Pathophysiology Assignment Paper

Pathophysiology & Clinical Findings of the Disease

Pathophysiology Assignment Paper

  1. Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?

The spirometry results indicate obstructive pulmonary disease. The lungs can take up much capacity, as seen in the vital and total inspiratory capacity and other lung volumes. Obstructive pulmonary disease entails restriction of normal airflow due to alveoli and other respiratory organs’ collapse and blockade by fluid or narrowing due to inflammation.

The changes are thus visible in the expiratory volumes, with a more than 30% decrease in forced expiratory volume (Sarkar et al., 2019). The most common conditions include asthma and bronchitis. In restrictive pulmonary disease, the lung is prevented from expanding intrinsic or extrinsic factors, and spirometry results show a marked decrease in inspiratory and expiratory volumes. Lung infections or diseases (pneumonitis, pulmonary fibrosis, and interstitial lung disease) that cause the replacement of normal lung tissue with fibrous tissues restricting movement also cause restrictive disorders.

Extrinsic factors include pleural effusion, respiratory muscle failure, and chest wall abnormalities, and they limit lung expansion, decrease lung volumes, and lead to progressive lung failure. The most likely condition is asthma to the patient history, review of systems, physical exam, and diagnostic tests.

  1. Explain the pathophysiology associated with the chosen pulmonary disease.

Asthma is a severe pulmonary disease that can be acute or chronic, depending on its severity—the condition results from pulmonary airway inflammation that presents with reversible lower airway obstruction. The patient presents with hyperresponsiveness and immune mediation to specific environmental triggers.

Sinyor and Perez (2021) note that the airway is triggered by allergens such as cold air, chemicals, and cigarette smoke which cause an early-phase immunoglobulin E (IgE)-mediated bronchial airflow reduction followed by a late-phase IgE media airflow reduction for 4-8 hours. Chronic asthmatic episodes lead to various changes, such as lung hyperinflation seen on an X-ray, smooth muscle hypertrophy, mucosal edema, and mucus gland hypersecretion.

The narrowing of the airway may lead to forced inspiration hence the wheezing sound in some asthmatic patients. Chronic obstruction impairs gaseous exchange leading to orthopnea. Exercises increase the oxygen demand, and with poor airflow, breathlessness worsens. In asthma, eosinophils, neutrophils, lymphocytes, and plasma cells increase. Leukocytes in the blood trigger these immune mediators to release inflammatory mediators such as histamine.

The activated T-lymphocytes also trigger interleukin IL-3, IL-4, and IL-5; interleukin 3 and 4 trigger the conversion of IgM to IgE responsible for the asthma presentations (Sinyor & Perez, 2021). IL increases eosinophils production and release. All these etiologies lead to asthma. Regardless of the etiology, asthma causes progressive damage to the lungs and airway, leading to changes in the lung and airway structures.

  1. Identify at least three subjective findings from the case which support the chosen diagnosis.

The patient was diagnosed with bronchitis three weeks ago. Asthma follows a chronic airway inflammation and is often associated with chronic bronchitis. The patient reports that exercise exacerbates breathlessness and severely limits cardiac rehabilitation exercises. The patient is experiencing shortness of breath. The patient also experiences a dry cough in the AM.

Asthma can cause bronchitis due to repeated damage to the epithelium and increased sensitivity to inflammation. However, chronic bronchitis can also lead to asthma. Airway obstruction causes hypoxia in the cells, and exercises increase oxygen demand. Cardio exercises coupled with narrowed airways worsen breathlessness. They may cause stridor, a high-pitched sound produced as individuals try to force air through the narrowed airways, a classical presentation in asthma (Hull et al., 2020). Constriction of the airway can irritate hence chronic dry cough. However, patients may produce phlegm due to the accumulation of secretions in the airway hence a productive cough

  1. Identify at least three objective findings from the case which support the chosen diagnosis

The X-ray reveals a hyperinflated lung, common in asthma and other COPD. Ullmann et al. (2019) note that most imaging studies are normal in asthma, but chronic illness causes structural changes in the airways and alveoli, and hyperinflation can be visible.

Auscultation of the lungs reveals bilateral wheezes noted with forced exhalation and a prolonged expiratory phase (increased respiratory effort coupled with fatigue from the subjective data indicate COPD such as asthma). The spirometry results indicate obstructive pulmonary disease with reductions in expiratory volumes (Sarkar et al., 2019). The respiratory rate is 22, above the normal respiratory rate to compensate for the obstructed airway movement

Management of the Disease

  1. Classify the patient’s disease severity. Is this considered stable or unstable?

The patient has moderately persistent asthma (stage 3), where patients feel like they are in a continuous flare-up. The symptoms of breathlessness are persistent and only worsen with time. The condition can be considered stable asthma due to the lack of recent changes in asthmatic symptoms. Unstable or brittle asthma reverberates from severe to mild episodes and places the patient at risk for severe life-threatening episodes, thus requiring aggressive management.

