Kankaanranta et al., (2016) highlight that adult asthma is a major cause of mortality/morbidity throughout the globe and is also linked with emerging comorbidities in adults such as cardiovascular diseases, cancer, mental disorders, and diabetes. The available literature on asthma has been conducted on healthy patients. However, in reality, comorbid infections are common in adult patients. Various factors are thought to predispose adults to the risk of developing asthma. The infection can occur to anybody without any risk factors involved, but it is less likely to occur when there are no predisposing factors present.
The composition of asthma is made up of a series of heterogeneous phenotypes that vary in etiology, presentation, and pathophysiology (Ilmarinen, Tuomisto, & Kankaanranta, 2015). Each phenotype suffers a range of risk factors that include the host, environmental, and genetic factors. Asthma infections have increased globally over the past few decades, with notable geographic variations observable in its rate of increase and the base prevalence. This means that environmental factors play a role in the prevalence of the infection in various geographical settings. Moreover, the incidence of family history of the infection is also common.
The clarity of its incidence and prevalence though still less clear, diet and food allergy are suggested to play a major role (Alsharairi, 2019). For instance, the western diet that is made up of refined grains, higher intake of sweets, and processed food is characterized by pro-inflammatory effects while the Mediterranean feedstuffs, characterized by fruits and vegetables, higher intake of whole grains, and seafood, has antioxidant and anti-inflammatory properties. This explains the higher incidence of the infection in the west in comparison to the Mediterranean environment among adults.
The infection is also caused by trigger factors, which are environmental influences that can potentially instigate an episode of the disease or even cause its signs and symptoms to persist in an already affected individual. Examples of these triggers include allergens, exercise, irritants like sprays and perfumes, and changes in weather conditions. Other risk factors of the disease among adults include;
Exposure to industrial pollutants
High level of stress (psychosocial factors)
Alcohol especially acetaldehyde and nonalcoholic components of alcoholic beverages
Exposure to pets and dust
Respiratory Infections, Sinusitis, and Rhinitis
Gender and sexual hormones
Figure 1: Risk Factors of Asthma in Adults. (Source: Kankaanranta et al., 2016)
Provided in the table above is an illustration of the major risk factors of asthma infection, indicating their level of risk to the occurrence of the infection among the adult population.
After analyzing the medical history, physical conditions, and the signs and symptoms of Mrs. Hudson in relation to asthmatic conditions, the case sort to understand the pathophysiological processes of the infection to the patient. Durham et al., (2017) explain that limitation in the patient's airway, especially those that are linked to mucus production, inflammation, airway hyperresponsiveness, edema, and bronchoconstriction are the major underlying etiologies for the signs and symptoms of asthma. The major contributing factor to the inflammation in asthmatic patients is the altering of the patient's immune response as well as the stimulation of inflammatory cells.
In asthmatic conditions, the layer that lines the airways (epithelium) in many instances damage and peels away. This can lead to hyperresponsiveness through barrier function loss, thereby, creating the possibility of allergen penetration. The situation can also lead to enzyme loss, especially those that break down inflammatory mediators and sensory nerve exposure, thus, leading to reflex neural effects along the airway.
The infection is characterized by the multiplication of the mucus-secreting cells and the expansion of the mucous glands. A situation where the production of mucus multiplies leads to the formation of viscid mucous plugs, which can block an adult's airways.
When there are dilation and leaking of an individual's capillaries in the airways, they might experience impaired mucociliary clearance, increased airway secretion, and edema, which may then lead to hyperresponsiveness.
This is mainly the sharp contraction of the muscles of the bronchial, thus, narrowing an individual's airways.
Asthma should be effectively controlled and treated to alleviate the possibility of changes in the structural tissues and cells in the bronchioles, trachea, and bronchi (Mims, 2015, September). These possible changes can lead to the remodeling of the patient's airways, thereby, causing permanent fibrotic damage.
To ascertain that the condition presented by Mrs. Hudson is asthma, she underwent a physical examination before further diagnostic tests. As explained by Quirt et al., (2018), asthma symptoms show higher variability, hence, the physical assessment of patients with asthmatic conditions may be unremarkable and physical results can only be observed when the patient is symptomatic. While assessing the patient's nose, throat, and upper airways, physical abnormalities and airflow limitations were observed. A stethoscope was then utilized to listen to Hudson's breathing. The intention is to capture any form of wheezing-a high pitched whistling sound that characterizes the presence of asthmatic conditions when asthma victims breathe. Importantly, after examining her skin, signs of possible allergic conditions like hives and eczema were detected. To sum up her physical assessment, probable signs and symptoms of asthma-like difficulty in breathing, coughing, chest tightness, recurrent wheezing, and possible symptoms that are mainly triggered by exercise, cold, and allergens were also observed.
