed that decreases the release of mast cells and histamine. These patients need to avoid dust allergens, mites, handling pets, etc. Non-pharmacological asthma management involves identification and restoring of the normal situation. Complete avoidance of environmental factors triggering asthma is the base rule. Avoiding food that irritates gastroesophageal reflux is necessary (Parshall et al. 2012). A comprehensive treatment plan is needed that helps control asthma along with educating a patient about details of the case and asthma management. In the given case study initial treatment decreased wheezing and coughing in the patient. But later other problems were noted such as abdominal discomfort and dark circles. Clinical tests identified low ferritin and haemoglobin level. So, asthma control plan was changed, and new medicines were prescribed that brought situation under control. Asthma care plan is changed from time to time with the change in severity and symptoms manifested. Patient and practitioner should efficiently collaborate and decide on to a correct action plan. Patients should also be helped to deal with psychological effects such as anger, confusion, anxiety and depression which are common in people with a prolonged disease. It is advisable to consult professional psychologists to learn to manage stressful experiences of chronic illnesses. Patients need to be in a positive state of mind. Apart from medication patients should engage in physical activities for both mental and physical well-being (Theoharides et al. 2012). Despite several efforts to manage asthma prevention of exacerbations, triggers remain an important problem in the world. Identification and mechanism of genetic factors in asthma is still under intense research. Continuous research is going on to understand the reason behind mismanagement and intervene asthma in early life so as to prevent its persistence in later life. References Bickley, L. and Szilagyi, P.G., 2012. Bates' guide to physical examination and history-taking. Lippincott Williams Wilkins. Bouzigon, E., Nadif, R., Le Moual, N., Dizier, M.H., Aschard, H., Boudier, A., Bousquet, J., Chanoine, S., Donnay, C., Dumas, O. and Gormand, F., 2015. [Genetic and environmental factors of asthma and allergy: Results of the EGEA study].Revue des maladies respiratoires,32(8), pp.822-840. Giraud, V., Allaert, F.A. and Roche, N., 2012. 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