Patient Assessment
The patient, Nancy, comes into the office with a complaint of exacerbated asthma. The patient has had persistent asthma since childhood and has had previous occurrences of flareups. The onset of the worsened symptoms happened two weeks ago. The primary affected area is the respiratory system. The symptoms are present continuously and worsen during physical activity and at night. The flareup is characterized by cough and difficulty breathing. As noted, physical exercise and lying down make the symptoms worse. The patient uses albuterol 4 to 5 times a day to relieve the symptoms, which is effective for short periods of time. The severity of the symptoms is high and can be measured as 8 out of 10.
Overall Health and Pathophysiology
The pathophysiology of asthma is linked to the three core defects of the airway – obstruction, hyperresponsiveness, and inflammation. The airways of a person with asthma are inflamed, which causes them to be thicker than those of a healthy individual (Yamauchi & Ogasawara, 2019). This contributes to obstruction, leading to such symptoms as shortness of breath (Yamauchi & Ogasawara, 2019).
During an asthma attack, the hyperresponsiveness of the airways leads to increased inflammation of the walls and the tightening of the smooth muscles. The increase of mucus-secreting cells causes mucus to plug the airway and damage the epithelium. Airways then become more hyperresponsive, lowering the effect of therapy and increasing the permeation of allergens. As a result, the person experiences shortness of breath, wheezing, and coughing (Yamauchi & Ogasawara, 2019). In Nancy’s case, the airways become inflamed several times a day, and physical activity acts as an exacerbating factor.
In Nancy’s case, the atopy of her disease plays a significant role in her condition. Atopic asthma develops in one’s childhood, and it involves a reaction of allergens which causes a response of IgE production (Di Cicco et al., 2020). Increased IgE release leads to the activation of B-lymphocyte and triggers inflammation, which results in bronchoconstriction – asthma attacks (Di Cicco et al., 2020).
Furthermore, the concept of “one continuous airway” also applies in Nancy’s case, as it describes the idea that the health of the upper and lower airways is interconnected (Di Cicco et al., 2020). For example, allergic rhinitis may exacerbate one’s response to allergens and result in a more severe type of asthma, while treating one condition is likely to improve the state of another. As Nancy had eczema as a child and was treated with allergy medication, her hyperresponsiveness to allergens is atopic, affecting her current health and requiring additional treatment attention.
Diagnosis
Spirometry is a test used to measure a patient’s lung capacity and function and detect obstruction or restriction. The first measurement is the forced expiratory volume in one second (FEV1), which represents the air volume exhaled during the forced exhalation in the first second after maximum inhalation (Gallucci et al., 2019). The normal values for FEV1 lie between 80% and 120%, and Nancy demonstrates a result of 81% and a 15% increase after using a bronchodilator, which denotes the lower limit of normalcy (Gallucci et al., 2019).
Second, FVC measures forced vital capacity – how much a person may exhale during forced exhalation. Similarly, the predicted range for FVC is between 80% and 120% (Gallucci et al., 2019). Nancy’s test shows 88% of FVC, which falls into the normal volume during forced exhalation. Finally, the FEV1/FVC shows the ratio between the two measurements, and the norm is more than 0.7 or within 5% of the FEV1 (Gallucci et al., 2019). Nancy’s FEV1/FVC ratio is 82%, which is 1% more than the FEV1 – an expected result.
Based on spirometry results and Nancy’s medical history, one can classify Nancy’s asthma as persistent moderate. Nancy experiences symptoms often and reports shortness of breath more than twice a week, eliminating the possibility of having intermittent asthma (Fanta & Barrett, 2022). Thus, the patient has one of the three levels of persistent asthma. Based on the spirometry results, which fall under the normal ranges and show a limited level of obstruction, severe persistent asthma may be dismissed as a potential diagnosis (National Health, Lung, and Blood Institute [NHLBI], 2020).
The difference between a mild and a moderate condition relies on the frequency of symptoms exacerbation and how they interfere with the patient’s daily life. According to Nancy, she uses her inhaler more than once daily, and asthma attacks significantly impact her ability to perform any tasks requiring physical activity. As mild persistent asthma is denoted by minimal influence on daily life and infrequent use of rescue inhalers, Nancy’s condition may be identified as moderate persistent asthma.
Informing the Patient
The patient should be informed that her medical history of taking allergy medication and increased sensitivity to allergens influences her asthma responses. As an outcome, Nancy should pay attention to avoid being in the presence of potential allergens. Furthermore, she should be notified that she has moderate persistent asthma, which requires medication that is more effective than rescue inhalers in the long term. According to the latest guidelines, it is recommended that Nancy adheres to daily inhaled corticosteroid treatment which she had failed to fill previously (NHLBI, 2020). Such medication should relieve her symptoms and allow her to lower the use of albuterol while improving her everyday life.
References
Di Cicco, M., D’Elios, S., Peroni, D. G., & Comberiati, P. (2020). The role of atopy in asthma development and persistence. Current Opinion in Allergy and Clinical Immunology, 20(2), 131-137. Web.
Fanta, C., & Barrett, N. (2022). An overview of asthma management. UpToDate. Web.
Gallucci, M., Carbonara, P., Pacilli, A. M. G., Di Palmo, E., Ricci, G., & Nava, S. (2019). Use of symptoms scores, spirometry, and other pulmonary function testing for asthma monitoring. Frontiers in Pediatrics, 7, 54. Web.
National Health, Lung, and Blood Institute. (2020). 2020 Focused Updated to the Asthma Management Guidelines. Web.
Yamauchi, K., & Ogasawara, M. (2019). The role of histamine in the pathophysiology of asthma and the clinical efficacy of antihistamines in asthma therapy. International Journal of Molecular Sciences, 20(7), 1733. Web.