Patient Diagnosis Case Study- Asthma

Patient Diagnosis Case Study- Asthma

Scenario

Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since she was a child, for which she was hospitalized several times. Her asthma was well controlled until the past couple of years. She has been seen in urgent care a few times over the past year (most recently, 4 months ago) and was given a prescription for an inhaled steroid (she never filled it), an albuterol inhaler, and oral steroids. She had eczema as a child and received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 4 to 5 times/day. She reports that she is very short of breath when climbing stairs or when walking to the mailbox. She has had nighttime coughing spells every day during the past week and has had to prop up herself up on pillows to breathe. She indicates that she has had similar previous flares in the past.

Health information:

Meds: Proair HFA, Claritin, Flonase prn.

Spirometry:

FEV1: 81% (post-bronchodilator results with 15% increase)

FVC: 88%

FEV1/FVC ratio: 82%

Pulse ox: 93% on RA

Based on the scenario provided, fully inform your patient and explain their diagnosis.

Use UpToDate, located in the University Library, to search for and locate the most current evidence-based guidelines to answer the following questions.

Overall Health and Pathophysiology

Discuss the pathophysiology of asthma, including the 3 core defects. Relate them to Nancy’s case.

Asthma is a chronic respiratory condition characterized by airway inflammation, bronchoconstriction, and increased mucus production. The pathophysiology of asthma involves three core defects, including airway inflammation, bronchoconstriction, and mucus hypersecretion.

Airway Inflammation

In asthma, the airways become inflamed due to immune system dysregulation. This inflammation results in swelling of the airway walls and increased mucus production, making it difficult for air to pass through (NHS, 2021; WHO, 2023). Nancy’s history of eczema and allergy shots suggests that she may have atopy, predisposing her to allergic reactions. Allergens can trigger airway inflammation in individuals with atopy, further exacerbating asthma. We offer case study help.

Bronchoconstriction

The smooth muscles surrounding the airways become hyperresponsive in asthma patients. When exposed to triggers such as allergens, irritants, or exercise, these muscles contract excessively, causing bronchoconstriction or narrowing of the airways (NHS, 2021; WHO, 2023). Nancy’s increased use of her albuterol inhaler (a bronchodilator) and oral steroids suggests ongoing bronchoconstriction in her case.

Mucus Hypersecretion

In response to inflammation and bronchoconstriction, the airway glands produce excessive mucus. This mucus further obstructs the airways, making breathing harder for Nancy. Her symptoms of coughing and the need to prop herself up on pillows to breathe at night indicate mucus hypersecretion during her recent exacerbation.

Explain the significance of “atopy” and “one continuous airway,” applying Nancy’s scenario.

“Atopy” refers to a genetic predisposition to develop allergic reactions, such as eczema and allergies. Nancy’s history of eczema and allergies suggests atopy, which is significant because it increases her susceptibility to asthma triggers, particularly allergens. Atopy, in her case, may explain why her asthma symptoms have flared up, as exposure to allergens can induce airway inflammation.

Consistently, “one continuous airway” is a concept that underscores the interconnectedness of the respiratory system. It means that the entire respiratory tract, from the nasal passages to the bronchioles, is susceptible to inflammation and obstruction. In Nancy’s case, this concept is relevant because her nighttime coughing and need to prop herself up on pillows to breathe suggest that her lower airways (bronchioles) are affected, making it challenging to get adequate oxygen at night.

Diagnosis

Interpret her spirometry results by defining and analyzing each value (FEV1, FVC, FEV1/FVC ratio) individually.

Spirometry is a valuable diagnostic tool for assessing lung function. Nancy’s spirometry results indicate the following values:

FEV1 (Forced Expiratory Volume in 1 second): 81% (post-bronchodilator results with 15% increase)

FVC (Forced Vital Capacity): 88%

FEV1/FVC Ratio: 82%

FEV1 represents the volume of air forcibly exhaled in the first second of a forced expiration. In Nancy’s case, her FEV1 value of 81% (with a 15% increase after bronchodilation) indicates that her airways are partially obstructed and she has reversible airflow limitation. The bronchodilation response suggests that bronchoconstriction is a contributing factor to her symptoms. Consistently, FVC represents the total volume of air exhaled during a forced expiration. Nancy’s FVC value of 88% is slightly reduced but still within the normal range (Morris, 2019; National Heart, Lung, and Blood Institute, 2022). This suggests that her lung capacity is somewhat compromised, possibly due to reduced compliance caused by inflammation and mucus. Lastly, the FEV1/FVC ratio is used to classify the severity of airflow limitation. An FEV1/FVC ratio of 82% is within the normal range, indicating that her lung function is not severely impaired. However, her symptoms and the bronchodilation response suggest ongoing airway inflammation and bronchoconstriction, which may not be fully reflected in these results.

