Case Study of Geronimo Suffering from Asthma Samples for Students

Questions: 1.Describe the Probable reasons for Geronimo's acute Exacerbation of Asthma. 2.Based on the history provided by Geronimo and his mother, determine which Classification of Asthma Geronimo's Asthma fits. 3.Explain the results of his Spirometry test. An arterial blood gas (ABG) testing is recommend by a junior doctor for Geronimo, do you agree with this Suggestion? 4.Describe the different forms of Asthma Medication and when each should be used. Answers: 1.From the case study it is identified that Geronimo has been experiencing an upper respiratory tract infection with unresolved cough and breathlessness since past 10 days. His usual asthma medication salbutamol got over for three days. These are the probable reasons for Geronimos acute exacerbation of asthma. Virus-associated upper respiratory tract infections (URTIs) are a vital trigger of severe exacerbations of asthma. Pertaining to the asthma pathogenesis and its exacerbations, the commonly related viruses include rhinovirus (RV), respiratory syncytial virus (RSV), coronavirus, influenza and parainfluenza viruses, adenovirus and enterovirus. Nevertheless, wheezing-related viral infections are considered by an age-associated distribution. Precisely, RV epitomizes the most recurrent cause of communicable respiratory illnesses that majorly affect the older children and the adults, whereas, RSV affects children less than 3 years of age. The airway epithelial cells that react with th e RV related infection with inflammatory response are mediated by augmented biosynthesis of interleukins 6, 8 and 16 (Gillissen, Paparoupa, 2014). All these are involved in the B and T lymphocytes maturation and in fibroblast proliferation. This also involves recruitment of neutrophils, chemotaxis of monocytes and eosinophils. The bronchial epithelial cells that are affected by RV also generates high amount of chemokines RANTES and eotaxin that play an influential chemotactic role in the eosinophilic airway infiltration. Salbutamol is a 2-agonist that relaxes bronchial smooth muscle and eases the severe exacerbations of asthma. It is more selective for 2 receptors than 1 receptors and gives it higher specificity for the pulmonary beta receptors (Beckhaus, Riutort, Castro-Rodriguez, 2013). Inadequate dosages might have increased Geronimos exacerbation of asthma. 2.Based on the history provided by Geronimo and his mother, Geronimos asthma falls under the second category that is mild persistent asthma. This is because in mild persistent asthma, without treatment any symptoms arise on more than 2 days in a week, but not regularly. Asthma attacks interfere with regular activities (Koterba, Saltoun, 2012). Symptoms at night may happen 3-4 times a month. Lung function examinations are normal, while the affected individual is not having asthma attack. The results of such examinations are approximately 80% and from morning to afternoon, PEF or peak expiratory flow varies between 20%-30% (Kaminsky et al., 2017). In this case study, as mentioned by Geronimo and his mother, Geronimo was well until he caught a cold. Due to a bad cough and colds, Geronimo has missed about 10 days of school in the last 12 months. Otherwise, he poses a good health. Geronimo agreed that he had difficultly playing sport particularly during his soccer games on weekends. He w heezed and coughed when laughing, he avoided running around with his mates to prevent symptoms. This supports the point that asthma attacks interfere with his regular activities. Geronimo was on medication but his condition exacerbated as he was running out of his usual asthma medication, salbutamol. The symptoms are visible while medication administration were withheld, which justifies the selection of Geronimos asthma categorization. Geronimos mother has stated that he poses overall good health except when he gets could and cold. This represents that symptoms do not occur every day and further justifies the selection of Geronimos asthma categorization. 