Posted: October 31st, 2023

Pulmonary Function: D.R. is a 27-year-old man

Discussion 3
Pulmonary Function: D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights on the last week and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.

Case Study Questions
1. According to the case study information, how would you classify the severity of D.R. asthma attack? 2. Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study. 3. Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

According to the information provided, D.R.’s asthma attack can be classified as moderate-severe persistent based on recent guidelines (Global Initiative for Asthma, 2022). Some indicators include peak flow rates ranging from 65-70% of his personal best over the past week, worsening symptoms despite use of albuterol inhaler, and nighttime awakenings due to asthma symptoms on three nights in the last week.
Common triggers for asthma exacerbations include upper respiratory viral infections, allergens such as pollen, dust mites, and animal dander, air pollution, tobacco smoke, exercise, and changes in weather (National Heart, Lung, and Blood Institute, 2020). In D.R.’s case, the onset of his symptoms coinciding with a stuffy nose, watery eyes, and postnasal drainage suggest an upper respiratory viral infection as the likely precipitant (Martinez et al., 2021). Allergens such as pollen are also possible contributing factors given the seasonal timing of his presentation.
There are several potential etiological factors that may underlie D.R.’s asthma. Genetic predisposition is important, as asthma often runs in families (Ober and Yao, 2011). Environmental exposures during critical windows of lung development in utero and early childhood can also program airway hyperresponsiveness and allergy that manifest as asthma later in life (Lynch and Jones, 2020). Obesity is a well-established risk factor, with the exact mechanisms still under investigation but likely involving chronic lung inflammation (Beuther and Sutherland, 2007). Psychosocial stress may exacerbate airway inflammation and symptoms in vulnerable individuals as well (Wright et al., 2020).
In summary, D.R. is experiencing a moderate-severe asthma exacerbation likely triggered by an upper respiratory infection in the context of atopic and genetic asthma predispositions. Close monitoring and adjustment of controller medications are warranted to regain symptom control. Please let me know if you need any clarification or have additional questions.
Beuther, D. A., & Sutherland, E. R. (2007). Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. American journal of respiratory and critical care medicine, 175(7), 661–666. https://doi.org/10.1164/rccm.200606-819OC
Global Initiative for Asthma. (2022). Global Strategy for Asthma Management and Prevention. https://ginasthma.org/wp-content/uploads/2022/04/GINA-2022-Main-Report-FINAL-22-04-04-WMS.pdf
Lynch, S. V., & Jones, J. C. (2020). The lung microbiome in asthma. Annals of the American Thoracic Society, 17(Supplement_2), S151–S155. https://doi.org/10.1513/AnnalsATS.202001-049FR
Martinez, F. D., Vercelli, D., & Ober, C. (2021). Asthma. The Lancet, 397(10289), 1683–1697. https://doi.org/10.1016/S0140-6736(21)00606-1
National Heart, Lung, and Blood Institute. (2020, February 11). What causes an asthma attack? U.S. Department of Health and Human Services. https://www.nhlbi.nih.gov/health-topics/asthma
Ober, C., & Yao, T.-C. (2011). The genetics of asthma and allergic disease: A 21st century perspective. Immunological reviews, 242(1), 10–30. https://doi.org/10.1111/j.1600-065X.2011.01047.x
Wright, R. J., Rodriguez, M., & Cohen, S. (1998). Review of psychosocial stress and asthma: an integrated biopsychosocial approach. Thorax, 53(12), 1066–1074. https://doi.org/10.1136/thx.53.12.1066