Introduction
Acute asthma and chronic asthma are closely related variants of asthma, which is an inflammatory disease that affects the flow of air in the lungs. The obstruction of airflow in the lungs leads to different symptoms including wheezing, coughing, tightness, and pain in the chest, and shortness of breath. The symptoms of these conditions occur in episodes, which can be subdued through proper medication. However, the symptoms may reappear as the efficacy of the medications used wears off and one is re-exposed to the triggers of the condition. Given the close relationship between the two conditions, healthcare practitioners should be in a position to differentiate them for improved care outcomes. This paper compares and contrasts acute asthma and chronic asthma together with highlighting their pathophysiology, diagnosis, and treatment.
Pathophysiology
Acute Asthma
Acute asthma is characterized by the inflammation and hyper-responsiveness of airways together with intermittent airflow obstruction. The mechanism of acute asthma inflammation involves mucus secretion and airway edema, which ultimately lead to the obstruction of airflow and bronchial reactivity (Trevor & Chipps, 2018). After the introduction of an allergen or a trigger factor, different inflammatory cells, and multiple mediators function to cause the characteristic pathophysiological features of acute asthma. Airway inflammation occurs after the activation of mast cells together with antigen-specific Th2 cells (Borish, 2016). This activation leads to the production of cytokines such as interleukin (IL) 4, 5, and 13 (Donahue & Jain, 2013). During an exacerbation, a trigger causes the constriction and narrowing of the airways, thus leading to acidosis, hypercapnia, and hypoxia (Donahue & Jain, 2013). Obstruction of airflow in the airways occurs after the bronchoconstriction of smooth muscles, inflammation, and edema. Additionally, the accumulation of excess mucus in the airways prevents the normal flow of air in and outside the lungs.
Chronic Asthma
The pathophysiology of chronic asthma is closely related to that of acute asthma. However, in chronic asthma, there is permanent or partially reversible damage of airways, and thus symptoms are experienced even in the absence of exacerbation. Due to the prolonged and irreversible nature of chronic asthma, airway remodeling occurs occasioned by the progressive loss of lung functioning (Bayes & Thompson, 2016). The structural changes that occur in this condition involve the thickening of the sub-basement membrane, hypertrophy, and hyperplasia of smooth muscles in the airways, sub-epithelial fibrosis, and the dilation and proliferation of blood cells together with hyper-secretion and hyperplasia of the mucous gland (Bayes & Thompson, 2016). During an attack, the inflammatory mechanism is the same as that of acute asthma discussed earlier.
Arterial Blood Patterns during Exacerbation
Different blood changes occur during acute and chronic asthma attacks. However, the commonly notable changes involve oxygenation and acidosis. According to Padmavathi, Sumangali, and Subash (2013), hypoxemia and acidosis are the main arterial blood changes observed during the exacerbation of acute and chronic asthma. With obstructed airways and airflow due to inflammation, the blood does not get enough oxygen, hence hypoxemia. Similarly, carbon dioxide is not eliminated effectively, thus lowering the blood’s pH to acidic levels.
Similarities and Differences
As mentioned earlier, acute and chronic asthma are closely related in different ways. First, they both involve the inflammation of the airways, which affects airflow in and outside the lungs. Additionally, the risk factors for the two conditions are almost the same. Anything that can trigger inflammatory responses to the airways is a predisposing factor for these health conditions.
The major difference between the two is that chronic asthma is a long-term condition occasioned by permanent or partially reversible damage to different organs involved in air circulation. Additionally, acute asthma is episodically occurring in short bursts after someone is exposed to triggers such as allergens.
Patient’s Behavior, Diagnosis, and Treatment
A patient’s behavior plays an important role in the exacerbation of both acute and chronic asthma. Exposure to triggers such as tobacco smoke, allergens, and air pollutants initiates a cascade of events that underline the pathophysiology of the two conditions. Therefore, it suffices to conclude that the probability of a patient experiencing an asthmatic attack depends on exposure to triggers. Patients with appropriate education concerning the condition are likely to avoid scenarios where they would be exposed to predisposing factors.
The common diagnoses of these conditions involve a physical examination and lung function tests. The first step is to establish whether one has a family history of any form of asthma. Lung tests include peak flow test, clinical spirometry, nitric oxide test, and blood-oxygen level tests to test blood oxygenation and acidity (Liu, Anderson, Dutmer, Searing, & Szefler, 2016).
The choice of medication given depends on the severity of the condition, patient’s age, and comorbidities. The first line of medications is called rescue drugs meant for short-term relief of symptoms. They include short-acting beta2-agonists, ipratropium bromide inhaler (Atrovent), and oral corticosteroids (Liu et al., 2016). Long-term medications are used to prevent attacks and they include leukotriene modifiers, inhaled corticosteroids, theophylline, and long-acting beta-agonists (LABAs) (Liu et al., 2016).
Summary
Acute and chronic asthma are inflammatory diseases affecting the flow of air through the airways. The conditions are closely related with the main difference being that chronic asthma is permanent or partially reversible. The pathophysiology of the two conditions is similar in different aspects as well as the risk factors. During an asthmatic attack, blood oxygen reduces considerably, while the pH drops to acidic levels due to the accumulation of carbon dioxide. Patient’s behavior such as exposure to air pollutants and other allergens may contribute significantly to the exacerbation of asthma. Diagnosis is done through different lung tests and drugs for treatment are available including short-term and long-term medications.
References
Bayes, H. K., & Thompson, N. C. (2016). Chronic severe asthma in adults. Medicine, 44(5), 301-304.
Borish, L. (2016). The immunology of asthma: Asthma phenotypes and their implications for personalized treatment. Annals of Allergy, Asthma & Immunology, 117(2), 108-114.
Donahue, J., & Jain, N. (2013). Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates. Respiratory Medicine 107(7), 943-952.
Liu, A. H., Anderson, W. C., Dutmer, C. M., Searing, D. A., & Szefler, S. J. (2016). Advances in asthma 2015: Across the lifespan. The Journal of Allergy and Clinical Immunology, 138(2), 397-404.
Padmavathi, K., Sumangali, P., & Subash, Y. E. (2013). Arterial blood gas analysis in acute and chronic bronchial asthma. Bulletin of Pharmaceutical and Medical Sciences, 1(3), 200-205.
Trevor, J. L., & Chipps, B. E. (2018). Severe asthma in primary care: Identification and management. The American Journal of Medicine, 131(5), 484-491.
Mind Map: Acute Asthma
Mind Map: Chronic Asthma
