[University’s name]
Diagnosis, Management and Follow-up of Asthma
PATHOPHYSIOLOGY:
According to Kumar, Abbas and Aster (2015), there are various types of asthma classified based on their etiology. Atopic asthma is thought to be caused by a response mounted by T- Helper2 cells and IgE. It is in response to exposure to environmental allergen in a specified group of genetically susceptible individuals. The core pathogenetic mechanism is inflammation of the airway which is brought about by release of inflammatory mediators. The cytokines and mediators that brought and amplify airway inflammation are interleukin-4, interleukin-5 and interleukin-13 which promote mucous secretion from mucus secreting glands in the lining mucosa of the conducting airway. In the early phases, there is marked bronchoconstriction, amplified mucus synthesis and secretion, altered vascular dilatation and increased vascular permeability.
According to the authors, asthma is a disease prevalent in industrialized cities. The reason behind this is that the environment of industrialized cities contains many pollutants and allergens in the air which can initiate and mount TH-2 response. On the other hand, there is hygiene hypothesis which states that children from cities are not exposed to certain pathogens or allergens which are supposed to give protection against asthmatic attacks.
The morphologic features of asthma are distention of lungs with small areas atelectasis. The hallmark feature found in asthmatic patient is occlusion of bronchioles by thick, firm mucus wads mixed with shedded epithelium. These plugs can come out via bronchoalveolar lavage or sputum and are called as Curschmann spirals. There are eosinophils which contains galectin-10 protein naming them as charcot-leyden crytals. There is thickening of the airway, fibrosis of the basement membrane, hypervascularization, hypercellularity and hypertrophy. These findings are collectively called as airway remodeling.
Epidemiology:
According to The Global Asthma Report (2014), currently asthmatic individuals in the world are about 334 million. It was also suggested that about 14% of the total pediatric population are likely to have encountered asthmatic symptoms last year. Asthma is found most lowly in Indian subcontinent, Mediterranean, Asia-Pacific and certain parts of Europe.
Diagnosis:
According to Papadakis and McPhee (2015), asthma is diagnosed based on severity and appearance of symptoms. It is classified as mild, moderate and severe. Three parameters are measured which are symptoms, signs and functional assessment. Breathlessness, alertness and sequence of talking are the three symptoms that are recorded. Similarly, respiratory rate, body posture, accessory muscle usage, wheeze, pulse per minute and pulsus paradoxus are recorder as reliable signs. Peak expiratory flow (PEF), PaO2,PCO2, and oxygen saturation are measured for functional assessment.
Management & Follow-up:
According to National Institute of Health’s (NIH) National Asthma Education and Prevention Program (2007), asthma medicines are divided into long term control medicines and quick relief medicines. Long-term medicines are corticosteroids, mast cell stabilizers like cromolyn and nedocromil, IgG monoclonal antibodies like omalizumab, leukotriene modifiers like montelukast, long acting beta agonists like salmeterol and methylxanthines like theophylline. Quick relief medicines are anticholinergics like ipratropium, short acting beta agonists like albuterol and systemic corticosteroids. They need to be assessed yearly to have their respiratory functions checked.
Cultural Barriers:
According to Enarson and Ait-Khaled (1999), socioeconomic barrier is very diverse when it comes to certain races. Undiagnosed asthma is mostly prevalent in African American as compared to whites. A study showed that utilization of emergency services are more consumed by nonwhites as compared to whites. It was also found in another study that poor children were more to remain undiagnosed despite universal health insurance was made available.
References
Enarson, D., & Ait-Khaled, N. (1999). Cultural barriers to asthma management. Pediatric Pulmonology, 28(4), 297-300. doi:10.1002/(sici)1099-0496(199910)28:4<297::aid-ppul9>3.0.co;2-s
Globalasthmareport.org,. (2014). The Global Asthma Report 2014. Retrieved 14 July 2015, from http://www.globalasthmareport.org/burden/burden.php
Kumar, V., Abbas, A. and Aster, J.(2015). In Chapter 15; The Lung. Robbins and Cotran Pathologic Basis of Disease. (9th Ed.). Philadelphia: Elsevier Saunders.
National Asthma Education, Prevention Program (National Heart, & Blood Institute). Second Expert Panel on the Management of Asthma. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma. National Institute of Health (NIH) and U.S Department of Health and Human Services.
Papadakis, M., & McPhee, S. (2015). In Chapter 9; Pulmonary Disorders. Current Medical Diagnosis & Treatment 2015 (54th ed.). New York: McGraw-Hill Education/Medical.
