PATHO C155 Asthma

Pathopharmacological Foundations for Advanced Nursing Practice Jaeca Casipit Western Governor's University A. Investigated Disease Process The disease process to be discussed is asthma, which is a chronic long disease that greatly affects individuals, families, and the community. Affecting all ages, its impact on one’s health can vary from managed to debilitating. This disease process will be further investigated and discussed. A1. Pathophysiology The National Heart, Lung, and Blood Institute’s 2007 definition of asthma is as follows: “asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells.” Due to these cells, susceptible individuals will likely experience inflammation that causes frequent symptoms such as wheezing, chest tightness, shortness of breath, and coughing at night or in early morning (National Heart, Lung, and Blood Institute, 2007). The inflammation results in bronchial hyperresponsiveness, which manifests as decreased airflow in the bronchioles after provocation by airway obstruction triggers (National Heart, Lung, and Blood Institute, 2007). The cause of these episodes are typically due to airflow obstruction that can be treated spontaneously or with medication (National Heart, Lung, and Blood Institute, 2007). To further understand the pathophysiology of asthma, knowledge and understanding of the anatomical structures of the respiratory and pulmonary system are important. The respiratory system consists of the upper and lower respiratory tracts, lungs, and blood vessels that are responsible for oxygen distribution and gas exchange (McCance and Huether, 2014). The upper respiratory tract includes the nose and nasal passages, mouth and oropharynx, pharynx, and larynx. The lower respiratory tract is comprised of the trachea, bronchi, and alveoli. The lungs are considered the main component of the respiratory system whose functions include air inspiration, oxygen extraction, and exhaling carbon dioxide (McCance and Huether, 2014). Asthma greatly affects how the lower respiratory tracts and the lungs function. The trachea works as a passageway for air to be transported through the bronchi into the lungs (McCance and Huether, 2014). The alveoli are tiny sacs of air within the lungs that are responsible for the exchange of oxygen and carbon dioxide to occur (McCance and Huether, 2014). It is important to understand the anatomical structures of the respiratory system as it leads into better understanding of the pulmonary system. According to McCance and Huether in 2014, “the pulmonary system functions to (1) ventilate the alveoli, (2) diffuse gases into and out of the blood, and (3) perfuse the lungs so that the organs and tissues of the body receive blood that is rich in oxygen and low in CO2.” As previously mentioned, asthma is caused by inflammation in the airways. Although there still needs to be more investigations in the process of this inflammation, it is widely known that many cell types and multiple mediators are the cause of asthma symptoms (National Heart, Lung, and Blood Institute, 2007). These cell types and mediators can be released by bronchoprovocation triggers such as cold air, exercise, respiratory infections, allergens, and smoke (National Heart, Lung, and Blood Institute, 2007). Bronchoconstriction occurs as a response mechanism by the airway due to exposure from a variety of stimuli such as allergens or irritants (National Heart, Lung, and Blood Institute, 2007). “Allergen-induced acute bronchoconstriction results from an immunoglobulin-E (IgE)-dependent release of mediators from mast cells that includes histamine, tryptase, leukotrienes, and prostaglandins that directly contract airway smooth muscle” (National Heart, Lung, and Blood Institute, 2007). When the inflammation process begins, leukocytes from the bloodstream are directed to the airways by activated T-lymphocyte cells, which also directs the release of other inflammatory mediators such as eosinophils and mast cells (National Heart, Lung, and Blood Institute, 2007). The activated mast cells and eosinophils respond by generating cytokines that further contribute to the inflammation process of the airways (National Heart, Lung, and Blood Institute, 2007). As asthma becomes more persistent and progresses, mechanisms that further limit airflow occur such as edema of the airways, hyper secretion of mucus and formation of mucus plugs that can be reversible with treatment; structural changes include hypertrophy and hyperplasia of the airway smooth muscle that may not respond easily to usual treatment (National Heart, Lung, and Blood Institute, 2007). Some patients with asthma may experience partially reversible airflow limitation (National Heart, Lung, and Blood Institute, 2007). Progressive loss of lung function that is not prevented by or fully reve