3.Spirometry is a common form of pulmonary function tests, which measures volume, flow of air that is inhales and exhales, lung function. It also helps in identifying breathing patterns during diseased condition like COPD, asthma, cystic fibrosis and pulmonary fibrosis. This this case, spirometry would enable the health care professionals to diagnose Geronimos asthma exacerbations. His FEV1 was 1.64 L, which is the air volume that forcibly is blown out within a second after complete inspiration. Average FEV1 in a healthy individual depends upon age, sex. The normal value considered is between 80%-120%. Lower score depicts presence of lung diseases or asthma that include swollen or constricted airways. This supports Geronimos condition, where his FEV1 was 55%. Simultaneously, his SpO2 was 94% on room air that represents normal oxygen saturation level within the blood that means % of oxygenated haemoglobin compared to total haemoglobin. 94%-99% is the normal SpO2 level (James, 2015). I ndividuals with mild respiratory complications may demonstrate 90% or more than that and should not fall below 90%, which requires supplementary oxygen administration. Oxygen saturation is not the best indicator to show how sever the asthma flare is. Asthma attack may have normal or near normal oxygen saturation level. Asthma is the airways disease and not alveoli where the gas exchange takes place. However, in case of wheeze, cough and clogging recommendation for an arterial blood gas (ABG) testing is justified. This test would enable the doctor to understand how well Geronimos lungs are able to carry oxygen into blood and remove carbon di oxide from the blood (Marshall, 2010). 4.The different forms of asthma medication are: continuing asthma control medication, quick relief medication and medicines for allergy-derived asthma (Axelsson, Ekerljung, Lundbck, 2015). The continuing asthma control medication are administered regularly in order to control lasting indications and prevents attacks of asthma. This is considered as one of the best type of treatment for majority of the asthma affecting individuals. Corticosteroid, LABA (Long-acting beta agonists), antagonists, leukotriene modifiers, and inhaled corticosteroids are fallen under this category. Quick relief medications are taken when needed for short-term and rapid relief: albuterol or short acting beta agonists, ipratropium, corticosteroids fall under this group. Allergy-derived asthma medications are taken on regular basis that reduce the systems sensitivity to a particular allergen: immunotherapy, Omalizumab fall under this category of medicines. In case of children, inhaled corticosteroids may dela y the healing process but act as good asthma control and eliminate associated risks. Throphylline is a bronchiodilator that treats mild asthma. It relaxes airways and reduces lungs response to various irritants. It effectively controls night-time asthma indications. Immunomodulator is a type of injection that is administered to control moderate to severe asthma associated with inflammation or allergies cause due to immune system and does not react to particular drugs. Reslizumab, Mepolizumab are some of immunomodulators (Zahran, Bailey, Qin, Johnson, 2017) References: Axelsson, M., Ekerljung, L., Lundbck, B. (2015). The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control.Nursing Research And Practice,2015, 1-7. https://dx.doi.org/10.1155/2015/139070 Beckhaus, A., Riutort, M., Castro-Rodriguez, J. (2013). Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review.Pediatric Pulmonology,49(4), 326-334. https://dx.doi.org/10.1002/ppul.22846 Gillissen, A., Paparoupa, M. (2014). Inflammation and infections in asthma.The Clinical Respiratory Journal,9(3), 257-269. https://dx.doi.org/10.1111/crj.12135 James, J. (2015). Mismatch Between Asthma Symptoms and Spirometry: Implications for Managing Asthma in Children.PEDIATRICS,136(Supplement), S264-S264. https://dx.doi.org/10.1542/peds.2015-2776ffff Kaminsky, D., Wang, L., Bates, J., Thamrin, C., Shade, D., Dixon, A. et al. (2017). Fluctuation Analysis of Peak Expiratory Flow and Its Association with Treatment Failure in Asthma.American Journal Of Respiratory And Critical Care Medicine,195(8), 993-999. https://dx.doi.org/10.1164/rccm.201601-0076oc Koterba, A., Saltoun, C. (2012). Chapter 9: Asthma classification.Allergy And Asthma Proceedings,33(3), 28-31. https://dx.doi.org/10.2500/aap.2012.33.3539 Marshall, W. (2010). Arterial Blood Gas Analysis.Annals Of Clinical Biochemistry,47(3), 283-283. https://dx.doi.org/10.1258/acb.2010.201005 Zahran, H., Bailey, C., Qin, X., Johnson, C. (2017). Long-term control medication use and asthma control status among children and adults with asthma.Journal Of Asthma, 1-8. https://dx.doi.org/10.1080/02770903.2017.1290105