1. Describe the pathophysiology, clinical manifestations, evaluation, and treatment of asthma (include the National Asthma Education and Prevention Program guidelines). 2. Describe the pathophysiology, clinical manifestations, evaluation, and treatment of tuberculosis pneumonia. Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
Asthma is a chronic inflammatory disorder of the airways that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It affects an estimated 358 million individuals worldwide and is associated with significant morbidity and mortality. The pathophysiology of asthma involves a combination of genetic and environmental factors that result in airway inflammation and hyperresponsiveness.
At the cellular level, asthma is characterized by an increase in the number of inflammatory cells, particularly eosinophils, in the airway walls. This inflammation leads to increased airway smooth muscle contraction, mucus production, and vascular leakage. These processes contribute to the clinical manifestations of asthma, such as wheezing and breathlessness.
The clinical manifestations of asthma can vary from mild intermittent symptoms to severe persistent symptoms. Patients with mild asthma may experience infrequent episodes of wheezing, usually triggered by specific allergens or irritants. In contrast, patients with severe asthma may have daily symptoms that significantly impair their quality of life.
The evaluation of asthma involves a combination of clinical history, physical examination, and pulmonary function tests. The clinical history should include information on the frequency and severity of symptoms, triggers, and response to previous treatments. Physical examination may reveal signs such as wheezing, prolonged expiration, and decreased breath sounds.
Pulmonary function tests, including spirometry, are essential in the diagnosis and monitoring of asthma. Spirometry measures the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). A reduced FEV1/FVC ratio, particularly after bronchodilator administration, indicates airflow obstruction, supporting the diagnosis of asthma.
The treatment of asthma is based on a stepwise approach, as outlined in the National Asthma Education and Prevention Program (NAEPP) guidelines. The goal of treatment is to achieve and maintain asthma control, which is defined as minimal symptoms, normal lung function, and a minimal need for rescue medication.
The initial treatment is typically with inhaled short-acting β2-agonists (SABA) on an as-needed basis. If symptoms persist, the next step involves the addition of inhaled corticosteroids (ICS), which are the most effective anti-inflammatory medications for asthma. ICS should be used regularly, even in patients with mild asthma, to achieve and maintain control.
If asthma control is not achieved with low-dose ICS, the next step involves either increasing the dose of ICS or adding a long-acting β2-agonist (LABA). LABAs provide sustained bronchodilation and should always be used in combination with ICS. In patients who continue to have uncontrolled symptoms despite these measures, other options include adding a leukotriene modifier, a theophylline, or a monoclonal antibody targeting specific cytokines.
For patients with severe asthma, who are refractory to high-dose ICS and LABAs, the NAEPP guidelines recommend considering the use of oral corticosteroids or, in select cases, biologic therapies such as omalizumab or mepolizumab. These medications target specific pathways involved in the pathogenesis of asthma and have shown efficacy in reducing exacerbations and improving lung function.
In summary, asthma is a chronic inflammatory disorder of the airways characterized by airway inflammation, hyperresponsiveness, and clinical manifestations such as wheezing and breathlessness. The evaluation of asthma involves a combination of clinical history, physical examination, and pulmonary function tests. Treatment is based on a stepwise approach, with the goal of achieving and maintaining asthma control. The NAEPP guidelines provide a comprehensive framework for the management of asthma, taking into account the individual’s symptoms, lung function, and response to treatment. Ongoing research continues to contribute to the understanding of asthma pathophysiology and the development of new treatment options.