Question

CASE STUDY 4.1 t worse during the summer CJ. a 19-year-old White female, has a history fever, which seems to get worse during the After a weekend camping trip, she devel- months. After a weekend camping oped difficulty breathing and needed to seek ca these symptoms, which were diagnosed as an ex bation of asthma. Think about which clinical model is most related to this process. From your reading re- lated to inflammation and immune function, answer the following questions: 1. What anatomic problem would most likely lead to difficulty breathing as a consequence of allergy and asthma? 2. What is the injury in asthma? 3. How would the immune system respond? 4. Why is this a chronic problem? 5. What pathophysiologic changes would most likely occur with chronic asthma and allergy? 6. What would you expect to find as clinical manifestations? 7. What diagnostic tests might be used? 8. What treatment measures would you anticipate? Log onto the Internet. Search for a relevant journal article or Web site that details asthma with an aller- gic component to confirm your predictions.

Answer 1

1.The smooth muscles surrounding the bronchial tubes begin to tighten,narrowing the airway. The bronchial tubes themselves become inflamed and swollen, which narrows the airways even further.

The inflamed membranes inside the bronchial tubes secrete a thick mucus. This can narrow the tubes to the point where almost no air is passing at all.

When breathing tubes of the lungs become chronically inflamed, they can become sensitive to inhaled environmental allergens and irritants that can trigger asthma. These environmental triggers include pollen, pollution, and tobacco smoke. Exercise can also be an asthma trigger for some.

2.Deposition of collagen in the epithelial subbasement membrane is a characteristic feature of the remodelling response in asthma. This may be due to abnormal associations between myofibroblasts and epithelium, both of which are involved in early lung development (epithelial-mesenchymal trophic unit). In asthma, there may be a primary defect in the epithelium such that it responds abnormally to various stimuli and cannot undergo the normal repair response. Epidermal growth factor (EGF) appears to be a key factor in bronchial epithelial repair; it stimulates epithelial cell proliferation and migration.

3.Adaptive immune responses. Antigen-presenting cells (APC) bind, process antigen (Ag), and display it on their surface on the major histocompatability complex (MHC). This is then able to bind an antigen-specific T cell receptor (TCR) on the surface of the naïve T cell (also known as signal 1). To respond to this antigen, the T cell must also be costimulated through additional receptors.This dual stimulation can lead to a T helper(Th)1 or T(2 response, depending on the antigen. The innate immune system plays a critical role in determining the type of T cell differentiation and, thus, the type of adaptive immune response. A newly described subset, Th17 cells, mediates neutrophil inflammation and may play a role in asthma.

4.Asthma is a chronic condition that affects the airways. It causes wheezing and can make it hard to breathe. Some triggers include exposure to an allergen or irritant, viruses, exercise, emotional stress, and other factors.

Asthma causes the inside walls of the airways, or the bronchial tubes, to become swollen and inflamed.

During an asthma attack, the airways will swell, the muscles around them will tighten, and it becomes difficult for air to move in and out of the lungs.

Around 7.9% of people in the United States had asthma in 2017. There are many types of asthma, and several factors can cause asthma or trigger an acute attack.

5. Pathophysiology of asthama- In the airway of an asthma patient, there is infiltration by inflammatory cells including (eosinophils,T cells,mast cells,basophils and neutrophils),with vasodilation.

Notable structural changes include desquamation of airway epithelium, mucosal and submucosal edema, hyperplasia of globet cells, submucosal granular hyperplasia subepithelial fibrotic changes, destruction of elastic fibres, and hypertrophy of smooth muscle .

Pathophysiology of allergy

Allergy is the clinical expression of atopy - the physical symptoms of allergy related to exposure. The immune response is dependent on the body's two subsets of T-lymphocytes, known as T helper cells TH1 and TH2.

6.The clinical manifestations of asthma include recurrent episodes of wheezing, chest tightness, cough and shortness of breath. The symptoms are often worse at night or on waking from sleep. Usually, they resolve spontaneously or with the inhalation of a reliever medication. In other cases, they may worsen over hours or minutes, leading to more severe airflow obstruction and an ‘attack’ or exacerbation of asthma that is relieved only by extra medication. Some very severe episodes are life-threatening, although death from asthma in adulthood is uncommon .

7.Diagnostic Test For Asthama-

Tests for asthma

The main tests used to help diagnose asthma are:

• FeNO test – you breathe into a machine that measures the level of nitric oxide in your breath, which is a sign of inflammation in your lungs
• spirometry – you blow into a machine that measures how fast you can breathe out and how much air you can hold in your lungs
• peak flow test – you blow into a handheld device that measures how fast you can breathe out, and this may be done several times over a few weeks to see if it changes over time

After you're diagnosed with asthma, you may also have allergy tests to see if your symptoms might be triggered by an allergy.

8.Treatment measure-

Stick to an asthma action plan to control symptoms effectively.

Asthma care places responsibility for treatment with both the doctor and the individual with the condition.

Working with a doctor and following the suggested action plan to the letter is vital for reducing the impact of asthma.

Avoiding asthma triggers is a primary way to reduce the risk of a severe attack and chronic symptoms.

Exercise is a potential trigger but maintaining an active physical regimen is an essential part of healthful living. People can ask their doctor about medications that might improve their asthma symptoms during physical activity.