Running head: CHILDHOOD ASTHMA, A CASE STUDY 1

Childhood Asthma, a Case Study

Tia Conway

College of Western Idaho

CHILDHOOD ASTHMA, A CASE STUDY 2

Katie Kingston: Introduction

Katie Kingston is an 11-year old female who arrived at the ER presenting with wheezing,

shortness of breath, and tachypnea. She was diagnosed with moderate persistent allergic asthma

at 5-years old after discovering she had a cat allergy. Her mother states that she uses two puffs of

Flovent HFA 110mcg daily, as well as a Pro-Air rescue inhaler 90 mcg for emergencies. Katie

admitted to not using her Flovent that morning and had visited her friend who has a cat.

Etiology and Pathophysiology of Allergic Asthma

As a chronic inflammatory disease, asthma causes the airways to spasm and narrow in

response to specific stimuli. Unlike those with healthy lungs, asthmatics have become

hyperreactive to substances the body recognizes as foreign (Cramer, 2016). In most cases, the

first time an allergen is encountered, it does not elicit an allergic reaction. The body produces

IgE, an antibody targeted towards the newly recognized antigen, and releases it in excess

(Cassell, 2017). Upon encountering the trigger, mast cells, eosinophils, and CD4 T-lymphocytes

(Fireman, 2003) in the bronchial walls (Cramer, 2016) secrete leukotrienes, histamine, and

cytokines (Cassell, 2017). These factors cause swelling, contraction of smooth muscle, and the
CHILDHOOD ASTHMA, A CASE STUDY 3

formation of mucus (Cramer, 2016). Other complications include mucosal edema, lung

hyperinflation, sloughing of epithelial cells, hypertrophy of smooth muscle cells, disruption of

cilia cells, and thickening of the lamina reticularis. Over time the repetition of asthmatic episodes

can cause airway remodeling through injury and the subsequent repair of tissues (Fireman,

2003).

Clinical Manifestations

Wheezing is a strong indicator of an asthma attack, as well as chest tightness and

shortness of breath. Thick, stringy sputum may be present, and a cough that worsens at nighttime

or early morning (Sorenson, 2017). The diagnosis of moderate persistent asthma includes

symptoms every day, nighttime symptoms at least once a week, and attacks that interfere with

the activity of the person (Cassell, 2017).

Cascading Effects

This type of lung disease and its treatments can lead to several other conditions, including

osteoporosis and pneumothorax (Cassell, 2017). Medications like glucocorticoids taken orally

and inhaled corticosteroids used to treat asthma can cause bone density loss. The mechanisms

involved are increased calcium loss through the kidneys, decreased dietary calcium absorption,

and interference with sex hormone production (“What People with Asthma,” 2018). Air trapping

in a severe case of asthma can cause tension pneumothorax (Porpodis, 2016), which is the

buildup of fluid inside the pleural space (Cassell, 2017). This is mostly related to hyperinflation

of the alveoli during mechanical ventilation (Porpodis, 2016).

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Epidemiology

In 2015, a report made by the Global Burden of Disease revealed that asthma is the most

common chronic respiratory disorder. The estimated prevalence is about 358 million worldwide.

In the United states, according the CDC, the prevalence in 2015 was about 7.8% (Kuruvilla,

2019). The prevalence among children is higher, at 8.3% (Sorenson, 2017). According to the

National Institutes of Health, allergic asthma accounts for about 60% of all cases, and is higher

among children, at 80% (Cassell, 2017). The asthma mortality rate in the United States in 2016

was around 9.34% for women and 7.78% for men (Kuruvilla, 2019).

The ethnic prevalence of asthma in order of lowest to highest are:

Asian, 5.2%

Mexican, 5.4%

Hispanics, 6.5%

Caucasians, 7.7%

Alaska Native, 9.4%

African American, 11.2%

Multiple races, 14.1%

Puerto Rican, 16.1%

(Sorenson, 2017).
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Risk Factors

Factors that predispose an individual to allergies, called atopy, is present in many cases of

asthma (Sorenson, 2017). Dust mites, pollen, animal dander, obesity, genetic variations, and

maternal smoking may also trigger the onset of asthma. Those that have been exposed to tobacco

smoke have lower pulmonary function than those who aren’t (Cassell, 2017).

Katie Kingston: Application

Katie has a family history of atopy on both maternal and paternal sides. Her aunt and

uncle both had childhood asthma and cat allergies, but they’ve both since “grown out” of it. She

is hopeful this resolves by adulthood, however, her mother smoked during pregnancy and is still

currently a smoker. She has many other allergies and triggers, such as eggs, tree pollen, grass,

and physical exertion. She has been hospitalized 4 to 6 times a year since her diagnosis at age 5.