Classify Nancy’s asthma. Which of the 4 categories (intermittent, persistent—mild, persistent or moderate, persistent—severe) does she fall under? Explain your justification.

Based on the spirometry results and her clinical presentation, Nancy’s asthma can be classified as “persistent—moderate.” The following considerations support this classification:

Her FEV1/FVC ratio, although typical, is not reflective of her ongoing symptoms and bronchodilation response.

She has a history of hospitalization for asthma as a child, suggesting a long-standing and potentially more severe form of the condition.

Her frequent use of albuterol (rescue medication) and oral steroids indicates inadequate control of her symptoms.

Nancy’s asthma falls into the “persistent” category because her symptoms are not fully relieved by bronchodilators, and her lung function is not normal. The “moderate” classification signifies that her asthma is not mild but also not at its most severe stage.

Asthma Management

From a pathophysiological perspective, what is the danger in Nancy overusing her rescue medication?

From a pathophysiological perspective, overusing rescue medication, such as albuterol, can be dangerous for several reasons. Firstly, frequent use of bronchodilators like albuterol can lead to tachyphylaxis, a phenomenon where the bronchodilator’s effectiveness diminishes over time. This occurs because the airway’s smooth muscles become less responsive to the medication, requiring higher doses for the same relief (Schiefer, 2021). This can lead to a cycle of escalating medication use. Secondly, masking underlying inflammation. While rescue medications temporarily relieve airway smooth muscles, they do not address the underlying airway inflammation. Overuse of rescue medication may mask symptoms without adequately treating the inflammation, potentially allowing the disease to progress unchecked. Thirdly, systemic side effects. Overusing oral steroids, such as the ones Nancy was prescribed, can lead to systemic side effects like osteoporosis, weight gain, and immunosuppression (Schiefer, 2021). These side effects can have a detrimental impact on overall health. Lastly, delayed Appropriate Treatment. Overreliance on rescue medication may delay the initiation of long-term controller medications, which are essential for managing chronic asthma and reducing the frequency of exacerbations.

In conclusion, Nancy’s case highlights the complex pathophysiology of asthma, focusing on airway inflammation, bronchoconstriction, and mucus hypersecretion. Her history of atopy and the concept of one continuous airway are relevant factors in understanding her asthma exacerbation. Spirometry results suggest moderate persistent asthma and the dangers of overusing rescue medication underscore the importance of addressing the underlying inflammation and implementing a comprehensive asthma management plan to control it better and prevent future exacerbations.

References

Morris, M. (2019, September 19). Asthma: Practice Essentials, Background, Anatomy. Medscape.com. https://emedicine.medscape.com/article/296301-overview

National Heart, Lung, and Blood Institute. (2022, March 24). What Is Asthma? Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/asthma

NHS. (2021, April 19). Asthma. NHS. https://www.nhs.uk/conditions/asthma/

Schiefer, A. (2021, March 1). Over-Reliance on Relief Inhalers | What Your Patients Need to Know. AARC. https://www.aarc.org/an21-over-reliance-on-relief-inhalers-what-your-patients-need-to-know/

WHO. (2023, May 4). Asthma. Www.who.int. https://www.who.int/news-room/fact-sheets/detail/asthma#:~:text=Asthma%20is%20a%20chronic%

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Based on the knowledge you have gained up to this point, it is time to apply your skills to complete a case study for a patient presenting with a recurring headache.

Complete the Patient Diagnosis Case Study: Headaches document.

Use the following resources to help with the assessment:

AccessMedicine in the University Library
Alzheimer’s Association
International Headache Society
Medscape
UpToDate in the University Library
National Institute of Neurological Disorders and Stroke
National Institute of Mental Health

Format your citations according to APA guidelines.
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