  1. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

There are various medications approved for asthma. The medication’s major focus is to dilate the airway and reduce inflammation. Medications can target the airway diameter change or inflammation to implement change. Different medications have different onsets of action hence their use in long-or short-term management. Inhaled short-acting beta2 agonists such as salbutamol and corticosteroids such as fluticasone are some first-line medications for asthma management according to GINA guidelines (Rajan et al., 2020). Other medications include leukotriene, which modifies that target inflammation mediators

  1. Describe the mechanism of action for each of the medication classes identified above.

Salbutamol is an FDA-approved beta 2A receptor agonist used in asthma patients. It is often given to asthmatic patients during asthmatic attacks as a nasal spray. It activates beta-2 receptors relaxing the bronchial smooth muscles through depolarization through the uptake of potassium ions into the cells (Krings et al., 2019). Bronchial muscle relaxation causes dilatation hence relieve of obstruction caused by bronchoconstriction. The medication also stabilizes mast cells, which are vital in inflammatory mediation, and reduces the inflammation that follows asthma.

Fluticasone is an FDA-approved medication for asthma and other chronic obstructive pulmonary disease in individuals aged four years and above. It is a corticosteroid that inhibits inflammatory mediators such as mast cells, neutrophils, lymphocytes, and macrophages responsible for asthma presentations (Krings et al., 2019). The medication also inhibits the secretion of histamines, cytokines, and leukotrienes, hence managing allergic symptoms in asthma. The drug has a late onset of action and takes three days to reach therapeutic plasma levels; hence, it is used for long-term asthma management.

  1. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

Asthma patient education is a priority in non-pharmacologic management. Nanda et al. (2020) note that allergen avoidance is an important management intervention for asthma, and patient education is thus paramount. Individuals who develop attacks after exposure to colds should keep warm and avoid other allergens to prevent asthmatic attacks. For example, athletes with asthma often practice intermittent work, exercises, and competitions to prevent asthma exacerbations (Williams et al., 2020).

Individuals also take supplements such as vitamin c, omega three fatty acids, and probiotics (especially in pediatrics) which help increase immunity and prevent asthma exacerbations. Breathing exercises can prove useful in patients with limited cardiac rehabilitation training. GINA recommends that asthma patients practice breathing exercises that include diaphragmatic, nasal, and pursed lip breathing exercises as effective non-pharmacological management interventions (Reddel et al., 2022). They include lung volumes and help improve lung health, airway opening, and oxygen supply to the tissues

Pathophysiology Assignment Paper References

Hull, J. H., Godbout, K., & Boulet, L. P. (2020). Exercise-associated dyspnea and stridor: thinking beyond asthma. The Journal of Allergy and Clinical Immunology: In Practice8(7), 2202-2208. https://doi.org/10.1016/j.jaip.2020.01.057

Nanda, A., Baptist, A. P., Divekar, R., Parikh, N., Seggev, J. S., Yusin, J. S., & Nyenhuis, S. M. (2020). Asthma in the older adult. Journal of Asthma57(3), 241-252. https://doi.org/10.1080/02770903.2019.1565828

Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., & Boulet, L. P. (2022). Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. American Journal of Respiratory and Critical Care Medicine205(1), 17-35. https://doi.org/10.1016/j.arbres.2021.10.003

Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India: Official Organ of Indian Chest Society36(1), 38. https://doi.org/10.4103/lungindia.lungindia_145_18

Sinyor, B., & Perez, L. C. (2021). Pathophysiology Of Asthma. In StatPearls [Internet]. StatPearls Publishing.

Ullmann, N., Mirra, V., Di Marco, A., Pavone, M., Porcaro, F., Negro, V., Onofri, A., & Cutrera, R. (2018). Asthma: differential diagnosis and comorbidities. Frontiers in Pediatrics6, 276. https://doi.org/10.3389/fped.2018.00276

Williams, N. C., Johnson, M. A., Adamic, E. M., & Mickleborough, T. D. (2020). Non-pharmacological management of asthma-related issues in athletes. Complete Guide to Respiratory Care in Athletes (pp. 86-98). Routledge. https://doi.org/10.4324/9780429492341-7