MDC Asthma Pathology Discussion

1. Classmate post below: provide feedback

• Describe the pathophysiology, clinical manifestations, evaluation, and treatment of asthma. Include recommendations from the USDHHS 2020 Focused Updates to the Asthma Management GuidelinesLinks to an external site.

Asthma is a common illness that can range from mild wheezing to life-threatening airway closure. Asthma is one of the most common childhood illnesses which can be triggered by many different factors that include both genetics and environmental components. The key component of asthma is airway hyper-responsiveness which can be triggered by many different factors. Without proper treatment, asthma can have high mortality rates. Some triggers for asthma include viral respiratory tract infections, exercise, GERD, chronic sinusitis, environmental allergens, tobacco smoke, obesity, and emotional factors, and stress (Hashmi, et al., 2022).

Pathophysiology

Asthma is characterized by acute upper airway inflammation, often following exposure to an allergen or irritant. This exposure leads to a hypersensitivity response causing airway inflammation and increased mucus production. It causes a significant increase in airway resistance which is often most pronounced during expiration. Airway obstruction occurs as a result of inflammatory cell infiltration, mucus hypersecretion with mucus plug formation, and smooth muscle contraction. Over time, chronic asthma can lead to irreversible changes like airway remodeling, basement membrane thickening, and smooth muscle hypertrophy. Asthma should be treated rapidly as it can become more difficult to treat as inflammation becomes more edematous (Hashmi, et al., 2022).

Clinical Manifestations

Clinical manifestations of asthma can vary from patient to patient, however, a key sign is a wheeze or a cough exacerbated by allergies, exercise, or cold. In addition, symptoms may become worse at night, like nocturnal coughing spells which resolve during the daytime. During an acute asthma exacerbation, signs and symptoms may include fine hand tremors, tachycardia, expiratory wheezing, oxygen saturation of less than 92%, peak expiratory flow of less than 33% of personal best, and leaning forward to splint open airways. In life-threatening asthma cases, the chest may be silent during auscultation with signs of hypoxia. Children experiencing asthma may appear drowsy, confused, and cyanotic (Hashmi, et al., 2022).

Evaluation & Treatment

In terms of evaluation, pulse oximetry can be used to assess asthma attacks and monitor for patient deterioration. Falling of )2 saturation is often a late finding indicating a severe asthma situation. Peak flow meters can be used to assess asthma and patients’ normal baseline function in comparison to asthma symptoms. Different severities of acute asthma have associated peak flow measurements as percentages. Arterial blood gas can reveal hypoxemia and respiratory acidosis. A chest X-ray can visualize the presence of a foreign body or possible infection.

For treatment and management, patients should be first encouraged to try to relax and be moved away from any environmental allergens or irritants. According to the U.S. Department of Health and Human Services (USDHHS, 2020), asthma management often involves the prescription of several medications. These medications serve different purposes and are tailored to the individual needs of the patient. Asthma treatment commonly involves a combination of medications to address various aspects of the condition. Long-acting beta-agonists (LABAs) and leukotriene modifiers are frequently prescribed as adjunctive therapies to provide additional bronchodilation and reduce inflammation. Inhaled corticosteroids (ICS) are the mainstay of long-term anti-inflammatory management, helping to control airway inflammation and prevent exacerbations. For immediate symptom relief, short-acting beta-agonists (SABAs) are commonly used.

The avoidance of allergens like tobacco, dust mites, animals, and pollen will greatly improve symptoms in patients with asthma. Pharmacological management includes bronchodilators like beta-2 agonists, muscarinic antagonists, and anti-inflammatories such as inhaled steroids. Patients should first be advised to use the inhaled bronchodilator followed by inhaled steroids if needed. During asthma exacerbation, if patients received 3 doses of an inhaled bronchodilator and show no response, hospitalization may be required. Early interventions provide improved outcomes in patients with severe asthma (Hashmi, et al., 2022).

2. How can a parent best prevent triggers for a child diagnosed with asthma? Please answer question with 1 paragraph and I credible resource.

