Caleb is 9 years old and an avid wrestler Whenever he visits

Caleb is 9 years old and an avid wrestler. Whenever he visits relatives and plays with their dogs he ends up in the hospital with an acute asthma attack.

1)Explain why Caleb has no difficulty wrestling but experiences asthmatic episodes when playing with dogs?

2)Describe the pathophysiology which occurs with the exposure?

3)What precautions you would take if ever working with Caleb?

4)What would your management plan be if Caleb began having an asthma attack in your presence?

5)Why would a bronchodilator be helpful in treating Caleb?

Solution

1). Caleb is experiencing an asthmatic attack only when playing with dogs because the dog\'s fur is allergic to some people. She is able to do wrestling without difficulty because she has no exercise induced asthma.

2).

Pathophysiology: Asthma caused due to persistent subacute inflammation of the airways. The clinical features and physiology of the asthma is due to interaction of the infiltrating and resident inflammatory cells, inflammatory mediators and cytokines with the airway surface epithelium.

Due to the inhalation of the allergens or due to luminal stimuli, Inflammatory mediators (endothelin-1, PGE2, 15-HETE), Cytokines (GM-CSF, IL-8, RANTES) and growth factors (EGF, IGF-1, PDGF) are released. Endothelin-1 causes bronchoconstriction. PGE2, PGI2, 15-HETE results in vasodilation. Cytokines causes inflammation and growth factors causes fibrosis and smooth muscle hyperplasia.

Inflammatory response during the immediate phase asthma: Allergen stimulates mast cells and mononuclear cells -à Releases spasmogens such as prostaglandins, leukotrienes (LTC4, LTD4 and LTE4) and histamine. Also, chemokines and chemotaxins are released. Results in bronchospasm. The immediate phase symptoms can be effectively relieved by adrenergic beta-2 receptor agonists (salbutamol).