Disorders of Ventilation and Gas Exchange

Disorders of Ventilation and Gas Exchange
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Disorders of Ventilation and Gas Exchange
Management of Asthma and the Drugs in use for long term and short term
Despite the nature of advances made in care, asthma remains a significant challenge, especially amongst the pediatric population. Statistics indicate that there has been a substantial rise in the mortality and hospitalization rates of children who have asthma. To date, inhalation therapies have been identified as the cornerstone for the treatment of asthma. Inhalation provides an ideal method to enhance the breathing abilities of the child. Corticosteroids are responsible for creating an anti-inflammatory effect, which in turn stabilizes mast cells and ensures that inflammatory mediators to be released are not allowed (Grossman & Porth, 2014). Bronchodilators (β2-agonist) act on the sympathetic nervous system, which causes the relaxation of the smooth bronchial muscles. The corticosteroid drugs are used as long-term drugs while bronchodilators are majorly used only in times of respiratory emergencies. The principal aim of prescribing an inhaled corticosteroid is to ensure that the patient has access to a small amount of the hormone in the long term such that the airways can experience reduced inflammation.
Inhaled corticosteroids are the preferred methodology of treatment of asthma. The use of the corticosteroids ensures that there is sufficient control of inflammatory on the patient’s airways.

Providing small doses of the drug is a feasible way to ensure that the bronchial tubes remain clear. The drug is perceived to be the most effective for long-term control of asthma. When the drug is taken consistently, it ensures that the lung function improves and thus minimizes incidences of asthmatic attacks and hospital admissions. A significant benefit of the medicine, unlike the β2-agonist, is that it is a long-term and effective controller of asthma (Higgins, 2015). It ensures that the production of any inflammatory cytokines is subdued to help reduce the stability of mRNA. Low doses of the medicine have been found to be effective in enhancing the responses to inflammations by switching off the gene that is responsible for accelerating incidences of inhalation attacks. The effect explains why using low doses of the medicine is more effective thus effectively controlling asthmatic conditions for the patient.
Earlier administration of systemic corticosteroids plays vital roles in enhancing the effectiveness of the drug. In fact, studies by DeBrosse, Moncrief and Bonnin (2017), identified that those who started using the drug much earlier depicted higher levels of improvement and minimized recurrence of asthmatic attacks. Subsequently, the hospital admission rates for those that used the drug were much lower, thereby validating the need for the use of the corticosteroids for long-term treatment instead of β2-agonist, which is administered in high doses (DeBrosse, Moncrief & Bonnin, 2017). Thus, it is ideal to consider the need to start treatment using corticosteroids, which offer a relatively stable outcome in the end compared to other alternatives such as the β2-agonist, which is only administered in times of emergencies and in high doses to help clear the airwaves.
Reason for Fatigue in Times of Prolonged Asthmatic Attacks
Asthmatic attacks occur when an individual experiences challenges in breathing. The attack occurs when the passages of the air in the lungs reduce airflow of oxygen levels entering the body. Oxygen is a vital component that ensures that the body functions as is required. Thus, when the body is deprived of the oxygen, it is likely that energy components transported through the blood will also fail to reach the body organs thereby leading to fatigue. The physiological events of an asthmatic attack may offer adequate information regarding the events that lead to fatigue. The same situation is evident in Emmanuel’s case who depicts fatigue and restlessness. Schneider and Herzog (2017), explain that people who experience severe asthmatic attacks feel as of their chests are tightening along the air trappings. Later, the person will be prompted to use their accessory muscles, which also demand significant energy levels in their attempt to breathe. In the process, a considerable amount of energy is lost as the victim tries to breathe a when the demand for oxygen is significantly high. The events have a detrimental effect on the capacities of the patient to retain the desired energy levels.
