Asthma

Given the speed at which asthma causes fatalities in pregnant women, it is critical for advanced healthcare practitioners to have an in-depth understanding of the similarities and variations of chronic asthma and acute asthma exacerbation (Hasegawa et al. 2015). This requires practitioners to have skills and competencies associated with the pathophysiological manifestations of the two conditions. This paper seeks to present discussions on how advanced healthcare practitioners can comprehensively identify differences and similarities related to chronic asthma as well as acute asthma exacerbation. This paper will also discuss pregnancy as a patient factor affecting how a patient can be diagnosed and treatment of chronic asthma and chronic asthma exacerbation. In the last section of this paper, two mind maps for the two asthma conditions are presented to highlight the pathophysiology, epidemiology, clinical presentation, diagnosis and treatments discussed herein.

Pathophysiology of Chronic and Acute Asthma

Inflammations to a patient’s airways play a very huge role in the pathophysiological manifestation of chronic and acute asthma exacerbation. These inflammations result from the adverse interactions among many types of cells and complex mediators affecting the airways leading to the pathophysiological manifestations which characterize this disease (Huether &McCance, 2012). Common manifestations include limited airflow due to bronchial inflammations which results in drastic arterial blood gas patterns during an exacerbation. These result in patients experiencing recurrent periods of shortness of breath, wheezing and uncontrollable coughing.

The exposure to air pollutants, allergens, physical exercises, respiratory infections, intense emotional expressions, drugs, food additives and changing weather patterns are some of the clinically proven triggers to chronic and acute asthma exacerbations (Huether &McCance, 2012). Other known triggers are such patient factors as pregnancy, menstruation, bacterial sinusitis, rhinitis.

The workings that result in the restriction of respiratory airways are closely associated to the human body’s mast cells. In asthmatic individuals, these mast cells tend to be localized within the smooth muscle of the bronchioles (Huether &McCance, 2012). There are other numerous cellular elements that play varying roles in the continued inflammation in bronchial mucosa linings and respiratory airways hyperactivity in patients. These elements include lymphocytes, macrophages or dendritic cells, basophils, eosinophils and neutrophils (Huether &McCance, 2012).

At the onset of an asthma exacerbation, the exposure of the bronchial mucosa lining to triggers such as allergens irritates plasma cells to emit a distinct antigen. Known as the IgE antigen, it interacts with mast cells results in the production of anti inflammatory elements (Huether &McCance, 2012). These include interleukins, bradykinins, histamines, prostaglandins as well as leukotrienes. These elements are known to cause the smooth bronchial muscles to experience vasodilatations, mucosal edema, contractions, excessive mucus excretion and increased capillary dilations (Hasegawa et al. 2015). These outcomes inhibit the respiratory system causing adverse arterial gas concentrations which cause patients to pass out unconscious after a prolonged asthma exacerbation.

Similarities and Differences in Chronic and Acute Asthma Exacerbation

It is important to understand that factors precipitating asthma exacerbation tend to vary among different patients presenting healthcare practitioners with dynamic challenges in the diagnosis and management of the disease. The main difference in the chronic and acute versions of the disease is that acute asthma presents symptoms that appear and tend to worsen quite rapidly often resulting in fatalities (Jackson, Sykes, Mallia & Johnston, 2011). It is quite common among children. Chronic asthma on the other hand tends to develop and progressively worsen over some period of time. It is common among pregnant women.

An asthma exacerbation episode is considered as acute or chronic relative to the complexity of symptoms as well as physical assessment factors. Arterial gas concentrations and lung functionality is one of the most potent means of differentiating between the two asthma conditions (Jackson, Sykes, Mallia & Johnston, 2011). For instance, in children and patients aged more than five years, a peak expiratory flow that falls below 40% indicates that such an individual is suffering from an acute asthma exacerbation. This needs to be treated at a hospital emergency department and in most cases requires the patient to be hospitalized for observation by an advanced healthcare practitioner. Chronic asthma exacerbations on the other hand can be treated at home thro the administering bronchial dilator based treatments with active beta 2 agonists (Jackson, Sykes, Mallia & Johnston, 2011).

Patient Factor: Pregnancy

It common to find women suffering from asthma during pregnancy which in some instances can be fatal for the fetus as well as the mother if improperly managed (Hasegawa et al. 2015). Some women suffer asthma for the first time upon becoming pregnant. In other women, their chronic or acute asthma exacerbation episodes may improve or worsen (Namazy, Murphy, Powell, Gibson, Chambers & Schatz, 2013). It is estimated that over 33% of pregnant women suffer worse conditions while another 33% realize improved asthma management outcomes. However, 33% of pregnant women experience no change in the conditions.

Poor diagnoses on the severity of chronic and acute as well as the treatment of exacerbations often lead to fatal fetal and maternal complications. Maternal complications include gestational hypertension, preeclampsia, vaginal hemorrhage hyperemesis gravidarum and toxemia (Hasegawa et al. 2015). Fetal complications include high perinatal mortality rates, preterm birth, neonatal hypoxia, low weight at birth and intrauterine development retardations (Hasegawa et al. 2015). Preganat women are thus advised to proactively avoid situations leading to asthma exacerbations, manage chronic symptoms and involve early intervention to arrest acute exacerbations.

Conclusion

This chronic disease affects millions of people all over the world. It is also regarded to as the most prevalent chronic disease affecting children. The prevalence of the disease has resulted in numerous deaths among children and in many instances just within hours of complaining of associated symptoms that result from inflammations which hinders a victim’s respiratory airways. More so, this paper has highlighted the severity of chronic and acute asthma exacerbations ion pregnant women. Understanding how pregnancy as a patient factor affects the diagnosis, treatment, management of acute and chronic asthma exacerbations is critical towards protecting both the mother and fetus.

Mind map for acute asthma exacerbation

Mind map for chronic asthma exacerbation

References

Hasegawa, K., Cydulka, R. K., Sullivan, A. F., Langdorf, M. I., Nonas, S. A., Nowak, R. M., … & Camargo, C. A. (2015). Improved Management of Acute Asthma Among Pregnant Women Presenting to the ED. CHEST Journal,147(2), 406-414.

Huether, S. E., &McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

Jackson, D. J., Sykes, A., Mallia, P., & Johnston, S. L. (2011). Asthma exacerbations: origin, effect, and prevention. Journal of Allergy and Clinical Immunology, 128(6), 1165-1174.

Namazy, J. A., Murphy, V. E., Powell, H., Gibson, P. G., Chambers, C., & Schatz, M. (2013). Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes. European Respiratory Journal, 41(5), 1082-1090.