Medical Treatment and Nursing Care
Asthma is efficaciously managed in a multidisciplinary clinical setting, where various medical professionals like a pharmacist, an accredited respiratory scientist, an experienced respiratory physician, and a nurse are required for the management of the infection. After the diagnosis of the patient is confirmed, management strategies were then prescribed for Mrs. Hudson. Education and add-on therapies aimed at coordinating the management of the disease were also be administered. Mrs. Hudson suffers from respiratory asthma based on the diagnostic tests performed in this case.
Therefore, the most ideal treatment options to consider include prescribing leukotriene modifiers, theophylline, anticholinergics (aclidinium or tiotropium), anti-immunoglobin E(IgE) antibody therapy with antibiotics, omalizumab, bronchial thermoplasty or enroll the patient in a clinical trial that is assessing the utilization of agents that control immunologic response and cell signaling observed in asthma. Possibly, therapies like the inhaled corticosteroid (ICS) or a mixture of long-acting beta-agonist (LABA) and ICS, leukotriene antagonists have produced highly effective results in asthma management, especially inpatient with known exercise and allergic symptoms (Ritchie et al., 2015). Moreover, tiotropium (anticholinergics) has also proved to have good efficacy in the management of the infection since it boosts bronchodilation and is also an important aide of ICS. Besides, omalizumab is considered a monoclonal antibody, especially, against IgE. The only non-medication treatment option is bronchial thermoplasty, which is a bronchoscopy method that utilizes thermal energy to dislocate bronchial smooth muscles.
This case considered bronchial thermoplasty since it should help Mrs. Hudson control her situation and start feeling great again in approximately 12 months after the procedure. Additionally, she should avoid systemic steroids in the mean-time and possibly get to resume her work-out sessions regularly within 12 months after leaving our clinic. It is also important to personalize her treatment based on phenotypes or personal characteristics that determine her possible response to treatment, her practical issues, and preferences, including costs and adherence to the therapeutic conditions.
Bronchial thermoplasty is a better option for many patients suffering from asthma, such as Mrs. Hudson. It offers many benefits to the patient, though it does not replace the standard medications for the infection. In the course of the procedure, thermal energy is released to the patient's airways through the bronchoscope to lower additional airway smooth muscle, hence, reducing the probability of it constricting the patient's airways (Laxmanan & Hogarth, 2015). Additionally, the procedure is outpatient and is performed by a trained physician in three sessions.
Using a leukotriene modifier is an option for Mrs. Hudson, though she does not wish to add many medication regimens to her care plan. Omalizumab was avoided on the care plan based on the same reason and also because her IgE level is low. Based on Mrs. Hudson's diagnosis tests, her bronchoscopy tested negative, therefore, adding antibiotics to her care regimen would not be an efficacious option. Moreover, vitamin D was not utilized since hers was sufficient. The possibility of enrolling her in a medical trial was also abandoned as not the right option since it does not assure her placement in a treatment arm and the probability of receiving a placebo, hence, she should opt for the option of utilizing the bronchial thermoplasty.
Despite being the best option, in this case, patients who go for bronchial thermoplasty procedure experience adverse effects within 1 day of the operation, though it resolves in 7 days. Studies have shown that it highly improves the life quality of the patient as well as lowers the rate of asthma exacerbation by more than 30%. Furthermore, patients undergoing the procedure also show fewer cases of adverse respiratory impacts, more than 80% emergency department visit risk reduction, and also minimal days lost from their daily routine such as work or school (Pavord et al., 2018). Therefore, it an important care plan for respiratory asthma patients and, such as Mrs. Hudson, and should offer positive results in the management of the infection.
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Ilmarinen, P., Tuomisto, L. E., & Kankaanranta, H. (2015). Phenotypes, risk factors, and mechanisms of adult-onset asthma. Mediators of inflammation, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619972/
Alsharairi, N. A. (2019). Diet and Food Allergy as Risk Factors for Asthma in the Arabian Gulf Region: Current Evidence and Future Research Needs. International Journal of Environmental Research and Public Health, 16(20), 3852.
Durham, C. O., Fowler, T., Smith, W., & Sterrett, J. (2017). Adult asthma: Diagnosis and treatment. The Nurse Practitioner, 42(11), 16-24.
Mims, J. W. (2015, September). Asthma: definitions and pathophysiology. In International forum of allergy & rhinology (Vol. 5, No. S1, pp. S2-S6). Retrieved from https://aaoa.cloud-cme.com/assets/aaoa/pdf/asthma/mod1/alr21609.pdf
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Ritchie, A. I., Farne, H. A., Singanayagam, A., Jackson, D. J., Mallia, P., & Johnston, S. L. (2015). Pathogenesis of viral infection in exacerbations of airway disease. Annals of the American Thoracic Society, 12(Supplement 2), S115-S132. Retrieved from https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201503-151AW