Running head: Academic Written Assignment- HSNS 264

Part A: Pathophysiology of Asthma

Name: Pavithra Asangani Samaranayake

Student No: 220194999
University of New England

Due Date: 08/04/2019

Unit Coordinator: Dr Zaneta Smith
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Asthma is a long term inflammatory disease of the respiratory tract that prevalence in
worldwide. It is the most common lung disease in children and the incidences of asthma are
more frequent in Australia (AIHW, 2005). Chronic asthma condition can be challenging for
many people’s daily activities and school attendance of children. Seven year old Zachy’s
story is a common example for a childhood acute asthma condition. When it critically
analyzes the phone call occurred between Zachy’s mother and the nurse reveals that Zachy is
in an acute asthmatic situation. Global Initiative for Asthma (2009) defined Asthma
exacerbation as an acute worsening of asthma warning signs of a person that cause to make
unhealthy and vital to visit to a health care provider. Most Asthma attacks may necessary to
have hospital admissions and sometimes it can be life threatening.

Anatomy and physiology of Respiratory system

The key role of the respiratory tract is to provide oxygen in to the body to sustain life. The
environmental air including oxygen moves through the respiratory tract to lungs. The
respiratory system can be divided into the upper respiratory tract and the lower respiratory
tract. The upper respiratory tract consists of nose and nostrils, pharynx, and larynx and the
lower respiratory tract consists of trachea, bronchus, bronchi, and lungs. Lungs are located in
the thoracic cavity with the heart. Right lung has three lobes and the left lung has only two
lobes. Inside the lungs, the bronchi stem into enormous number of smaller, narrow tubes
called bronchioles. These tubes connect to bunch of small air sacs called alveoli which
exchange oxygen, carbon dioxide and other gases through blood circulation (National Heart,
Lung and Blood Institute, USA, n.d.).

What is Asthma

According to National Asthma Council, Australia (2019), Asthma can be defining as an

abnormal variation in lung function due to air way inflammation and it can be also explained
with the warning respiratory signs namely wheezing, shortness of breath, cough and chest
tightness. These symptoms can be worse in night, in early morning or when doing exercises.
According to the organization of Global Initiative for Asthma (2018), Asthma is
characterised by chronic involvement of some inflammatory cells, airway hyper-
responsiveness and airflow limitation.
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Causes of Asthma

Pruitt & Lawson. (2011) explained that Asthma is known to increase by host factors namely
genetic predisposition, obesity, and gender (males have a higher risk to get asthma in children
but a higher incidence among adult women). The environmental factors that cause for
asthma comprise allergens, respiratory infections, occupational chemicals that makes
hypersensitivity, active or passive tobacco smoke, air pollution, pollen and certain food
particularly intact cow's milk or soy protein. In order to the explanation of Zachy’s mother,
Zachy does not have any previous asthmatic history. Although that, Zachy has been suffered
with a runny nose and a cough for days. This illustrates that he has had a respiratory infection
in previous days and probably it has been lead to an acute asthmatic condition.

Pathophysiology of Asthma

Pruitt & Lawson (2011) illustrate that environmental factors or predisposition of genetic
factors result in airway inflammation in asthmatic patients. This leads to breathing
difficulties, cough, and wheeze and short of breath. Asthma attribute by airway inflammation
and hyperresponsiveness. These involve the inflammatory cells and inflammatory mediators.
Airway inflammation causes to bronchospasms and edema of airway, epithelial and muscle
damage and narrowing of air way due to excessive mucous production. The contraction of
damaged smooth muscles and further narrowing of airway lumen leads to acute asthma attack
or asthma exacerbation. When it reflects the scenario of Zachy, the suspecting respiratory
infection can cause to make an inflammation and hyperresponsivness in his airway. When an
infection is in the respiratory tract, the inflammatory cells and the inflammatory mediators
produce an inflammatory action in the airway and produce excessive mucous and cause to
narrow the bronchus.

