Acute Asthma

While taking an afternoon walk with her sister. It is a cold, windy, early spring weekend. She complains of acute shortness of breath and has audible wheezing, episodic cough, and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose. These symptoms become worse within 5 minutes. Her sister called 000, and paramedics promptly attended to Shane, who was fully Twenty-one-year-old Shane has long been suffering from asthma and is now experiencing an asthma attack conscious, appeared wide-eyed and frightened, and unable to breathe effectively. She was immediately transferred to the nearest hospital for full respiratory function assessment and treatment for acute asthma.

A physical exam reveals a heart rate (HR) of 120/min and a respiratory rate (RR) of 38/min with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. Shane is coughing up small amounts of sputum and has an arterial oxygen saturation of 90%.

Nebulised salbutamol, oxygen by facial mask, and systemic corticosteroid were administered, and then a second, small-volume nebuliser treatment was ordered 20 minutes later. Chest auscultation revealed diminished wheezes; her RR was 24/min at this time, and her HR decreased to 102/min. Over the next 24 hours Shane showed steady improvement and was discharged for follow-up with her local GP to review her asthma action plan and change any medications as needed to help prevent future exacerbations.

Question 3/1 Choose two risk factors from the case study above and explain how they may have contributed to the pathogenesis of Shane’s current acute asthma attack. In your answer, discuss the role of histamine in Shane’s present condition. (8 marks)

Question 3/2 Explain the mechanisms of action of salbutamol in the treatment of acute asthma and describe its benefits in Shane’s condition. (4 marks)

Question 3/3 By reflecting on your learning experience, describe three benefits of corticosteroid administration in the long-term management of asthma. (3 marks)

Shane’s grandmother, Maria, is a 67-year-old retired, clinically obese woman, who lives with her life partner, Robin. She enjoys sitting down to a movie every night with a large packet of salt and vinegar chips or a tub of cookies and cream ice cream. Maria doesn’t like to exercise; her only form of exercise is walking around Coles on Fridays whilst doing her weekly shopping. Her sister has asked her to join her walking group on numerous occasions, but Maria would rather stay home and bake. Maria’s mother moved in with her many years ago when her father passed away from a heart attack at the age of 60. Her mother isn’t in the best of health: she has type II diabetes and hypertension, which are under control.
One day Maria decides to visit her neighbour, taking with her a batch of freshly baked cookies. Whilst walking to her neighbour’s house, she notices that she is short of breath and is feeling a slight pain in her chest, but when she sits down, she feels fine, so she dismisses it once again, putting it down to her poor fitness. However, on her way home she begins to feel light-headed and weak and feels like she is going to be sick. She notices that she has been feeling like this quite a lot lately, even when resting in the evening, so she decides to make an appointment with her GP for later in the week.
At the medical clinic, the GP takes Maria’s blood pressure reading. It has been elevated on a number of occasions, and today is no different—the reading shows 145/95 mmHg. The GP prescribes an ACE inhibitor and tells Maria she really needs to make some lifestyle changes. He writes a referral for her to see a cardiovascular specialist for an ECG and a coronary angiogram to determine why Maria has been short of breath and unwell.
One day, whilst waiting for her results, Maria starts to feel more nauseous and dizzier than usual. She starts to feel clammy and sweaty, and her face seems grey in colour. The chest pain returns but now feels like a crushing pain, and she can’t breathe. Robin dials 000, and she is rushed to hospital. An ECG shows that Maria has ST elevation, and a blood test indicates that she has high levels of cardiac-specific troponin in her blood. Maria is given heparin intravenously as well as an anti-platelet and a fibrinolytic drug. She is taken into surgery, where a coronary angioplasty is performed.

Question 3/4 Name the condition Maria was suffering from when she was rushed to hospital and discuss two clinical findings that support your suggestion. (4 marks)

Question 3/5 Explain the expected benefits of a fibrinolytic drug in the above case study by referring to its pharmacodynamics and pharmacological effects. (3 marks)

BIOL122 End-of-semester worksheet Semester 1, 2022 Maria has recovered and in addition to the ACE inhibitor has now been placed on a diuretic as well.
Question 3/6 Considering the pharmacodynamics of ACE inhibitors, discuss three different mechanisms by which they decrease cardiac workload. (3 marks)

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