The physician on call in the ER orders a series of tests for Katie to determine the severity of her

symptoms.

Appropriate Tests

Appropriate tests for measuring an asthma attack are spirometry, peak flow, ESR on

CBC, and exhalation of nitric oxide. Peak flow includes the measurement of forcefully exhaled

air after a maximum inhalation (Sorenson, 2017). Spirometry measures the volume and speed of

air is exhaled after breathing deeply (Wells, 2015). An elevated ESR rate is indicative of an acute

asthmatic episode, as well as increased amounts of exhaled nitric oxide (Sorenson, 2017).
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Katie Kingston: Application

Katie is 4 foot 3 inches tall and weighs 74 pounds. Her physical examination revealed

crackling on auscultation, blood pressure of 115/74, temperature of 98.2 degrees Fahrenheit,

pulse of 116, oxygen saturation at 93%, a respiratory rate of 27, and an elevated ESR rate. Her

peak flow was measured at 185L/min, which is 73% of expected flow at 254L/min. The

physician noted she was unresponsive to lower levels of bronchodilators and ordered treatment

with a nebulizer until she becomes stable.

Treatment

The most important treatment is avoidance of triggers (Cramer, 2016). Medications play

a key role in prevention and control of symptoms. Medications that usually offer relief include

short- and long-acting bronchodilators, antihistamines, inhaled corticosteroids, theophyllines,

mast cell stabilizers, and anti-IgE therapy (Sorenson, 2017). Allergists can inject small doses of a

known allergen to cause desensitization to it (Cassell, 2017).

Katie Kingston: Outcome

Katie’s diagnosis remains the same, and she is advised to continue her daily Flovent HFA

regimen for preventive measures. She is also prescribed an antihistamine for increased control

and prevention of future attacks. After successful nebulization, she is sent home. Her mother is

advised to discontinue use of cigarettes and assess Katie with an at-home peak flow monitor. She

is referred to an allergist for experimental treatment.

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Prognosis

Currently, over 50% of childhood asthma cases resolve by adulthood. Smoking and

exposure to cigarette smoke can decrease the chances of resolving the condition (Cramer, 2016).

With careful treatment and monitoring, asthma can be controlled effectively.

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References Cited

Cassell, D. K., & Rose, N. (2017). allergic asthma. In D. K. Cassell, & N. Rose, Facts on File

library of health and living: The encyclopedia of autoimmune diseases (2nd ed.). Facts

On File. Credo Reference: https://cwi.idm.oclc.org/login?

url=https://search.credoreference.com/content/entry/fofad/allergic_asthma/0?

institutionId=5230

Cramer, D. A., & Bullard, E. C. (2016). Asthma. In Gale (Ed.), Gale encyclopedia of children's

health: Infancy through adolescence (3rd ed.). Gale. Credo Reference:

https://cwi.idm.oclc.org/login?

url=https://search.credoreference.com/content/entry/galegchita/asthma/0?

institutionId=5230

Fireman, P. (2003). Understanding asthma pathophysiology. Retrieved March 7, 2020, from

https://www.ncbi.nlm.nih.gov/pubmed/12776439/

Kuruvilla, M., Vanijcharoenkarn, K., Shih, J., & Eun-Hyung Lee, F. (2019, April).

Epidemiology and Risk Factors for Asthma. Retrieved March 5, 2020, from https://www-

sciencedirect-com.cwi.idm.oclc.org/science/article/pii/S0954611119300307

Porpodis, K., Zarogoulidis, P., Spyratos, D., Domvri, K., Kioumis, I., Angelis, N., …

Zarogoulidis, K. (2014, March). Pneumothorax and asthma. Retrieved March 7, 2020,

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966154/

Sorenson, M., Quinn, L., & Klein, D. (2017). Pathophysiology: Concepts of Human Disease.

Retrieved from https://etext-

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ise.pearson.com/courses/5879304/products/6AAPAODR2NV/pages/a78d37b297c3e9d09

b916dc26916c8826678c6b47?locale=&key=23027139171113176281282020

Wells, K. R., Mertz, L., & Oberleitner, M. G. (2015). Asthma. In Gale (Ed.), The Gale

encyclopedia of senior health: a guide for seniors and their caregivers (2nd ed.). Gale.

Credo Reference: https://cwi.idm.oclc.org/login?

url=https://search.credoreference.com/content/entry/galegsh/asthma/0?institutionId=5230

What People With Asthma Need To Know About Osteoporosis. (2018, November). Retrieved

March 7, 2020, from https://www.bones.nih.gov/health-

info/bone/osteoporosis/conditions-behaviors/asthma