Ha Huu Pham Mr Carabello Anatomy and Physioly (H) May 10 2011

Barb is an Asthma victim, a common chronic inflammatory disease of the airways that cause the patient experience difficulties in breathing. Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in one second and peak expiratory flow rate. The prevalence of asthma has increased significantly since the 1970s. As of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally. Therefore as an asthma victim, Barb, as well as her family should have more knowledge about the Asthma, to have better control of her life. (Wikipedia)

The exact cause of asthma is not completely known. It is believed to be partially inherited, but it also involves many other environmental, infectious, and chemical factors. After a person is exposed to a certain trigger, the body releases histamine and other agents that can cause inflammation in the airways. The body also releases other factors that can cause the muscles of the airways to tighten, or become smaller. There is also an increase in mucus production that may clog the airways (University of Maryland Medical
Center).

Chemical factors such as drugs can precipitate an asthma attack. The patients

need to be aware of which medications may be triggers, for instance, Aspirin and other painkillers. Approximately 10% to 20% of adults with asthma have sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn). These drugs are frequently used to treat pain and reduce fevers( Web Medication ). If these medications have never triggered the

patients asthma, it is still best to take the medications with caution because a reaction can occur at any time. The common known asthma triggers are things that irritate the air flow passage such as animals (pet hair or dander), dust, changes in weather (most often cold weather), mold, pollen, respiratory infections, such as the common cold and tobacco smoke. Patient family should be aware of these triggers and keep them away from Asthma patient at all time.

Exercise and stress is the less commonly known triggers. Some persons have exercise-induced asthma, which is caused by varying degrees of exercise. Symptoms can occur during, or shortly after, exercise. Each person has different triggers that cause the asthma to worsen. The patients should discuss this with their physician. Stress is a common asthma trigger. Stress and anxiety sometimes make you feel short of breath and may cause your asthma symptoms to become worse. As human, we cannot avoid stress; it is part of daily life. However, developing effective ways to manage stress and learning to relax can help you prevent shortness of breath and avoid panic. In Barb case, It could be the stress after a long nineteen hours drive. Moreover with the interaction of dust, bacteria and fur from the old teddy bear, Barb eventually has an asthma attack. Family members play an important factor in making Asthma patient life easier. Therefore it is important for patient families to have a well awareness of asthma triggers. If Barb and her family have a better knowledge then they should put her to rest when she arrives.

In all of the airways: trachea, bronchi, and bronchioles, the bronchioles or bronchioli are the first airway branches that no longer contain cartilage. They are

branches of the bronchi. The bronchioles terminate by entering the circular sacs called alveoli. Bronchioles collapses are pliable and lack cartilaginous support, They become compressed by surrounding structures in the absence of inflowing air needed to keep them inflated. The condition occurs in disorders such as emphysema, cystic fibrosis, and bronchiectasis.

When Barb inhales the fur from the old bear. There is an immediate response to the trigger that leads her airways to swell and narrow. This makes it initially difficult to breathe, wheezing, coughing, chest tightness, and shortness of breath. A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. Depending on the site of airway obstruction, wheezes occupy different portions of the respiratory cycle. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. Wheezes usually worse when asthmatics exhale because it indicates Bronchiolar disease. The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal. While wheezes occur throughout the inspiratory phase is monotonal, which can be heard more proximally, in the trachea. As Borchioles are located deeper into the body, it is more complicate to treat the patient with a bronchiolar disease.(Wikipedia) Because of unclear method to classify different subgroups of asthma, Barbs second asthma attack could a later response of asthma attack, which can happen four to eight hours after the initial exposure to the allergen, leads to further inflammation of the airways and obstruction of airflow. There could also be a possibilities that Barb experiences Gastro-esophageal reflux disease or sleep disorders. Which are examples of

asthma that get worse at night. Gastro-esophageal reflux disease coexists with asthma in 80% of people with asthma increases lung pressures, promoting bronchoconstriction, and through chronic aspiration at night. Or Barb may has sleep disorders due to altered anatomy of the respiratory tract: increased upper airway adipose deposition, altered pharynx skeletal morphology, and extension of the pharyngeal airway; leading to upper airway collapse. (Symptoms and Treatments for COPD Exacerbation)

Another possibility is that Barb had a Chronic Obstructive Pulmonary Disease which can coexist with asthma and can occur as a complication of chronic asthma. After the age of 65 most people with obstructive airway disease will have asthma and COPD. In this setting, COPD can be differentiated by increased airway neutrophils, abnormally increased wall thickness, and increased smooth muscle in the bronchi. However, this level of investigation is not performed due to COPD and asthma sharing similar principles of management: corticosteroids, long acting beta agonists, and smoking cessation. It closely resembles asthma in symptoms, is correlated with more exposure to cigarette smoke, an older age, less symptom reversibility after bronchodilator administration and decreased likelihood of family history of atopy (University of Maryland
Medical Center)

Finally, With Barb symptoms, she may has experienced a status asthmaticus is a medical emergency in which asthma symptoms are refractory to initial bronchodilator therapy in the emergency department. Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to a potent allergen or irritant, or after exercise in a cold environment. Frequently, patients have underused or have been underprescribed anti-inflammatory therapy. Illicit drug use may play a role in poor

adherence to anti-inflammatory therapy. Patients report chest tightness, rapidly progressive shortness of breath, dry cough, and wheezing and may have increased their beta-agonist intake to as often as every few minutes. To determine the exact subgroups of asthma, further speculation about Barbaras condition is needed. (Symptoms and Treatments
for COPD Exacerbation)

3. Imagine that you are performing a lab in which you are monitoring breathing in a student volunteer. Draw a graph, with time on the horizontal axis and breathing movements on the vertical axis. Draw a line to show the results you would expect for a healthy student, assuming that inhaling produces an upward deflection of the line and exhaling produces a downward deflection of the line. http://biomhs.blogspot.com/2011/05/lung-volume.html

4. Draw a second line to show the results you would expect from someone having an asthmatic episode. Pay close attention to the slopes of the lines (the rate of air movement) and the amplitude of the waves (the amount of air fl owing in and out of the lung during each breath).

Works Cited "ACVS - Tracheal Collapse." American College of Veterinary Surgeons. Web. 13 May 2011. <http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/TrachealCollapse/index.cfm? dspPrintReady=Y>. "Asthma." Wikipedia, the Free Encyclopedia. Web. 13 May 2011. <http://en.wikipedia.org/wiki/Asthma>. Http://www.euronet.nl/~jonkr/, Ron Jonk-. "Asthma Attacks." University of Maryland Medical Center | Home. Web. 13 May 2011. <http://www.umm.edu/non_trauma/asthma.htm>. Leader, Deborah. "COPD Exacerbation - Symptoms and Treatments for COPD Exacerbation." COPD Emphysema - Quitting Smoking - COPD Symptoms - COPD Diagnosis - COPD Treatment. Web. 13 May 2011. <http://copd.about.com/od/copd/a/copdexac.htm>. Web. 13 May 2011. <http://www.ncbi.nlm.nih.gov/pubmed/16456385>.