Question

Hilda Wilde is a 45-year-old woman who was diagnosed with asthma as a child. She recalls her first asthma attack being horrendous; chest tightness, difficulty breathing, wheezing, feeling anxious and sweating profusely. She was rushed to hospital and spent many days in hospital as a child until she managed to work out the triggers and control it early. The triggers for her asthma were cold temperatures, pollen, smoky environments and respiratory infections/colds, which continue to be the triggers throughout her adult life. She also developed hay fever and an allergy to penicillin in her 20’s, which didn’t surprise her as her mum also had these conditions.

One cold Spring day Hilda is outside gardening as she is finding herself stressed by the current coronavirus and gardening usually relaxes her. Hilda is making good progress on weeding when she starts to experience those dreaded sensations she knows only too well; tightness in the chest, shortness of breath and dizziness. She starts to wheeze and cannot stop coughing. Her husband notices Hilda is struggling and brings Hilda’s inhaler (Ventolin) for her. Hilda’s wheezing and shortness of breath does not ease off, even with her inhaler. She finds it hard to talk or get up and walk. Her lips start to turn blue. Hilda’s husband calls an ambulance and Hilda is taken to hospital where she is given corticosteroids. She is told she has to stay in hospital a few days so that her condition can be monitored. However, Hilda is worried about staying in hospital due to the novel coronavirus outbreak. Her GP has previously told her that if she contracts the virus, she is at a greater risk of developing more serious symptoms such as pneumonia or acute respiratory distress. The hospital staff have assured her that they take all the necessary precautions. All coronavirus affected patients are isolated in private rooms, and all healthcare staff practice proper hand hygiene and appropriate use of PPE.

A few days later, Hilda’s asthma is under control and she is discharged from hospital. She is told to take her preventer medicine every day, even when she is feeling well. She is also told to follow routine practices and precautions to lessen her risk of contracting coronavirus.

Question

Choose 2 signs or symptoms that are characteristic of Hilda’s respiratory disease and link them to the pathophysiology of her condition (i.e., explain how the pathophysiological changes cause the signs and symptoms you specified).

Answer 1

☆ Shortness in breath and wheezing

Airway inflammation contributes to the respiratory symptoms.


Shortness of breath one of the primary symptoms of asthma, where the lung's airways are inflamed and blocked.

Wheezing is caused when air being forced through narrow, constricted air passages.

When exposed to the stimuli such as allergence ,airways get narrow due to bronchial smooth muscle contraction
This is called bronchioconstriction.This leads to the release of IgE-dependent release of mediators from mast cells that includes histamine, tryptase, leukotrienes, and prostaglandins that directly contract airway smooth muscle.

Stress is an another factor releasing pro inflammatory cytokines.

Exaggerated bronchoconstriction occurs when there is wide variety of stimuli causing Airway hyper responsiveness.

Inflammation appears to be a major factor in determining the degree of airway hyperresponsiveness.

Air way remodelling is an another issue causing permanent obstruction in the air way caused by thickening of the sub-basement membrane, subepithelial fibrosis, airway smooth muscle hypertrophy and hyperplasia, blood vessel proliferation and dilation, and mucous gland hyperplasia and hypersecretion.

Air way inflammation has a major role in asthma which involves interactions of many cell types and multiple mediators that causing characteristic pathophysiological features of the asthma such as cough, wheeze, and shortness of breath.