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    Science for nursing and midwifery

    Introduction

    Asthma is a serious disease of the human respiratory system and can turn fatal if not treated accurately. Frequent coughing, wheezing, breathing problem, breathing shortness, and many others are vital signs of asthma. Asthma can occur due to a variety of reasons starting from a virus attack to smoking during pregnancy and thus, a child is most prone to asthma. Hence, the essay highlights the causes and symptoms of asthma along with the respiratory damage caused by it.   

    Discussion

    Asthma is a condition when the respiratory system of the human body swells and the airways narrow producing excess mucus. This leads to difficulty in breathing and therefore, triggers wheezing, coughing and breathing shortness. The different signs and symptoms of asthma include- Chest pain or chest tightness, shortness of breath, sleeping trouble due to coughing or wheezing, wheezing or whistling sound while exhaling and coughing attacks are worsened if affected by flu (Lockey & Ledford, 2014).  The asthma signs are bothersome and are frequent. The increase in breathing difficulty can be measured using a peak flow meter. This helps in checking the healthy working principle of the lungs. Additionally, the physicians recommend a quick-relief inhaler to support the patients from pain and sufferings of asthma. Thus, asthma cannot be cured but can be kept acute if appropriate treatment is provided to the victim. Hence, it is recommended to visit a doctor once an individual encounter breathing problem, as asthma can turn fatal if it is not treated.         

    Asthma can occur due to various reasons. Suppose a family runs asthma in their gene, it is common that the child of the family will be affected by asthma. These kinds of allergies are said to be atopic for the child. Thus, generation after generation asthma can run in the family. Additionally, researches have suggested that smoking during pregnancy can be fatal for the child (Clark, 2010). This is because the child can be affected by asthma from his infant period. It is evident that smoking plays a significant role in the onset of asthma. Moreover, a child can be affected by asthma if he or she is prematurely born. They need a ventilator system to help them in breathing. Furthermore, low birth weight can lead to the development of asthma. Bronchiolitis affects the babies and is caused by a virus (Ray et al., 2016). It causes swelling of the lungs and airways. Occupational asthma has become common, especially in people working in asbestos and cement factory.            

    Asthma has a serious impact on the respiratory system of the human body. The fatalities of the disease are discussed below:

    In asthma, epithelial abnormalities are common which is associated with the injury to the epithelium. The epithelial damage is related to AHR and several reports suggest that it is present in all subjects, which are associated with persistent asthma (Douglas & Elward, 2010). In the case of fatal and severe asthma, enormous denudation of the epithelium is evident. Mucosal inflammation is observed in patients affected by asthma that is in an initial stage. BAL (Bronchoalveolar Lavage) or induced sputum is a common technique to detect epithelial shedding. It occurs at a rate of about four-fold with respect to the normal subjects. These cells are ciliated and seem to be shed frequently and rapidly. Additionally, asthma causes alternation in the mucus-secreting structures. A strong connection between goblet cell hyperplasia and asthma is evident. However, this is not associated with asthma severity, but an increased in the areas of the submucosal mucous gland is observed both in fatal and severe asthma (Johnston & Holgate, 2008). Matrix abnormalities such as thickening of the matrix layer are another significant impact of asthma on the human respiratory system. This is referred to as sub-epithelial fibrosis. Moreover, the thickness of the disease increases with an increase in the severity of the disease. Furthermore, elastin abnormalities are observed in asthmatic airways (Lambrecht & Hammad, 2015). The electron microscope evidence suggests a fragmented structure of the elastin. Elastin distortion is observed in the immediate layer of sub-epithelial tissue. Alterations are more prominent in the central airways of the respiratory system. An increase in smooth muscle mass is observed as one of the severities of asthma. This is evident from the increase in bundle size and increases in the myocyte mass that increases the surrounding matrix cells (Froidure et al., 2016). Additionally, it is believed that multiple mechanisms are responsible for enhancing smooth muscle fibers during asthma. Estimation related to asthma fatalities revealed that an increase in smooth muscle cells in fatal asthma is in the range of 200%-400%, whereas, in non-fatal asthma is around 50%-200%.  Besides this, vascular remodeling and angiogenesis is observed in asthma. The thickening of the air wall is also evident in the case of asthma (Otto et al., 2018). Both the outer and inner respiratory wall undergoes changes in asthma. Some alterations can also be transient. 

    The calculated medication and dosage for asthma for long-term control are discussed in a tabular format:

    Medication              

    0-4 years

    5-11 years

    >12 years

    Oral systemic corticosteroids

    Methylprednisolone

    0.25–2 mg/kg daily in single dose

    0.25–2 mg/kg daily in single dose

    7.5–60 mg daily in a single dose

    Prednisolone

    1–2 mg/kg/day (Short-term bursts)

    1–2 mg/kg/day, maximum 60 mg/day for 3–10 days

    To achieve control, 40–60 mg per day

    Prednisone

    5 mg/cc

    -

    -

    Inhaled LABA (Long Acting Beta2 Agonists)

    Salmeterol

    Not Applicable

    1 blister q 12 hours

    1 blister q 12 hours

    Formoterol            

    Not Applicable

    1 capsule q 12 hours

    1 capsule q 12 hours

    Nedocromil/Cromolyn

    Nebulizer

    1 ampule qid Not Applicable <2>

    1 ampule qid

    1 ampule qid

    Nedocromil

    -

    -

    -

    Table 1: Dosage and medication for asthma

    (Source- Created by the learner)

    Conclusion

    The essay explores the cause and effects of asthma and its potential impact on the respiratory system of human beings. Premature babies can be affected by asthma and smoking during pregnancies can also cause long-term asthma in a child. The mucus-secreting cells are damaged by asthma. Additionally, epithelial distortion is likely to occur along with the thickening of the airways. Appropriate medication can help prevent the fatalities of asthma and it is provided in the essay in a tabular form.  

     

     

    References

    Clark, M. V. (2010). Asthma: a clinician's guide. Jones & Bartlett Learning.

    Douglas, J., & Elward, K. (2010). Asthma: Clinician's Desk Reference. CRC Press.

    Froidure, A., Mouthuy, J., Durham, S. R., Chanez, P., Sibille, Y., & Pilette, C. (2016). Asthma phenotypes and IgE responses. European Respiratory Journal47(1), 304-319.

    Johnston, S. L., & Holgate, S. T. (Eds.). (2008). Asthma: critical debates. John Wiley & Sons.

    Lambrecht, B. N., & Hammad, H. (2015). The immunology of asthma. Nature immunology16(1), 45.

    Lockey, M. R. F., & Ledford, M. D. K. (Eds.). (2014). Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis. Oxford University Press.

    Otto, C., Barthel, D., Klasen, F., Nolte, S., Rose, M., Meyrose, A. K., ... & Ravens-Sieberer, U. (2018). Predictors of self-reported health-related quality of life according to the EQ-5D-Y in chronically ill children and adolescents with asthma, diabetes, and juvenile arthritis: longitudinal results. Quality of Life Research27(4), 879-890.

    Ray, A., Raundhal, M., Oriss, T. B., Ray, P., & Wenzel, S. E. (2016). Current concepts of severe asthma. The Journal of clinical investigation126(7), 2394-2403.

     

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