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Acute Asthma Exacerbation
My patient was a nine-year-old girl, brought into the ER and admitted with a diagnosis of acute asthma exacerbation. “Asthma is a highly prevalent, chronic respiratory condition characterized by reversible airﬂow obstruction, airway hyperresponsiveness (AHR), and airway inﬂammation producing symptoms of shortness of breath, cough, wheezing, and chest tightness (Dougherty, & Fahy, 2009).” Her asthma has been well controlled and she takes Flovent daily. She also has an albuterol inhaler, but rarely needs to use it. “According to the latest NIH National Asthma Education and Prevention Guidelines, asthma exacerbations are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness, or some combination of these symptoms, characterized by decreases in expiratory airﬂow and objective measures of lung function (spirometry and peak ﬂow) (Dougherty, & Fahy, 2009).” The patient began having chest pain, shortness of breath, and coughing in the morning. She didn’t tell her mother that she was feeling bad, and by that evening she was wheezing and her shortness of breath had gotten so bad that she was unable to walk and had to be carried into the ER.
“The precipitants of acute asthma exacerbations are numerous and include viruses, allergens (dust mite, pollen, animal dander), occupational exposures (grains, ﬂours, cleaning agents, metals, irritants, woods), hormones (menstrual asthma), drugs [ASA, non-steroidal anti-inﬂammatory drugs (NSAIDs), b-blockers], exercise, stress, and air pollutants. Common respiratory viruses, especially rhinoviruses, cause the majority of exacerbations in children and adults. Infection of airway epithelial cells with rhinovirus causes the release of pro-inﬂammatory cytokines and chemokines, as well as recruitment of inﬂammatory cells, particularly neutrophils, lymphocytes, and eosinophils (Dougherty, & Fahy, 2009).” The patient had...
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