Asthma:Chronic Asthma and Acute Asthma Exacerbation
In the contemporary medical world, asthma accounts for a high a proportion of the total population suffering from it. For instance, as reported by Zein, and Erzurum, (2015), the total number of asthmatics is approximately 40 million (12.9%) in the USA. Such a statistic is worrying and necessitates an understanding of this condition, which has the capacity of affecting persons of all ages and in different settings. Primarily, Asthma is a chronic airway disorder that may have acute exacerbation periods, which can be due to various triggers such as infection, smoking, and allergens, and characterized with airway inflammation, hyperresponsiveness, airflow obstruction, and recurrent respiratory symptoms (Broaddus, et al., 2015). Based on this nature of asthma, a differentiation between chronic asthma and acute exacerbation asthma is of utmost significance for the proper management of this condition, which at times is life threatening. In essence, this paper aims at shedding more light on the same issue by establishing the pathophysiological mechanisms of both conditions. Moreover, the discussion will highlight the impact of a specific patient factor (gender) on the pathophysiology, diagnosis, and treatment of both types of asthma. Lastly, the paper will crown it all with a representation of the clinical picture of both types of asthma in the form of two mind maps.
Epidemiology
Chronic Asthma
Chronic asthma affects persons of all ages and in different setting namely, school, home, and work. Atopy, exercise, and environmental factors like smoke and dust are some of the common triggers for this condition (Porth, & Gaspard, 2015).
Acute Exacerbation Asthma
Firstly, it is non-selective of the setting of the individual since its environmental triggers are everywhere (school, home, and work). Moreover, acute exacerbation asthma affects persons of all age groups. However, it is more common in adults as compared to children (Vincent, Abraham, Moore, Kochanek, & Fink, 2015).
Pathophysiology
Chronic Asthma
Characteristic of the chronic asthma is the evidence of some airway narrowing in the absence of an attack and increased narrowing during an asthmatic attack. Of the essence to the development of chronic asthma are the external causes namely atopy and environmental factors that predispose one to hypersensitivity to certain allergens. Upon exposure to triggers such as smoke, dust, and exercise, inflammation of the airway begins. The inflammatory reaction causes an increase in mucus secretion and bronchoconstriction. Overtime, airway remodeling occurs due to the increase in goblet cells, smooth muscles and thick membranes giving rise to a continuously narrowed airway that is characteristic of chronic asthma (Broaddus, et al., 2015).
Acute Exacerbation Asthma
Central to the development of an acute exacerbation of asthma are various triggers including infections especially viral respiratory infections, environmental factors, allergens and non-adherence to prescribed asthma medications. Upon exposure to these triggers, an inflammatory action of the airway commences resulting in the narrowing of the airways, which resolves in between the exacerbation periods. The other pathophysiological features (bronchoconstriction and hypersecretion) are also present during an exacerbation and are contributory to the various clinical manifestations (Huether & McCance, 2012).
Clinical Presentation
Chronic Asthma
The clinical features of chronic asthma include but not limited to shortness of breath, wheezing, nocturnal productive cough, exercise intolerance, hyperinflated chest and decreased peak flow (Broaddus, et al., 2015).
Acute Exacerbation Asthma
According to Huether and McCance, (2012) characteristic of acute exacerbation asthma are clinical manifestations such as breathlessness, agitation, coughing, tachypnea, wheezing, tachycardia, chest tightness and decreased lung function. Reduced lung function is evident by the derangements in the FEV1, peak expiratory flow (PEF), arterial blood gas (PaO2 and PaCO2), and saturated arterial oxygen levels during exacerbations. However, these values remain normal in between exacerbations. The use of accessory muscles and the inability to talk is dependent on the severity of the exacerbation (Vincent, Abraham, Moore, Kochanek, & Fink, 2015).
