Question

Ruta is a 36 years old female with a weight of 60kg. She was admitted to the hospital on 15/04/2020. She was just getting home from her gardening and she just felt uneasy to breathe. She has been noticing for a while that she is having trouble in breathing and her chest tightens. She is also having coughing with mucus. She said because of shortness of breath (SOB), sometimes she is not able to speak in full sentence. She also stays awake occasionally in the night because of SOB and wheezing. Her past medical histories were hypercholesterolemia and asthma. She has no known drug and food allergy. She is working occasionally now and is living alone. She is a smoker and drinks occasionally. She has no known family history. The Emergency Department (ED) doctor has diagnosed her with Exacerbation of Asthma.

She is on salbutamol 200mcg as required.

Question

1. Two major pathological changes that occur in the lungs during an asthma attack are: • Bronchial smooth muscle contraction • Increased mucus production Explain how these pathological changes arise in your person/client (ie. the pathophysiology).

Hint: your answer should include discussion of the immune cell mediated response.

Answer 1

ASTHMA

Definition

Asthma is a condition in which the the airway becomes narrow and swell and produce extra mucus.This can make breathing difficult and trigger coughing ,whistling sound(wheezing)when breaths and shortness of the breath.

Pathophysiology

There are two phases of asthma exacerbation which includes

1. EARLY PHASE
2. LATE PHASE

EARLY PHASE

• The early phase is initiated by IgE antibodies that are sensitized and released by plasma cells.
• These antibodies will responce to some environmental risk factors of asthma.
• IgE antibodies will bind to mast cell and basophils
• When the person inhaled any pollutants these T cells releases cystokines and eventually de-granulate.
• The release from mast cells are Histamin,Prostaglandines and leukotrienes.
• These cells in turn,contract the smooth muscels and cause airway tightening.
• Th2lymphocytes will produce interleukins (IL4=-4,IL-5,IL-13) and GM-CSF which substain the imflammation by communicating with other cells.
• IL-3 and IL5 helps the basophils and esiniphils to survive.
• IL-13 attributes to remodeling fibrosis,hyperplasia.

LATE PHASE

• In this phase the esinophils,basophils,neutrophils and helper and memory T cells all localize to lung which perform Bronchoconstruction and cause inflammation.
• Mast cells also play an important role in late phase which reacts to the inflammed sites.
• It is critical to regognize both these two mechanisms to target therapy and relieve both bronchoconstriction and inflammation depending upon the sevearity of the disease due to narrower airway which will lead to the tightening of the muscles around the airway and there is an increased production of the mucus(phlegm).
• As a result of inflammation and bronchoconstriction,there is an intermittent airflow obstruction which lead to increased work of breathing.