Acute Vs. Chronic Asthma Exacerbations - Essay Sample

Introduction

In the event asthma exacerbation, there is an exaggerated response in the lower airways triggered by an environmental exposure. Some of the environment exposures include allergens of different chemical and physical properties, environmental pollutants, occupational irritants, medications and viral infections-that are predisposed by factors such as genetics, gender, ethnicity, age, or behavior. As part of the asthma exacerbation, there is marked inflammation in the airways as a response by the immune system to the irritant that leads to a life threatening airflow obstruction and increased responsiveness of the airway.

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The classification of asthma exacerbations as either life threatening, moderate, severe or mild is based on the severity of the symptoms, parameters of physical examination, as well as oxygen saturation and lung function of the patient. Depending on the duration in the onset of symptoms, the asthmatic exacerbations may be described as either acute or chronic. The write-up deliberates to characterize acute and chronic asthma exacerbations, their physiological mechanisms, similarities and differences, contributing factors to the two conditions as well as factors leading to prompt diagnosis and treatment of the disease. The paper puts special emphasis the behavioral factors as a major contributor of the asthma attacks.

Acute asthma exacerbations present their symptoms rapidly upon exposure to the triggering factor. The wheezing and the respiratory distress arise within a short time and there is normally no history of serious asthmatic attacks. Acute asthma exacerbations may be predisposed by conditions such as inhalation of cold air, and inhalations from tobacco, pollen, mold, pets, and dust mites (Guibas, Makris & Papadopoulos, 2012). On the other hand, chronic asthma exacerbations arise from chronic respiratory disorders causing the inflammation. Such cases have diagnostic, management, and prevention implications resulting to a poor prognosis. The chronic asthma attacks are predisposed by conditions such as infections in the upper respiratory tract, stress, gastroesophageal reflux disease, and continued exposure to allergens that lead to progressive damage of the airways (Guibas et al., 2012). Both acute and chronic asthma are characterized by infiltration of the inflammatory cells such as neutrophils, eosinophils, lymphocytes, injury to the epithelial cells as well as activation of the mast cells that bring the thickening of airways and subsequent blockage leading to labored breathing.

In the event of an asthma exacerbation, the airways become swollen and inflamed. There is muscle contraction around the airways and additional production of mucus leading to the narrowing of the bronchial tubes (Oland, Booster & Bender, 2017). At the time of the attack, the patient wheezes, coughs, and experiences troubled breathing that varies in severity (Oland et al., 2017) Severe attacks calls for immediate medical assistance since are life-threatening emergencies and are characterized by hyperventilation, agitation, increased heart rate, difficulty in breathing, and decreased lung function (Oland et al., 2017).

Physiologically, upon exposure to the asthma trigger, several physiological processes occur. There is bronchoconstriction which is the classical symptom leading to narrowing and interference to the flow of air in the bronchioles. In case of acute exacerbation, the contraction of the smooth bronchial muscles occur very fast. The immune response results from the release of IgE-dependent mediators from the mast cells that effect directly on the smooth muscles of the airway (Wark & Gibson, 2006; Ishigatsubo & Aoki, 2013). In the same way, other stimuli such cold air and irritants cause the acute obstruction in the airways. If the inflammatory response becomes persistent, airway edema sets in accompanied by hypersecretion of mucus that forms a plug leading to hypertrophy and hyperplasia of the airway smooth muscles. Other asthma complications include airway hyper-responsiveness and airway remodeling that are reversible and irreversible consecutively. In both acute and chronic asthmatic exacerbations, behavioral factors contribute to the manifestation of the disease. Behavioral factors include the human activities in the lifestyles of different people. For example, a new occupation may predispose a chronic asthmatic patient to an attack if the allergens such as pollen or dust are present at the work place. Other human activities such as tobacco smoking near an asthmatic patient may trigger the disease. Additionally if a patient changes the routine and starts working in cold hours, an asthmatic attack may be imminent.

The behavioral factors may also affect the diagnosis and treatment of both acute and chronic asthmatic exacerbations. Depending on the severity of the attack, it may be described from mild to life threatening. Grading the severity is dependent on the lung function, oxygen saturation as well as symptoms and the parameters at physical exam. In patients older than five years, a peak expiratory flow (PEF) of lesser than 40% indicate a severe attack. Other diagnostic parameters include; retractions on the chest wall, cyanosis, tachypnea, expiratory and inspiratory wheezing, and oxygen saturation of less than 94%. Such symptoms indicate an urgent medical intervention (Pollart, Compton & Elward, 2011)). Emergency treatment includes use of inhalable bronchodilators, subcutaneous epinephrine, nebulized ipratropium, systemic corticosteroids, antibiotics, as well as supplemental oxygen (Szefler, Holguin & Wechsler, 2017). The treatment depends on the patient factors. In case of failure to improve, relapse after drug administration, and other signs of respiratory failure such as partial pressure of carbon dioxide indicate the need for hospitalization.

References

Education, N. A., on the Diagnosis, T. E. P., & of Asthma, M. (2007). Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma. https://www.ncbi.nlm.nih.gov/books/NBK7223/

Guibas, G. V., Makris, M., & Papadopoulos, N. G. (2012). Acute asthma exacerbations in childhood: risk factors, prevention and treatment. Expert review of respiratory medicine, 6(6), 629-638. Retrieved from https://www.tandfonline.com/doi/abs/10.1586/ers.12.68

Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4, 263. doi: 10.3389/fmicb.2013.00263

Oland, A. A., Booster, G. D., & Bender, B. G. (2017). Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organization Journal, 10(1), 35. doi.org/10.1186/s40413-017-0169-9

Pollart, S. M., Compton, R. M., & Elward, K. S. (2011). Management of acute asthma exacerbations. American family physician, 84(1). Retrieved from https://www.aafp.org/afp/2011/0701/p40.html

Szefler, S. J., Holguin, F., & Wechsler, M. E. (Eds.). (2017). Personalizing Asthma Management for the Clinician. Elsevier Health Sciences. https://www.msdmanuals.com/professional/pulmonary-disorders/asthma-and-related-disorders/treatment-of-acute-asthma-exacerbations

Wark, P. A. B., & Gibson, P. G. (2006). Asthma exacerbations 3: pathogenesis. Thorax, 61(10), 909-915. doi: 10.1136/thx.2005.045187