Pathophysiology of Asthma and Pneumonia in Pediatric Patients: A Comparative Analysis
Brian seems to have an acute exacerbation of asthma. Asthma is most common in boys prior to adolescence. Also asthma exacerbation triggers are common after bacterial or viral cold infections. Asthma occurs in two phases, an early and late phase. The early phase of asthma occurs upon initial exposure to an irritant or antigen. Antigen exposure to bronchial mucosa attracts T-helper cells to release interleukins.
Interleukins are a protein made by white blood cells. The release of interleukins activates an immune response causing B-lymphocytes to flood the area and create antibodies. Antibodies bind to pathogens in the form of IgE on mast cells. Mast cells release chemical mediators which create cell and tissue injury in an attempt to destroy the pathogen, this process is called degranulation.
Some chemical mediators released are histamine, which causes smooth muscle constriction, and bradykinin which causes vasodilation and bronchoconstriction. At the end of the early phase there is a narrowing of the airway, bronchospasm, mucosal edema, and increased amounts of mucosal secretions along with airway obstruction with extreme cases (Brashers & Heuter, 2020).
The late phase of asthma occurs at least 4-8 hours after initial exposure. In this phase leukotrienes are released, causing prolonged smooth muscle contraction. Eosinophils destroy fibroblasts, which are the cells that create fibrosis tissue. This leads to airway scarring and damage to cilia which eventually causes airway remodeling.
This airway remodeling causes airway obstruction due to the decreased ability of cilia to remove forgien matter and decreased airway compliance. The result is impaired expiration, increased airflow resistance, and uneven distribution of air. These factors are contributing to the patient having tachypnea of 32 breaths a minute, tachycardia, the use of accessory muscles and expiratory wheezes. (Brashers & Heuter, 2020).
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Pneumonia would be ruled out in this scenario because this patient is young and he is at decreased risk of pneumonia compared to older adults. Pneumonia occurs when a bacteria or virus enters the respiratory tract and is unable to be removed by coughing, cilla clearance or alveolar macrophages. Most commonly the signs and symptoms of pneumonia include crackles, productive cough, malaise and dyspnea.
COVID-19 would also be ruled out in this patient because children usually manifested symptoms such as rhinorrhea, headache, and fatigue when diagnosed with COVID-19 (Molteni et al., 2022). No matter the potential diagnosis a chest x ray and labs will need to be obtained. To rule out COVID-19 a respiratory nasal swab is warranted and to actually diagnose asthma a pulmonary function test will be performed with attention on peak flow meter readingsa before and after treatment.
References
Brashers,V.L., & Heuter, S.E. (2020). Alterations of pulmonary function. In S.E. Huether, K.L. McCance, V.L. Brashers & N.S. Rote (Eds.), Understanding pathophysiology (7th ed., pp. 670-696). Elsevier.
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