3. Classmate post: provide feedback. Describe the pathophysiology, clinical manifestations, evaluation, and treatment of asthma. Include recommendations from the USDHHS 2020 Focused Updates to the Asthma Management Guidelines

Asthma is known to have chronic inflammation of the airway with symptoms such as wheezing, shortness of breath, chest tightness, and cough that can vary in intensity and time, with a limitation of variable expiratory airflow (Rogers, 2023, p. 1167). Bronchial hyperresponsiveness, airway constriction, and variable obstruction of airflow that is reversible is caused by chronic inflammation (Rogers, 2023, p. 1167). More than 120 genes have been identified to contribute to the pathogenesis, susceptibility, and treatment response of asthma (Rogers, 2023, p. 1167).

The pathophysiology of asthma depends on exposure to the allergen or irritant (Rogers, 2023, p. 1169). Airway epithelial exposure to an antigen will trigger an innate and adaptive immune response during allergic asthma (Rogers, 2023, p. 1167). In the early stage of an asthmatic response, dendritic cells are activated by the antigen exposure to the bronchial epithelium which will then present the antigen to T-helper cells which will then differentiate into Th2 cells to release cytokines (Rogers, 2023, p. 1169). During the response, IL4 activates B lymphocytes, IL-5 will activate eosinophils, IL-13 will allow for Th2 cell maturation and activation of mast cells, basophils, and eosinophils (Rogers, 2023, p. 1169). Plasma cells allow production of antigen-specific IgE that will bind to mast cell surface and cross-linking of IgE molecules to antigen which will cause degranulation of mast cells to release mediators of inflammation that include histamine, bradykinins, leukotrienes, interleukins, prostaglandins, and platelet-activating factor (Rogers, 2023, p. 1169). Inflammatory mediators will result in vasodilation, increased permeability of capillaries, mucosal edema, contraction of bronchial smooth muscle, and secretion of mucus that will block the airways which can eventually obstruct airflow (Rogers, 2023, p. 1169). Increased bronchial hyperresponsiveness can also be caused by the release of toxic neuropeptides from eosinophils (Rogers, 2023, p. 1169).

Between four to eight hours after the early response, the late asthmatic response begins (Rogers, 2023, p. 1170). Inflammatory mediators are released due to neutrophil, eosinophils, and lymphocytes that were part of the chemotactic recruitment which trigger bronchospasm, edema, and mucus secretion that obstructs airflow (Rogers, 2023, p. 1170). Prolonged smooth muscle contraction is due to leukotriene synthesis (Rogers, 2023, p. 1170). Direct tissue injury is caused by eosinophils, proliferation of fibroblasts, and scarring of the airway (Rogers, 2023, p. 1170). Mucus accumulation, cellular debris, and formation of mucus plugs in the airway is caused from ciliated epithelial cell damage (Rogers, 2023, p. 1170). If this inflammation goes untreated, it can cause long-term airway damage that can cause subepithelial fibrosis and hypertrophy of smooth muscles which could be irreversible (Rogers, 2023, p. 1170). Obstruction of the airways results in increased airflow resistance and decreased expiratory flow rates that can cause air trapping, lung hyperinflation, and increased work of breathing (Rogers, 2023, p. 1170). V/Q mismatch and hypoxemia is a result of uneven distribution of inspired air and changes of airflow resistance that is not the same throughout the lungs (Rogers, 2023, p. 1170).

Clinical manifestations at the beginning of an asthma attack can include: chest constriction, difficulty breathing, expiratory wheeze, prolonged expiration, nonproductive cough, tachycardia, tachypnea, use of expiratory muscles, and pulsus paradoxus can be present (Rogers, 2023, p. 1170). Status asthmaticus is when there are severely acute bronchospasm that is not reversed by typical treatment measures (Rogers, 2023, p. 1170). Clinical manifestations of status asthmaticus include worsening hypoxemia, decreased expiratory flow, decreased volumes, and decreased effective ventilation (Rogers, 2023, p. 1170). Signs of imminent death include silent chest, PaCO2 greater than 70 mmHg, and a cease in ventilation (Rogers, 2023, p. 1170).

