Answer

Asthma is the leading cause of chronic respiratory conditions that changes the respiratory function of the body. As indicated by Asthma and Allergy Foundation of America (2012), the World Health Organization defines asthma as an inflammatory disease of the airways that is characterized by episodes of wheezing and breathlessness. The difficulty in breathing is attributed to the constricting and swelling of the airways. Exposure to pollutants, cold air, allergens, infection, and exercise all can increase the risk of asthma victims to have an attack (Asthma and Allergy Foundation of America, 2012). This essay will discuss the pathophysiology mechanisms of acute and chronic asthma exacerbation, diagnosis, medical management, as well as clinical manifestations of asthma based on the gender factor. Asthma is an important cause of chronic disease in young children, which is both upsetting and life threatening. According to Briscoe (2012), asthma patients often have frequent visits to the Emergency Department of the hospitals. Therefore, early diagnosis, prevention as well as the long-term treatment is essential to prevent the frequent asthma attacks.

According to Patel (2013), uncontrolled Asthma is associated with the reduction of quality and quantity of sleep caused by the onset of asthma symptoms during the night. The patterns of airway inflammation are allergen-specific and extremely complex. Detection of an allergen by the body initiates a Th-2-mediated immunoglobulin E respiratory response that generates an inflammatory reaction that results in airway inflammation, constriction of small airways with mucus, as well as bronchial hyper reactivity. Collectively, these processes contribute significantly to airway obstruction characteristic of asthma exacerbations. Airway inflammation results to airway hyper reactivity and swollen bronchial membranes that lead to bronchospasm. Both of these processes lead to contracted airways (Huether & McCance, 2012). In addition, mucus discharge leads to occluded airways and contributes further to obstruction of airflow. It is believed that the final stage is common to all inflammatory mechanisms, with vasoactive prostaglandins; histamine, leukotrienes, as well as other cellular mediators, have a role in pathogenesis.

Asthma exacerbations can be critical and in most cases require medical intervention, through either emergency department (ED) visit, an unscheduled visit to the doctor, admission to the hospital, or a hospital appointment. Children experience the most of ED attendances for asthma (63%). The ED attendance rates for asthma exacerbations in Australian children alone range between 35 and 240 visits/100 000 counts of the population. There is a significant seasonal deviation in the presentation to ED with severe asthma exacerbations, with a peak occurring in early summer in school age teens, coinciding with the return to school. For infants, the peak of asthma symptoms occurs in winter months. The above trends reflect variation in asthma exposures exacerbations and, given the pivotal role in asthma exacerbations in children, these trends infer specific viral transmission forms within the community (Briscoe, 2012).

Chronic asthma exacerbations may also result in death. Mathematically, most asthma attacks or episodes occur in the older age groups, but asthma is overrepresented as a cause of death in teenagers (Patel, 2013). Patel (2013) futher notes that the mortality rates from asthma are specifically higher in winter months, consistent with the rise in influenza infection that is linked with very severe asthma exacerbations. He found that influenza infection led to critical refractory asthma exacerbation often requiring ICU admission. The pathogenesis of asthma exacerbation causing mortality from asthma is multifactorial. There is frequently indication of airway inflammation, with the pattern of granulocyte response associated with the acuity of the episode. Rapid onset of fatal asthma typically shows a neutrophil infiltrate, whereas slower onset exacerbations have the main eosinophil infiltrate (Asthma and Allergy Foundation of America, 2012).

Glissman (2013) noted in his reseach that in recent years, there has been progress in understanding the pathophysiological mechanisms of respiratory gas exchange in bronchial asthma, which is through the information provided by the multiple inert gas elimination technique known as (MIGET). This is a vigorous tool for quantitative and qualitative assessment of the distribution of V'A/Q' ratios in the lung.  Of importance, MIGET provides a quantum leap forward to unravelling the complex interaction among the different intrapulmonary determinants, namely V'A/Q' imbalance increased intrapulmonary shunt and alveolar-to-end-capillary diffusion limitation to oxygen, and extra pulmonary determinants that include overall ventilation, cardiac output and oxygen consumption that modulate the physiological blood gas values in the medical sense. Presently, it is largely accepted that V'A/Q' mismatch is the pivotal mechanism causing abnormal arterial blood gas values, as the primary factor that controls the varying levels of arterial hypoxemia (Glissman, 2012). Carbon dioxide retention during ASA can in part be associated with V'A/Q' inequality, although it is more likely that alveolar hypoventilation related to respiratory muscle fatigue can also play a key role.

According to research by Patel (2013), women with asthma compared to men experience more impact and frequency of respiratory symptoms and often have asthma-related limitations in daily living. These differences have been the target of many studies, which investigate physiological, environmental, and psychological mechanisms related to asthma. For women, the higher prevalence of asthma during their reproductive years overlaps with increased bronchial hyper responsiveness. Approximately, about 20-40% of women with asthma echo worsening of their respiratory symptoms during the menstrual and premenstrual period  (Patel, 2013). The mechanism of deterioration of asthma during the menstrual cycle are still anonymous, but suggestions include increased mucous secretions, increased serum levels of progesterone, increased synthesis of prostaglandins during the premenstrual period, as well as the abnormal β2-adrenergic receptor regulation (Patel, 2013). Although the influence of endogenous estrogen on airways is yet to be evidently defined, exogenous hormones can affect asthma in women. The hormonal factor appears to be the key element to understanding the differences perceived between genders.

One of the justifications for the difference between genders can be attributed to the greater exposure of women to risk factors including household environmental factors as well as presence of pets in their houses. However, in the present study, there were no noteworthy gender differences in exposure to passive smoking as a child or at home, use of maintenance medication or presence of pets. Elderly people both males and females exposed to air pollution and showing airway hyperreactivity and high total IgE levels have been reported to have different responses to the same level of exposure (Samarasinghe et al., 2014).

In conclusion, it is of importance that health care professionals be cognizant of and understand the greater impairment in women than in men with asthma. Appropriate asthma management requires an ongoing partnership between the patient and her physician regarding physiological factors including pregnancy, sexual hormones, obesity, and depression as well as non-physiological factors including smoking and drug adherence. All of which can contribute to improvement in asthma control. Asthma-related risks are higher for women than for men, however, implementation of a specific management plan together with psychological support, can certainly help in reducing the burden of asthma on women.

Asthma Mind Map for Chronic Asthma/Acute Asthma Exacerbation

Mind map for acute asthma

Picture of chronic asthma showing the narrower bronchiole

Picture showing how the airways look during an episode of acute asthma

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