Arterial Blood Gas Patterns in Acute Exacerbation Asthma
Primarily, during an acute exacerbation of asthma, the individuals present with hypoxemia during acute attacks as evidenced by the arterial blood gas analysis and pulse oximetry findings. Initially during an exacerbation, the asthmatic persons manifest with hypocapnia (decreased PaCO2), which indicates respiratory alkalosis. As the condition worsens and one becomes more fatigued, the PaCO2 rises resulting in respiratory acidosis. A normal PaCO2 value, however, during this period is unexpected and may be suggestive of respiratory acidosis (Hinkle, Brunner, Cheever, & Suddarth, 2014).
Impact of Gender on the Pathophysiology Chronic Asthma and Acute Exacerbation Asthma
Zein, and Erzurum, (2015) are of the idea that in overall terms, the female gender predisposes one to develop either chronic asthma or acute exacerbation asthma. The reasons for such an observation remains unknown but immunological and hormonal factors, as well as the differences in gender-specific responses to environmental or occupational exposures, are often implicated.
Impact of Gender on the Diagnosis and Treatment of Chronic Asthma and Acute Exacerbation Asthma
Diagnosis
Chronic Asthma. According to Porth, and Gaspard, (2015), making a diagnosis of chronic asthma in both females and males is reliant on various diagnostic techniques. They include complete patient history (especially occupational, environmental and family history), physical examination and diagnostic tests such as arterial blood gas analysis, pulmonary function tests like spirometry measurements (peak expiratory flow (PEF), FEV1), pulse oximetry, saturated arterial oxygen levels and allergy testing, usually with skin tests.
Acute Exacerbation Asthma. Similarly, of the essence to the diagnosis of acute exacerbation asthma in both males and females are various techniques that are worth noting. They include complete patient history (occupational, environmental and family history), physical examination and diagnostic tests such as arterial blood gas analysis, pulmonary function tests like spirometry measurements (peak expiratory flow (PEF), FEV1), pulse oximetry, saturated arterial oxygen levels and allergy testing, usually with skin tests (Vincent et al., 2015).
Treatment
Chronic Asthma. With all factors kept constant, the gender of an individual does not affect the treatment options for the management of chronic asthma. As such, the main treatment options used for the treatment of chronic asthma include corticosteroids (beclomethasone), mast cell stabilizers (cromolyn sodium), long-acting beta2-adrenergic agents (salmeterol), xanthine derivatives (aminophylline, theophylline), leukotriene modifiers (zafirlukast) and combination products (albuterol sulfate + ipratropium bromide (Combivent)) (Hinkle, Brunner, Cheever, & Suddarth, 2014).
Acute Exacerbation Asthma. Precisely, the gender of an individual does not affect the treatment choice for the management of acute exacerbation asthma except for the dosage used. Hinkle, Brunner, Cheever, and Suddarth, (2014) are of the opinion that fast-acting beta-adrenergic medications such as albuterol and levalbuterol are the first remedy for managing the airflow obstruction. The use of systemic corticosteroids is necessary if the airway inflammation fails to respond to the inhaled beta-adrenergic medications. Lastly, one might consider oxygen supplementation if the patient presents with hypoxemia associated with a moderate and severe exacerbation.
Mind Map of Chronic Asthma
Mind Map for Acute Exacerbation Asthma
References
Broaddus, V. C., Mason, R. C., Ernst, J. D., King, T. E., Lazarus, S. C., Murray, J. F., Nadel, J. A., Slutsky, A., Gotway, M. (2015). Murray & Nadel’s Textbook of Respiratory Medicine. London: Elsevier Health Sciences.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate customed.). St. Louis, MO: Mosby.
Porth, C., & Gaspard, K. J. (2015). Essentials of pathophysiology: Concepts of altered health states. Philadelphia: Wolters Kluwer.
Vincent, J., Abraham, E., Moore, F., Kochanek, P., & Fink, M. (2015). Textbook of Critical Care: Common Problems in the ICU. W B Saunders Co.
Zein, J., & Erzurum, S. (2015). Asthma is Different in Women. Current Allergy And Asthma Reports, 15(6). http://dx.doi.org/10.1007/s11882-015-0528-y