Signs and symptoms of Asthma

According to American College of Allergy, Asthma & Immunology (2018), symptoms of

young age asthma can range from a cough that remain for days and to a sudden deterioration
into breathing emergencies. In further it describes that parents should be observe for
especially at nocturnal cough, wheezing sound when breathing out, difficulty in breathing or
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fast breathing and recurrent colds. With it consider the scenario of Zachy, he has been
suffering with a runny nose and coughs for couple of days and has faced with a worsening of
symptoms in the mid night. Sharma, G.D. et.al (2019) in the article of Pediatric
Asthma Clinical Presentation explains clinical manifestation of Asthma as wheezing
(Whistling sound formed by airflow during exhalation), coughing (usually, the children with
nocturnal asthma be likely to cough after midnight, during the early hours of morning.) and
chest tightness, sputum production and shortness of breath. Zachy’s mother describes her
son’s situation as awake and can talk, but cannot catch his breath and having persistent
cough. Moreover she explains his breathing pattern as strange wheezy sound with fast
breathing.

Classification of Asthma exacerbation

According to Carlos, Camargo, Rachelefsky, and Schatz (2009) severity of asthma

exacerbation can be categorized as mild, moderate and severe. In mild stage, patient is
difficult to breathe while walking, increasing respiratory rate, can talks in sentence, can lie
down, may be agitated, normally not use accessory muscles and wheezing happens only in
end expiration. In moderate stage, patient is difficult to breathe even in rest, increase
respiratory rate, prefers sitting, talks in phrases, usually agitated, frequently use accessory
muscles, wheezing happens in exhalation. In severe asthmatic attack, patient is difficult to
breathe even in rest, sits upright, increase respiratory rate, prefers sitting, talks in words or
cannot talk, usually agitated, frequently use accessory muscles, wheezing happens in both
inhalation and exhalation. When compare this classification with the clinical features of
Zachy, he is in a mild to moderate acute asthmatic condition. Therefore after taking the
history and the present clinical signs, the Registered nurse recommend Zachy’s mother to
make him calm down and to bring down him directly to the Emergency department as the
most favourable decision.

Conclusion

Asthma can seriously limit the daily living activities of a person. Onset worsening of asthma
symptoms is known as an asthma attack or an 'acute asthma exacerbation'. According to the
presentation of signs and symptoms, asthma exacerbation can classify as mild, moderate and
severe stage. Some particular gene and environmental factors cause to the expression of
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Asthma. Acute Asthma attack associates with wheezing, shortness of breath, cough & chest
tightness. Zachy’s story is an instance of a common worsening of asthmatic condition that
can happen among children in that age. Respiratory infection continues for couple of days
with the signs of persistent cough with cold may lead to the Zachy’s acute asthmatic
condition. In Asthma, the inflammatory reaction of cells and mediators cause to create more
mucous in airway and narrow the lower respiratory tract and to make bronchospasms and
constrictions. This leads to manifest clinical features of acute asthmatic attacks.
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References

AIHW. (2005, August 24). Chronic respiratory diseases in Australia: Their prevalence,
consequences and prevention, Summary. Retrieved from
https://www.aihw.gov.au/reports/chronic-respiratory-conditions/chronic-respiratory-diseases-
australia/contents/summary

Global Initiative for Asthma.(2009). Global Strategy for the Diagnosis and Management of
Asthma in Children 5 years and Younger. Retrieved from < www.ginasthma.org> [PubMed]

National Heart, Lung and Blood Institute,USA. (n.d.). How the Lungs Work. Retrieved from
https://www.nhlbi.nih.gov/health-topics/how-lungs-work

National Asthma Council Australia. (2019). Definitions and commonly used terms. Retrieved
from https://www.asthmahandbook.org.au/resources/definitions

Global Initiative for Asthma- GINA (2018). Global strategy for asthma management and
prevention. Retrieved from https://ginasthma.org/gina-reports/

Pruitt, B., Lawson, R., (2011). Assessing and managing asthma: A Global Initiative for
Asthma Update. Nursing, 41(5), 46-52 .Retrieved from
https://journals.lww.com/nursing/Fulltext/2011/05000/Melanoma.14.aspx#pdf-link

American College of Allergy, Asthma & Immunology (2018, December 31). Asthma in
Children. Retrieved from https://acaai.org/asthma/asthma-101/asthma-in-children
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Sharma, G.D. et.al(2019, January 08). Pediatric Asthma Clinical Presentation: History,
Physical Examination, Staging. Retrieved from
https://emedicine.medscape.com/article/1000997-clinical

Carlos, A., Camargo, J. , Rachelefsky, G., Schatz ,M., (2009, August 01). Managing
Asthma Exacerbations in the Emergency Department. Retrieved from
https://www.atsjournals.org/doi/full/10.1513/pats.p09st2