Case Study On Respiratory System

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Case Study On Respiratory System

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Questions:
1.Based on the information in the case study, which type of asthma is Tegan Smith likely to have suffered?

2.Discuss the pathophysiological changes in asthma.

3.Discuss different treatment options for asthma (Australian perspective).

4.List the standard asthma management education for parents and children before discharge (Australian perspective).

Answers:

1.According to several medical studies, asthma can be classified into six types, depending on the source of stimulation of the disease. These types are allergic asthma, asthma without allergy, Aspirin Exacerbated Respiratory Disease (AERD), asthma induced by exercise, asthma due to cough variation, and asthma from occupational causes. From the information of the case study, Tegan Smith had been suffering from wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage for seven days. Thus, she likely to have suffered from inherited allergic asthma. For allergic asthma, the nutritional environment is considered as the source of stimulation. From the pathophysiological aspect, allergic ashtma results probably from the anomalous expansion of CD4+ T cells which produce type two cytokines interleukin-5 (IL-5) and interleukin-4 (IL-4). However, the necessary cause for allergic asthma would be type 2 cytokine IL-13 (Thomsen, 2015). Her mother Christine Smith had symptomps like nasal polyps, allergy and sinusitis. Thus, Tegan must have suffered from AERD and on Tegan’s part her symptomps had been influenced both by genetic and environmental factors. AERD is an acute medical condition where nadsal polyps is developed as a symptom and the patient becomes sensitive to Aspirine. From the case study, it is clear that she did not develop occupational asthma, so in her case asthma is caused due to multiple interacting genes. Some have protective effect while others contribute to the disease pathogenesis. Each gene has its own propensity to be controlled by the environment. Moreover, as Tegan had inherited this disease from her mother, it is clear that this disease is autosomally inherited (Bønnelykke et al., 2015).
2.Asthma is a common chronic disease which causes notable disability and social load. It shows highly complex airway-obstruction disease conditions. Asthma is a common respiratory disease occurring now-a-days. The respiratory disease follows the reduction in perfusion and ventilation. One of the significant causes of asthma is airflow obstruction. According to Doeing and Solway (2013), chronic inflammation of airways is recognized as one of the major causes asthma. Inflammation in asthmatic airways not only infects the bronchi and trachea but also affects the terminal bronchioles and parenchyma. Inflammation should reach a certain limit to show the symptoms in animal body. The level of inflammation does not relate to asthma extremity but relates to airway hyperresponsiveness (AHR). The enhanced airway responsiveness caused by asthma, is a noticeable physiological abnormality. It is present even when the airway is functioning normally. The medical condition of asthma is composite, with various inflammatory cells and various mediators resulting in chronic and serious inflammatory effects on the airways. However, the significant advances can be achieved by comprehending asthma pathogenesis. It can be done by applying new molecular and genetic techniques. The development of new specifically chosen drugs analyze the interacting pathways operated in asthma. Recently, the death caused by asthma has been reduced to a certain percentage, however, the asthma patients continue to face poor control over the symptoms of asthma (Burrowes et al., 2013).
3.The several treatment options available for curing asthma in Australia are-

Antileukotrienes or leukotriene modifiers
Inhaled corticosteroids (ICS)
Oral corticosteroids (OCS)
Long-acting inhaled beta2-agonists (operated with any other asthma-related medication)
Methylxanthines
Immunomodulators

