Common Type Of Asthma

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Common Type Of Asthma

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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.From the provided case study, it is evident that Tegan Smith could possibly be suffering from allergic asthma. Allergic asthma is the most common type of asthma and it is usually very severe among adults who are diagnosed with it during adulthood. This type of asthma tends to run in the family and thus genetics play a role in whether an individual will have allergic asthma if one of their family members has it (Mukherjee & Zhang, 2011). From the scenario that we are presented with, we are informed that Tegan’s mother, Christine Smith has a history of sinusitis, nasal polyps and allergy. This implies that Tegan must have inherited this condition from her mother.
Allergic asthma has several symptoms that include shortness of breath, coughing, wheezing, and tightness in the chest. In addition, Tegan also displays other symptoms that include watery eyes, stuffy nose, and postnasal drainage (Mukherjee & Zhang, 2011). Normally, these symptoms start showing when an individual inhales allergens which in Tegan’s case, had been a week earlier. Furthermore, she is has dyspnea and agitations despite treatments an indication that the condition has become severe.
We can also notice that her respiratory rate increases to 35 breaths per minute which is higher than the normal rate. This could be an indication of tachypnea which can be described as rapid shallow breaths. She also has an abnormally high heart rate of 125 bpm and her pulsus paradoxus also increases to 30 mmHg which are other characteristics of allergic asthma.
2.Several pathophysiological changes affect the airflow limitation in asthma. Some of these changes include bronchoconstriction, airway edema, airway hyper-responsiveness, and airway remodeling. Bronchoconstriction is described as the contraction of the bronchial smooth muscles thus leading to narrowing of the airway which in-turn interferes with airflow (Murphy & O’Byrne, 2010). Bronchoconstriction occurs rapidly to narrow the airway as a result of an exposure to allergens and other irritants. Allergen-induced bronchoconstriction results from the release of mediators such as histamine, leukotriene, tryptase, and prostaglandins which directly leads to the contraction of the airway smooth muscle.
Airway hyperresponsiveness can be described as an exaggerated bronchoconstriction in response to several stimuli and irritants. It is a major contributing factor in asthma. The clinical severity of asthma, in most cases, determines the degree to which the hyperresponsiveness of the airway can be defined due to contractile responses to methacholine challenges (Murphy & O’Byrne, 2010). Mechanisms such as inflammation, structural changes, and dysfunctional neuro-regulations affect the hyper-responsiveness of the airways.
Airway remodeling, on the other hand, can be described as the activation of the structural cells which consequently leads to permanent changes in the airway thus increasing the obstruction to airflow and may make the patient become less responsive to therapy. This permanent change of the airway structure may be associated with the gradual loss of the lung function (Bara, Ozier, De Lara, Marthan & Berger, 2010). Changes might involve sub-epithelial fibrosis, dilation and proliferation of the blood vessels, hypersecretion of the mucous glands, and thickening of the sub-basement membrane. Finally, airway edema further limits airflow as the disease becomes more severe.

3.One of the most common treatment options for asthma is the reliever medication that is administered by the use of an asthma spacer device. One of the reliever medications is the inhaled short-acting beta2 that is normally very effective as a first aid medication for asthmatic patients (Asthmaaustralia.org.au, 2018). Patients diagnosed with allergic asthma, like is the case with Tegan are prescribed reliever medications for emergency purposes. This reliever medication commonly comes in a device known as the metered-dose inhaler. This device is used to deliver a specific dosage of medication to the lungs to help with airflow (Asthmaaustralia.org.au, 2018). The relievers are available in most pharmacies in Australia without prescription.
Another available treatment option may be the use of preventer medication such as an inhaled corticosteroid. This medication should be taken on a daily basis in combination with relievers in case any symptoms are available. This medication is appropriate for patients who have had any symptoms of asthma in more than once in the past one month (Bosnjak, Stelzmueller, Erb, & Epstein, 2011). Preventer medication may sometimes involve a second medicine in addition to the inhaled corticosteroid. This according to the Australian guidelines is referred to as combined therapy.
Inhaled corticosteroid reduces the inflammation of the airways thus lowering an individual’s risk of suffering a severe flare-up of asthma. It is normally administered in a low dose to help in achieving good control for the symptoms of asthma (Lazarus, 2010). The preventer is taken every day even in the absence of symptoms unless otherwise stated by the doctor to avoid asthma flare-up.
4.Some of the standard asthma management education for the parents and their children in moments preceding discharge is as described below.
Skill Training for an Appropriate Use of the Inhaler
It is important that the parent and the child are educated on the appropriate use of the inhaler to enhance an efficient control of the symptom and avoid exacerbations. To ensure effective usage, the doctor should choose the most suitable device for their patient before the prescription (Ginasthma.org, 2018). It is further important to check the inhaler technique and use a physical demonstration to show the patient the effective use of the device.
An Improved Adherence to the Medications
Most patients rarely take their medication as prescribed by the doctor. Non-adherence to medication is another leading cause of poor control of asthmatic symptoms. Poor adherence may be unintentional or non-intentional (Boulet, Vervloet, Magar & Foster, J2012). It is important to engage the parents in a shared decision-making for the choice of dose and medication. Additionally, reducing the complexity of the regimen could help in improving the adherence to medication. Furthermore, it is important to perform a comprehensive education on the symptoms of asthma and the management techniques.
A Written Action Plan
The patient should be provided with a written action plan that describes their asthmatic condition to help them in the control and manage asthma by recognizing worsening asthma and appropriately responding to them (Ginasthma.org, 2018). This action plan should have the asthma medications that are normally used by the patient, the procedure of increasing medication if the need arises, and the way to access medical care if the symptoms persist.

References
(2018). Asthmaaustralia.org.au. Retrieved 1 May 2018, from https://www.asthmaaustralia.org.au/ArticleDocuments/1594/Asthma%20Schools%20Guidelines%20Victoria%202017.pdf.aspx
(2018). Ginasthma.org. Retrieved 1 May 2018, from https://ginasthma.org/wp-content/uploads/2016/01/GINA_Pocket_2015.pdf
Bara, I., Ozier, A., De Lara, J. T., Marthan, R., & Berger, P. (2010). Pathophysiology of bronchial smooth muscle remodelling in asthma. European Respiratory Journal, 36(5), 1174-1184.
Bosnjak, B., Stelzmueller, B., Erb, K. J., & Epstein, M. M. (2011). Treatment of allergic asthma: modulation of Th2 cells and their responses. Respiratory research, 12(1), 114.
Boulet, L. P., Vervloet, D., Magar, Y., & Foster, J. M. (2012). Adherence: the goal to control asthma. Clinics in chest medicine, 33(3), 405-417.
Lazarus, S. C. (2010). Emergency treatment of asthma. New England Journal of Medicine, 363(8), 755-764.
Mukherjee, A. B., & Zhang, Z. (2011). Allergic asthma: influence of genetic and environmental factors. Journal of Biological Chemistry, 286(38), 32883-32889.
Murphy, D. M., & O’byrne, P. M. (2010). Recent advances in the pathophysiology of asthma. Chest, 137(6), 1417-1426.

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