The pulmonary pathophysiologic processes that result in the patient presenting these symptoms.
• The pulmonary pathophysiologic processes that result in the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.
Scenario: A 16-year-old black female presents with her mother to the emergency room with complaints of dyspnea and wheezing without relief after using her albuterol inhaler. The patient was diagnosed with COVID 6 days ago and started noticing that her breathing effort was getting harder in the last 2 days. She reports a fever of 101F originally but has not had a fever in the last 24 hours. She denies any chest pain but is having some increased dyspnea when she is walking around. The patient has a 5-year history of intermittent asthma which has been controlled with her current medication. The patient is currently using loratadine 10mg po daily, singular 10mg at bedtime, and albuterol 2 puffs via inhalation every 6 hrs. as needed. She reports that she had to use multiple doses in the last 24 hours because her symptoms were worsening. VS: BP 132/88, pulse 120, respirations 28, O2 sat 94%, and temp 99.4F. Upon exam the patient has diffuse wheezing bilaterally on expiration and minimal upon inspiration. Breath sounds are diminished bilaterally. Chest x-ray reveals hyperinflation with no infiltrates.
Pulmonary Pathophysiology in the Presented Case
This 16-year-old Black female with asthma is experiencing an exacerbation likely due to a combination of factors related to her recent COVID-1 infection and underlying asthma. Here's a breakdown of the relevant processes:
COVID-19 and Lung Injury:
- Viral Infection: The SARS-CoV-2 virus can directly infect airway epithelial cells, causing inflammation and damage.
- Increased Mucus Production: Inflammation can lead to increased mucus production, making it harder to breathe (dyspnea).
- Immune Response: The body's immune response to the virus can contribute to inflammation and airway narrowing.
- Microvascular Dysfunction: COVID-19 can damage small blood vessels in the lungs, further hindering oxygen exchange.
- Hypersensitivity: In asthma, the airways are hypersensitive to triggers, leading to inflammation and bronchoconstriction (narrowing).
- Viral Infection: Viral infections, like COVID-19, are common triggers for asthma exacerbations.
- Airway Inflammation: Inflammation from both COVID-19 and asthma can worsen bronchoconstriction and airflow limitation.
- Mucus Hypersecretion: Similar to COVID-19, asthma can increase mucus production, further obstructing airways.
- More severe asthma: Black individuals are more likely to have uncontrolled asthma and experience more frequent exacerbations.
- Socioeconomic factors: Social determinants of health, like access to healthcare and quality housing, can impact asthma management in Black communities.
- COVID-19 infection sensitizes the airways, making them more susceptible to asthma triggers.
- Increased inflammation from both conditions worsens bronchoconstriction and reduces airflow.
- Mucus production from both COVID-19 and asthma creates additional airway obstruction.
- While the chest x-ray doesn't show infiltrates (fluid in the lungs), which can occur with COVID-19 pneumonia, it doesn't rule out COVID-19 involvement.
- Although her fever has subsided, the patient's respiratory symptoms require further evaluation and treatment to prevent a potentially life-threatening asthma attack.