Good Asthma- Case Analysis Report Research Paper Example
Patho physiological basis
Sam’s Heart Rate (HR) was 106. This value is a little in the higher side since the normal heart rate for an adult is between 60 and 100 beats per minute. He had a Pulse Oximetry of 98 percent at rest. Oximetry is a procedure for measuring the concentration of oxygen in the blood (Medicinenet). Slight wheezes were also detected on both sides of his chest.
Sam’s clinic spirometry (measurement of lung volumes and airflow) results for Forced Expiratory Volume (FEV) in one second FEV1 was 61 percent and post-albuterol treatment was 76 percent. Spirometry is usually assessed before and after the administration of short acting beta agonists. This is a 15 percent improvement post-albuterol treatment. This is indicative of intermittent asthma.
Asthma can affect the trachea, bronchi and bronchioles which form part of the lower respiratory tract. Asthmatic patients are characterized by the presence of underlying airway inflammation which is variable and has distinct but underlying patterns that reflect different aspects of the disease such as intermittent versus persistent or acute versus chronic forms of the disease (NHLBI, 2007).
Genetic factors, environmental factors and specific triggers can cause asthmatic symptoms. Triggers for asthma include pollutants, respiratory infections, weather changes, smoke and dust, foods and additives, and allergens such as house dust mite and pollen. Cigarette smoking is associated with worse asthma symptoms. Persistent symptoms of asthma cause considerable morbidity and absence from work and school (Kaufman, 2011).
Pharmacological basis (action of drug)
Albuterol was the drug prescribed to Sam. It is a short acting beta agonist. Short acting beta agonists are the first line treatment for mild intermittent asthma. Albuterol is prescribed to prevent and treat shortness of breath caused due to wheezing, chest tightening and coughing due to lung diseases such as asthma (Albuterol information, Medline). It is a bronchodilator that works by opening air passages to the lungs to make it easier to breathe by relaxing muscles in the airways and increasing airflow to the lungs (Albuterol information, Drugs).
These quick relief medications such as albuterol (short acting bronchodilators) which open air passages in order to make it easier to breathe are known as rescue medications (Asthma medications, Webmd). Other examples of quick relief medications are anticholinergics and systemic corticosteroids that help get symptoms under control quickly.
Long term controller medications are another type of asthma medication which helps prevent asthma attacks by decreasing airway inflammation over time and resulting in the patient being less likely to respond to triggers (Asthma medications, Webmd). These long term controller medications for asthma include long acting beta agonists, inhaled corticosteroids, leukotriene modifiers, mast cell stabilizers and theophylline (Kaufman G, 2011). A range of drugs are used in the management of asthma and the clinical guidelines advocate stepwise approach to therapy. Step down therapy is also followed when asthma control is good.
For patients with very severe asthma that is not well controlled with high dose inhaled corticosteroids, and have also tried a leukotriene antagonist or theophylline will also require oral corticosteroid tablets (Kaufman G, 2011).
3. Patho physiological changes
Airway inflammation causes airway hyper responsiveness, respiratory symptoms, airflow limitations and chronic disease. In some asthmatic patients, persistent changes in airway structure occur. These changes include mucus hyper secretion, injury to epithelial cells and smooth muscle hypertrophy (NHLBI, 2007). Asthma causes bronchoconstriction of the airways as a result of epithelial damage, narrowing of the airways due to epithelial damage, mucus over-production, bronchospasm and muscle damage (Kaufman G, 2011).
Albuterol is a bronchodilator that works by opening air passages to the lungs to make it easier to breathe by relaxing muscles in the airways (Albuterol information, Medline). If the patient does not adhere to the treatment plan these patho physiological changes could occur due to changes in airway structure.
Acute symptoms of asthma usually arise due to bronchospasm and require bronchodilator therapy. Airflow complexity changes in asthmatics can be detected by spirometric exams and by newer methods such as analyzing the airflow approximate entropy (ApEnQ) (Veiga J, 2011).
Poor asthma control results in increased hospitalization and urgent care visits. Self-management of asthmatic symptoms is very important for all asthmatic patients (Kaufman G, 2011). Along with pharmacological management of asthma, partnership between healthcare professionals and patients, personalized written asthma action plans, information and education are all very important (Kaufman G, 2011).
NHLBI (National Heart Lung Blood Institute), National Asthma Education and Prevention Program (2007), Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full Report
Medicine.net retrieved on Feb 15, 2015 from the website http://www.medicinenet.com/oximetry/article.htm
Kaufman G, (2011) Asthma: Pathophysiology, Diagnosis and Management, Nursing Standard, Volume 26, Number 5, 48-56
Albuterol information retrieved on Feb 15, 2015 from the website http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682145.html
Albuterol information retrieved on Feb 15, 2015 from the website http://www.drugs.com/albuterol.html
Asthma medications information retrieved on Feb 15, 2015 from the website http://www.webmd.com/asthma/guide/asthma-medications
Veiga J, Lopes AJ, Jansen JM and Melo PL, (2011) Airflow pattern complexity and airway obstruction in asthma, Journal of Applied Physiology, Volume 111, 412-419