A Comprehensive Exploration of Asthma

Introduction

Asthma is a long-term lung disease that causes chest tightness, wheezing, breathlessness, and coughing (Dodge & Burrows, 2018). In the U.S., there are 19 million adults and 6.2 million kids with asthma (Centers for Disease Control and Prevention, 2018). You can manage asthma by avoiding triggers and using prescribed meds properly. Asthma can be either acute or chronic. This essay will talk about the pathophysiology of both chronic asthma and acute asthma attacks, describe changes in arterial blood gas during an attack, and discuss how age affects the pathophysiology of these conditions.

Acute Asthma

Acute asthma exacerbation, or an asthma attack, happens when someone is exposed to a trigger like pollen, mold, cat dander, or tobacco smoke. The allergen binds with a mast cell, which then releases inflammatory mediators like bradykinins, histamine, prostaglandins, interleukins, and leukotrienes (Lemanske & Busse, 2017). These mediators cause the smooth muscles in the airway to spasm. Increased capillary permeability leads to edema, narrowing the airway and making it hard to breathe. The wheezing sound is air struggling to pass through the narrowed airway.

Asthma attacks can vary in severity. Severe attacks might need more intensive treatment, such as intubation. To check how severe an attack is, doctors can do an arterial blood gas (ABG) test. This test measures oxygen, carbon dioxide, and pH levels in the blood, showing how well the lungs deliver oxygen and remove carbon dioxide.

Chronic Asthma

Asthma is considered a chronic disorder of the airways, although some childhood asthma symptoms can disappear in adulthood. But kids with severe asthma are less likely to outgrow it. Early diagnosis is crucial for better management. Identifying the allergen that causes airway obstruction is an important step. Obstruction can result from inflammation, bronchospasm, or mucus hypersecretion. Asthma can be caused by host factors, environmental factors, or both. Host factors include gender, obesity, and genetics. Asthma can be atopic or nonatopic. Holgate (2017) states that atopic asthma begins in childhood and is linked to triggers that cause wheezing, like pollen. This triggers the release of IgE, which binds to cells involved in inflammation. This leads to the release of cytokines, causing inflammation and bronchoconstriction. Nonatopic asthma usually occurs in adults and doesn’t involve IgE, often triggered by viral infections.

Impact of Gender on Pathophysiology

Gender affects asthma prevalence. Boys have smaller airways compared to girls, making them more likely to have asthma symptoms as kids. Boys are twice as likely to be hospitalized for asthma exacerbation than girls, but this changes during adolescence (Mandhane, et al., 2015). Mild asthma is more common in boys during childhood but becomes severe in females later on. As adults, women have a higher asthma prevalence than men. Clinical findings show that from puberty, females begin showing more asthma symptoms than males. According to Wright et al. (2016), animal studies show that estrogen increases Th2-mediated airway inflammation, while testosterone decreases it. How ovarian hormones and testosterone affect other pathways in airway inflammation is still unclear. Thomas, Lemanske, & Jackson (2014) note that about 30–40% of women with asthma report pre or peri-menstrual worsening of symptoms.

Diagnosis and Treatment

Asthma diagnosis is based on patient history, physical exams, and diagnostic tests. Tests include Peak Expiratory Flow (PEF), Spirometry, Exhaled Nitric Oxide, Bronchial provocation, and X-rays. Some tests aren't definitive but help in diagnosis. For instance, exhaled nitric oxide tests for nitric oxide, a gas produced in the lungs during inflammation. While asthma involves inflammation, so do many other conditions.

Asthma management can be pharmacological or non-pharmacological. Non-pharmacological treatments include avoiding known triggers, having an action plan for worsening symptoms, and understanding the condition and prescribed meds. Pharmacological management involves short-term relief and long-term management. For short-term relief, albuterol is commonly prescribed in forms like dry powdered inhalers, metered-dose inhalers, and nebulizers. For long-term management, inhaled corticosteroids are the preferred drugs.

Conclusion

Asthma is a chronic lung disease affecting over 25 million people in the U.S. It causes chest tightness, wheezing, coughing, and breathlessness. While it often lasts a lifetime, some children outgrow it. Asthma can be acute or chronic. Acute asthma, or asthma attack, can be triggered by allergens, causing mediators like histamine and cytokines to initiate bronchospasm and airway inflammation. Gender affects asthma prevalence and pathophysiology. Boys are more likely to have asthma symptoms as kids, but this changes during adolescence. From puberty, females show more symptoms than males, and about 30–40% of women report worsening asthma symptoms pre or peri-menstrually. Asthma diagnosis involves patient history, physical exams, and diagnostic tests. Management can be pharmacological or non-pharmacological, with albuterol as the most prescribed rescue medication and inhaled corticosteroids for long-term management.