During an asthmatic attack, the airways narrow. The narrowing occurs because of mucus plugging and bronchospasm, which is an edema of the bronchial mucosa. When the progressive obstruction is prolonged, it causes the expiration process to be affected. Thus, the amount of air that is being released during the second peak of the breathing process is significantly decreased. The air becomes trapped for more extended periods during prolonged attacks. The blockage of the air for more extended periods leads to hyperinflation of the lungs. Hyperinflation of the lungs leads to an increase in the residual volume and the inspiratory reserve capacity. Thus, the patient is forced to breathe on the vital capacity of the functional residual amount (Schneider & Herzog, 2017). The outcomes of such activities result in an increased demand for energy required to ease the tension being experienced in the lungs. The accessory muscles are also in need of the energy to maintain gas exchange and the ventilation process. The outcomes are that air is trapped in the alveoli and the inspiration process occurs at higher residual volumes, thereby making alternative actions such as coughing less effective. In the process, hypercapnia and hypoxemia also contribute to fatigue as the condition progresses. In effect, the effectiveness of the alveolar ventilation declines while the process fails to match perfusion levels. The physiological processes are all known to have an impact on a person’s ability to recover out of the process.
Complications of Respiratory Fatigue
Hypercapnia refers to the increased levels of carbon dioxide in the bloodstream. Conversely, hypoxemia leads to the decreased levels of oxygen as seen amongst a majority of individuals who suffer asthmatic episodes. Typically, in times of respiratory fatigue, the body attempts to compensate the increase in carbon dioxide by enhancing the pace of carbon dioxide elimination, which is in excess. Unfortunately, those that suffer from asthmatic conditions are unable to eliminate excess carbon dioxide. Notably, the carbon dioxide readily crosses the barrier of the blood-brain and in effect, has an impact on the central nervous system. The changes are attributed to the fact that a change in the oxygen levels affects the blood quality thus changing its pH. Those who are affected experience headache, irritability, blurred vision, psychological disturbances, and muscle twitching immediately. Any increases in the CSF pressure and papilledema may prolong the situation especially when in extreme levels. The outcomes may lead to impaired consciousness and even lead to commas. In extreme capacities, it may lead to depression. In acute hypercapnia, respiratory failures may occur at any time between few minutes and hours. Grossman and Porth (2014) explain that during hypoventilation, the body increases in its respiratory response. The process aims at enabling it to reduce the levels of carbon dioxide and instead increase the oxygen capacities in the blood. At this time, the blood pH levels are usually less than 7.3 (Grossman & Porth, 2014). However, chronic breathing failures may take several days to develop, and the pH level may increase especially when the bicarbonate concentration increase.
Acute hypercapnia increases the sympathetic nervous system discharge. The effects of may lead to a rise of epinephrine and norepinephrine increase thus enhancing myocardial contractility. The cardiac output also increases thus increasing the risk for cardiac arrhythmias. The process may lead to cerebral vasodilation and an increased intracranial pressure, which in turn lowers the seizure threshold. The management of asthma especially for younger children demands caution and adherence to the prescriptions given. Thus, controlling hypercapnia ensures that there is substantial management in the management of the asthmatic condition while at the same time allowing adequate oxygenation to take place.
The process ensures that the oxygen is reduced at tissue level to reduce the susceptibility to further respiratory failure. Clancy and Blake (2013), further explains that hypercapnia occurs when acidosis takes place. The process also increases a decrease in the contraction of the respiration process as well as arterial vasodilation. Some of the effects of the process are that the victim would feel disoriented and sleepy. The same is evident in Emmanuel’s case, who after the asthmatic attack and the use of the emergency drug depicted a sense of disorientation and sleepiness. It is recommended that in patients experiencing acute it is imperative to also watch out for incidences of coronary heart disease and heart failure, which may also emerge in the course of managing asthma.

References
Clancy , J., & Blake, D. (2013). Pathophysiology and pharmacological management of asthma from a nature-nurture perspective. Primary Health Care, 23(7), 34-41.
DeBrosse, C. W., Moncrief, T. M., & Bonnin, A. J. (2017). Steroid Induced Acne Secondary to Low Dose Inhaled Corticosteroids in a Pediatric Patient and Resolution with Every Other Day Ics Dosing. Journal of Allergy and Clinical Immunology, 139(2), AB98.
Grossman, S. & Porth, C. (2014).  Porth’s pathophysiology: Concepts of altered health states, 9th ed. Philadelphia, PA: Wolters Klwuer Health/Lippincott  Williams & Wilkins.
Higgins, J. C. (2015). The’Crashing Asthmatic’. American Family Physician, 91.
Schneider, A., & Herzog, R. (2017). Inhaled Corticosteroid for Asthma, A Call for Monitoring in Pediatrics. Journal of Allergy and Clinical Immunology, 139(2), AB98.