ICS are very successful in decreasing symptoms and outburst of asthma. In the year 2013, the drug was dispensed on 6.3% of the population in Australia. In that year, the dispense of the medicine on females was 6.9% and on males, 5.7%. The dispense of ICS was more applicable to people who belong to high socioeconomic status. Australians aged 65 years or more were allocated more under the ICS medication than young Australians. According to the Australian guidelines for the asthma management suggestesd that ICS should be taken on a regular basis. However, it was observed that people who are 65 years older or more, and who experienced ICS in 2013, only 30 percent of them had faced consistent dispensing frequencies with regular use. The people of 35 to 64 years of age faced the frequencies at a lower rate (15.8%). The rate is lowest for people aged 15 to 34 years (7.3%) (Wenzel et al., 2016).
Oral corticosteroids (OCS) are recommendable for curing the outburst of asthma. Only 1.6 peercent among those who were dispensed any inhaling medications in 2013, were assigned for OCS treatment. Thus, it can be assumed that only these 1.6% are prone to the risk of eruption of asthma in the year 2013 (Zazzali et al., 2015).
The initial biological medication accepted for asthma management in Australia is Anti-IgE monoclonal antibody therapy (omalizumab). The application of this treatment is quite uncommon, with just 0.001 percentage of the total population in Australia (approximately 298 people ) being dispensed this drug in 2013 (“Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD, Summary – Australian Institute of Health and Welfare”, 2018)
4.According to Zwar et al., (2017), asthma is one of the chronic diseases that can be managed by primary care. The aim is to enesure that each patient should get the proper education for taking care of asthma before discharge from the hospital. According to the Australian asthma management guidelines, it is recommended that any asthma patient should be clinically assessed by the taken care properly in order to maintain the lung function to the level best. Besides, quick-relief and rescue medications should be used to get instant relaxation. It helps in openning the air ways during asthma flare-up (Armour et al., 2013).
The patient as well as his/her parents or guardians before discharge should get awareness session about the causes, triggers, symptoms, and treatment of asthma before discharge (Jordan et al., 2013). According to Kim and Bird (2015), patients of 2 to 18 years of age should be taken extra care to check asthma treatments post asthma discharge from hospital and prior hospital readmission. Before the discahrge of the patient, the doctors and nurses should demostrate the patients and their families about the way of post asthma take care at home. The hospital authority should ensure that the patient and his/her family has adequate understanding of the disease and the related first aid. Before the discharge, the patient’s family should know all the asthma medications like Short-Acting Beta Agonists (SABA), OCS, Long-Acting Beta Agonists (LABA), and ICS and also know which medication works better for that particular patient in case of emergency at home after discharge from the hospital

References:
Armour, C. L., Reddel, H. K., Lemay, K. S., Saini, B., Smith, L. D., Bosnic-Anticevich, S. Z., … & Stewart, K. (2013). Feasibility and effectiveness of an evidence-based asthma service in Australian community pharmacies: a pragmatic cluster randomized trial. Journal of Asthma, 50(3), 302-309.
Bønnelykke, K., Sparks, R., Waage, J., & Milner, J. D. (2015). Genetics of allergy and allergic sensitization: common variants, rare mutations. Current opinion in immunology, 36, 115-126.
Burrowes, K. S., De Backer, J., Smallwood, R., Sterk, P. J., Gut, I., Wirix-Speetjens, R., … & Brightling, C. (2013). Multi-scale computational models of the airways to unravel the pathophysiological mechanisms in asthma and chronic obstructive pulmonary disease (AirPROM). Interface Focus, 3(2), 20120057.
Doeing, D. C., & Solway, J. (2013). Airway smooth muscle in the pathophysiology and treatment of asthma. Journal of applied physiology, 114(7), 834-843.
Jordan, J. E., Buchbinder, R., Briggs, A. M., Elsworth, G. R., Busija, L., Batterham, R., & Osborne, R. H. (2013). The Health Literacy Management Scale (HeLMS): A measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. Patient education and counseling, 91(2), 228-235.
Kim, J. K., & Bird, J. A. (2015). Childhood Asthma Hospital Discharge Medication Fills and Risk of Subsequent Readmission. Pediatrics, 136(Supplement 3), S271-S272.
Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD, Summary – Australian Institute of Health and Welfare. (2018). Australian Institute of Health and Welfare. Retrieved 27 April 2018, from https://www.aihw.gov.au/reports/asthma-other-chronic-respiratory-conditions/respiratory-medication-use-in-australia-2003-2013/contents/summary
Thomsen, S. F. (2015). Genetics of asthma: an introduction for the clinician. European clinical respiratory journal, 2(1), 24643.
Wenzel, S., Castro, M., Corren, J., Maspero, J., Wang, L., Zhang, B., … & Eckert, L. (2016). Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. The Lancet, 388(10039), 31-44.
Zazzali, J. L., Broder, M. S., Omachi, T. A., Chang, E., Sun, G. H., & Raimundo, K. (2015, July). Risk of corticosteroid-related adverse events in asthma patients with high oral corticosteroid use. In Allergy and asthma proceedings (Vol. 36, No. 4, pp. 268-274). OceanSide Publications, Inc.
Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management

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