Shortness of Breath Essay
The patient in the case scenario most likely has asthma. Asthma is an acute and reversible obstructive airway disorder. It is characterized by the limitation of expiratory airflow. Patients usually have bronchospasms which can present as shortness of breath, chest tightness, and wheezing, as in the case of Darla. The etiology of asthma is multifactorial. Genetic and environmental factors are thought to play a role in the causation of asthma. Family history is an important component of asthma. Asthma is strongly related to atopy. Allergic asthma attacks can be caused by exposure to specific agents, which may trigger asthma attacks and symptoms. Some of the triggers include pollen, dust, pet dander, smoke, and mold spores (Chabra & Gupta, 2021). The patient reports that her symptoms have recently worsened since her new roommate moved in with a cat. The patient also reports that she smokes occasionally. There is a relationship between smoking and an increased risk of asthma. The patient also reports that her symptoms are worse during the spring. This might be due to allergies to pollen, dust, and mold spores.
Asthma primarily occurs due to an exaggerated hypersensitivity response to an allergen or an environmental agent. This is usually an IgE-mediated response. The presence of the offending agent leads to an increase in mast cells, eosinophils, and lymphocytes. These cells are responsible for causing inflammation of the airway and damage to the bronchial epithelium. Cytokines also play a role in the pathogenesis of asthma. Eosinophils are the cells that are mostly accumulated in allergic inflammations and asthma (Hirano & Matsunaga, 2018).
Sensitized IgE antibodies are released in response to certain environmental triggers. These antibodies then bind to mast cells which then release histamine, leukotrienes, and prostaglandins in response to the environmental agent. These then cause constriction of the airway smooth muscles, mucus secretion, increased inflammation of the airway, and increased microvascular permeability. Lymphocytes play an integral role by producing interleukins that aid in sustaining inflammation. Inflammation and bronchoconstriction lead to intermittent obstruction of airflow. This leads to increased work of breathing. Patients may present with shortness of breath, wheezing, a cough, and chest tightness (Quirce et al., 2020). Sensitization to allergens such as mold and their seasonal increase parallel the seasonal exacerbations and greater severity of asthma
Spirometry can be used to diagnose asthma as well as assess the severity of obstruction. The expected spirometry finding is an FEV1 less than 0.8 and an FEV1/FVC ratio of less than 0.70. FEV1 less than 0.8 indicates airflow obstruction (Castillo et al., 2017).
The plan of care for this patient would entail patient education, patient monitoring control of known triggers, and the commencement of a pharmacological regimen. The expected outcome would be a reduction in the episodes of asthma exacerbations and better control of the symptoms. Education of the patient would include encouraging smoking cessation. The patient should also avoid known allergens and triggers of her symptoms, such as the cat. Pharmacological treatment using inhaled corticosteroids (ICS) should also be started. ICS reduces asthma exacerbations and improves disease control. Inhaled short-acting β2-agonists (SABAs), such as albuterol, can also be used to resolve acute symptoms and provide symptomatic relief (Castillo et al., 2017). The patient’s symptoms and lung function should be monitored regularly, preferably every month. This is done to assess the effectiveness of the asthma control and to determine any adjustments that need to be made to the care plan.
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References
Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. The journal of allergy and clinical immunology. In practice, 5(4), 918–927. https://doi.org/10.1016/j.jaip.2017.05.001
Chabra R, & Gupta M. (2021). Allergic And Environmental Induced Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526018/
Hirano, T., & Matsunaga, K. (2018). Late-onset asthma: current perspectives. Journal of Asthma and Allergy, 11, 19–27. https://doi.org/10.2147/JAA.S125948
Quirce, S., Heffler, E., Nenasheva, N., Demoly, P., Menzies-Gow, A., Moreira-Jorge, A., Nissen, F., & Hanania, N. A. (2020). Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. Journal of Asthma and Allergy, 13, 743–752. https://doi.org/10.2147/JAA.S282205
Overview
Darla Thomas, a 25-year-old African-American previously well woman, presents to her primary care Nurse Practitioner\’s office with complaints of
episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened
lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or
nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives
with a roommate, who moved in approximately 2 months ago. The roommate has a cat. The patient smokes occasionally when out with friends,
drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to
confirm the diagnosis.
In this discussion:
1. Discuss what you think this patient\’s likely diagnosis is. Provide literature support for your choice.
2. Identify the pathogenetic mechanisms that are responsible for this patient\’s symptoms of wheezing, shortness of breath, and chest
tightness.
3. What might you expect the results of her pulmonary function tests to be? Why?
4. Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these
outcomes?
Include citations from the text, information from the Shadow Health simulation assignment, and/or the external literature in your discussions.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria
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