asthma

asthma
Case study:
At 22.00 hours Jason, a 10 year old boy, is brought to the emergency department by ambulance accompanied by his parents. On arrival Jason is anxious, severely dyspnoeic with an audible wheeze and can only respond in single words. His mother tells the staff that Jason had developed a cough and runny nose two days ago and earlier today had begun wheezing. Although 2 puffs of salbutamol had initially given relief, his shortness of breath worsened during the evening. When he became very short of breath at about 9pm she gave him 4 puffs of salbutamol using a spacer, but there had been little relief. This was repeated after 5 minutes, and when there was still no relief his parents called an ambulance.
Observations on admission.
Temperature: 36.9�C
Pulse: 136 beats/minute
Respirations: 46 breaths/minute
Oxygen saturation: 90%
His breathing is laboured with supraventricular, intercostal and subcostal retractions.
On auscultation there is a loud inspiratory and expiratory wheeze.
Jason is diagnosed with an acute asthma exacerbation.
History obtained from mother.
At six months of age Jason developed a recurrent cough and when he was two years old asthma was diagnosed. Although there is no family history of asthma, Jason�s mother suffers from hay fever and his younger brother has episodes of eczema. Jason�s asthma is managed by inhaled fluticasone propionate (50 micrograms twice /day) and 2 puffs of a salbutamol metered-dose inhaler using a spacer when required for relief of symptoms. He usually needs salbutamol once or twice a week. He has had two previous admissions to hospital for exacerbation of asthma which were triggered on both occasions by a respiratory infection. However, his mother thinks that this episode is much severer than previous exacerbations.
Management
Jason is commenced on continuous oxygen at 6L/minute. He is also commenced on continuous nebulisation with salbutamol 0.5%. 250 micrograms of ipratonium bromide is
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added to the salbutamol at 20 minute intervals for the first hour. Prednisolone 40mg is given orally. Over the next hour Jason�s respiratory rate falls to 32 breaths/minute and he is able to speak in full sentences. He performs a peak flow which is 50% of expected. His oxygen saturations remain 92% on room air. Continuous nebulisation is discontinued and Jason�s treatment is changed to salbutamol 4 puffs via spacer every two hours, ipratropium bromide 2 puffs via spacer every 6 hours and daily prednisolone 40mg orally for three days. He is transferred to the paediatric ward.
Over the next two days Jason�s salbutamol is tapered as his condition continues to improve with breathing and oxygen saturations returning to normal and peak flow 85%. He is discharged on an increased dose of fluticasone (100 micrograms twice per day). Except for the increased dose of preventer medication, his asthma action plan remains unchanged.
PART 1 � Pathophysiology template. (2 A4 pages).
Complete a pathophysiology template related to the case study.
PART 2 � Questions related to the case study.
1. Explain the process that leads to the structural and functional changes resulting from Jason�s asthma. (750 words)
2. Explain how four of Jason�s clinical manifestations are related to the structural and functional changes. (300 words)
3. Select two drugs that have been used in the treatment of Jason�s asthma. Relating your discussion to the pathophysiological process, discuss the rationales for the administration of these drugs. (200 words)