Asthma is diagnosed based on symptom pattern history along with the evidence of variable and reversible limitation of airflow (Rogers, 2023, p. 1171). Other conditions that could be mistaken for asthma include cystic fibrosis, dysfunction of vocal cords, heart disease, and medication related-cough (Rogers, 2023, p. 1171). An acute asthma attack should be evaluated with an arterial blood gas and expiratory flow rates via the use of a peak flow meter, and determining the underlying trigger which could be an infection (Rogers, 2023, p. 1171). According to the USDHHS (2021), core measures for asthma exacerbations include oral and parenteral corticosteroids, emergency departments visits specifically for asthma, and hospitalization (p. 8). For individuals with persistent asthma, regardless of age, daily scheduled inhaled corticosteroid treatment is the preferred pharmacologic controller therapy (USDHHS, 2021, p. 53). According to Rogers (2023), short-acting beta-agonist usage has an increased risk for severe exacerbations therefore it should only be given to individuals with intermittent asthma symptoms (p. 1171).

4. Classmate post: Provide feedback. My research project focuses on how controlled and uncontrolled hypertension increases the likelihood of having a stroke and patient outcomes. My research questions are as follows:

• How does uncontrolled hypertension contribute to stroke?
• What is the prevalence of stroke in patients with controlled versus uncontrolled hypertension?
• What are effective interventions in managing hypertension in order to reduce the risk of stroke?

There are several quantitative analyses and tests that can be used for this study. The comparative analysis would probably be most appropriate. To put it simply, in a comparative analysis, variables are evaluated and essentially compared (Tappen, 2016). In quantitative studies, the t-test, chi-square test, or regression analysis is commonly used. The chi-square test is appropriate because it can be used to analyze the association between the two hypertension groups (controlled and uncontrolled) and the occurrence of stroke (present or absent). The chi-square test is straightforward and helps determine if there is a significant relationship between the variables (Tappen, 2016). This is precisely what my study attempts to demonstrate.

5. Classmate post: provide feedback Research Questions:

My research project is on telehealth and its effect on patient quality. My first research question is does the use of telehealth have a significant impact on patient satisfaction with healthcare delivery? The second question is does telehealth negatively affect patient outcomes compared to in-person healthcare delivery?

Quantitative Analysis:

The quantitative analysis that I will be using for this research project is regression analysis. Regression analysis would be useful to explore the potential relationship between telehealth utilization and patient outcomes (Tappen, 2015). By using this type of analysis, I would be able to see if telehealth has an impact on patient outcomes. It would help determine the extent to which telehealth affects patient outcomes (Tappen, 2015). Another type of quantitative analysis that I could use is the analysis of Variance (ANOVA). It can help to assess the differences in patient satisfaction or outcomes across multiple groups (Tappen, 2015). I could also use it to compare outcomes between telehealth and in-person care for certain conditions. Using these two types of quantitative analysis should allow me to get the results that I need to collect data for my research project.

6. Classmate post: provide feedback. My research project focuses on how controlled and uncontrolled hypertension increases the likelihood of having a stroke and patient outcomes. Independent variables are the cause and are not dependent on other variables in the study, while dependent variables are the effect and have a dependence on the independent variables (Tappen, 2016). The two independent variables are individuals with controlled and uncontrolled blood pressure. The dependent variable is stroke risk, which will represent the likelihood of experiencing a stroke in the participants of the study. For this study, my research hypothesis will be: In adult patients, there is a significant risk of stroke with uncontrolled hypertension compared to controlled hypertension during their lifetime. According to Tappen (2016), the purpose of a null hypothesis is to show “that no difference will be found between the treatment and control groups, that the treatment has had no effect” (p. 69). For my study, a potential null hypothesis could be: There is no significant difference in stroke risk between patients with controlled hypertension and uncontrolled hypertension during a lifetime.

7. Classmate post: Provide feedback. Research topic: Telehealth and patient quality

Research question: What is the effect of telehealth on patient quality?

Independent variable: Telehealth

Dependent variable: Patient quality which could be measured by health outcomes and patient satisfaction.

Research hypothesis: Telehealth negatively affects patient quality which can lead to decreased outcomes and patient satisfaction.

Null hypothesis: There is no significant effect of telehealth on patient quality, and it does not lead to any noticeable diminished outcomes or patient satisfaction