Emmа Hаrtsfield: Initiаl Pоst оn Asthma Intrоduction “Asthma is characterized as a chronic inflammatory disease that is shown through hyperreactiveness of the airway, airflow obstruction, and persistence.” (Borrelli et al., 2025) The disease is reversible and affects millions of people worldwide, so it is important to understand it fully. Etiology and Genetic Risk Asthma has multiple etiologies and is deemed a multifactorial or heterogeneous disease, meaning it can fester in a variety of ways. (Capriotti, 2024) (O’Keefe, Connors, Ling, & Kim, 2025) “The most common etiology of asthma is allergy (also called atopy), which includes a variety of environmental hypersensitivities such as exhaust fumes, perfumes, pollen, grasses, flowers, dust, smoke, animal dander, molds, and spores.” Indoor allergens include animal dander and other parts of the animal, such as hair, saliva, and skin (which is widespread in children). Air pollution due to the urbanization of the Earth has contributed to the cause and development of asthma. The pollutants generally come from cars and other fossil fuels, where children of low income have shown a higher risk of these effects. Viral infections that occur in the lungs are common asthma triggers. Many asthma attacks in children are caused by viral infections. Additionally, asthma attacks can lead to acute bronchitis and bronchospasms in adults. “GERD (gastroesophageal reflux disease) and AERD (aspirin exacerbated respiratory disease)” are also common triggers. Asthma can also be silent in some individuals and only show when they exercise. (Capriotti, 2024) Furthermore, asthma has several genetic components. “There are sex related differences in asthma; in females, the inflammatory response is amplified due to the X chromosome because it harbors immune-regulatory genes. Estrogen in females has been shown to enhance type 2 inflammation and contributes to increased asthma severity, whereas testosterone appears to have a more protective effect.” (Borrelli et al., 2025) There are genes that are associated with the development of asthma; on chromosome 17, the locus 17q21, contains several genes that associate with early onset/childhood asthma. (Capriotti, 2024) Clinical Presentation and Signs/Symptoms A doctor should assess the severity of asthma and be sure to get an adequate history of his or her asthma. Family history and a history of childhood asthma are important to know to determine the treatment for the patient. (Capriotti, 2024) The shortening of smooth muscle in the airway causes the airway to narrow, which in turn evokes wheezing, chest tightness, cough, and dyspnea. (McDuffie, Panettieri, & Scott, 2024) A patient's symptoms may vary depending on the severity of hyperresponsiveness or reversibility of whatever is obstructing the airway. Patients may not be able to get but one or two words out before having to take another breath. A patient may also go into respiratory failure, which is shown by inaudible breath sounds and a constant hacking cough. Rhonchi may be present, and when asthma is related to allergies, nasal edema, eczema, nasal polyps, and oropharyngeal erythema may be present. (Capriotti, 2024) Diagnosis “Asthma is based on both a clinical history, physical examination, laboratory findings, and PFTs;” there is no “gold standard test” to diagnose asthma. A physical exam can be done; however, since asthma is multifactorial, a physical finding may present when the patient is showing symptoms. Furthermore, the absence of symptoms rules out the patient having asthma. The most common finding is wheezing after auscultation (listening) of the lungs. “Spirometry (PFT) measures a patient’s forced expiratory volume in one second (FEV) and forced vital capacity (FVC) and determines the severity of the asthma.” In children 1-5 years of age, a documentation of wheezing and other airflow signs should be documented, and given corticosteroids and SABA (short-acting beta agonist: inhaler). In children over 6 years, a spirometry should be done, and a bronchodilator should be administered after, and both results should be documented to find out the severity. The diagnosis of asthma should be considered if there is an increase in FEV after a bronchodilator there is a greater than 12% in FEC. In patients 18 years or older, spirometry should be done, and a diagnosis is shown if there is an increase of FEC of 12% or more and at least 200mL after inhaling the SABA (Inhaler). In patients where a PT may not be able to be performed, the addition of fractional exhaled nitric oxide or FeNNO can also be used to diagnose asthma and “is an adjunct to the evaluation process.” (This test is typically done in people ages 5 years and older) (O’Keefe, Connors, Ling, & Kim, 2025) (Capriotti, 2024) Treatment/Management The goal when treating asthma is to control it and to reach the best possible outcomes for each individual. Asthma is typically treated or managed in a stepwise approach, meaning that each step of treatment should include educating the patient, controlling environmental factors, care of comorbidities (presence of more than one health condition), and medication. In the stepwise treatment, based on the results, the patient may move up a step, or they may move down a step as needed. It is important to determine the allergens that affect individuals with allergy-induced asthma, so that whatever they are allergic to, they can avoid it, if possible. Allergen immunotherapy may also help with allergic asthma. Allergen immunotherapy, or AIT, involves a patient going to the doctor several times to administer minute amounts of their allergen by injection to “desensitize the individual” to their allergen. SLIT or sublingual immunotherapy is the same process but without injections. In the treatment of asthma, medications typically fall into two categories: controllers and relievers. Controllers are medications that are taken long-term or daily and typically have anti-inflammatory effects to control asthma. Relievers are medications that are used as-needed for quick relief of bronchoconstriction.” Inhalers are commonly prescribed, with many of them containing a combination of formoterol (LABA: long-acting adrenergic beta-2 agonist) and ICS (inhaled corticosteroids), which are used for maintenance therapy of asthma. In addition to stepwise treatment, the Global Initiative for Asthma recommends treatment in terms of two tracks. Track 1 is low-dose ICS-formoterol as the rescue and reliever medication (track 1 is generally the preferred route). Track 2 has SABA (as mentioned in the diagnosis section) as the rescue and reliever medication (not the preferred route). Track 2 is recommended when Track 1 is not possible, or the patient has good treatment results showing with their controller, and “has not had any exacerbations in the last 12 months.” SABA is not recommended because it has shown results leading to reduced bronchodilation response and increased allergic responses. As mentioned above, it is important to educate your patient so that they are using their inhalers efficiently and correctly (demonstration of the technique for using the inhaler is recommended). A spacer device is given to the patient to ensure proper delivery of the inhaler (especially in children). “In patients who have severe and persistent asthma that is not being helped with medication, bronchial thermoplasty, performed with a bronchoscope, uses a wire probe to deliver heat to the airway and decrease the smooth muscle that is constricting the patient's airway.” (O’Keefe, Connors, Ling, & Kim, 2025) (Capriotti, 2024) Complications Asthma is one of those diseases that can lead to several different complications (especially in the respiratory system). Status asthmaticus is an underlying condition that is defined by persistent bronchoconstriction that remains despite attempts to treat the attacks. “Pulmonary gas exchange is diminished by the uneven distribution of ventilation because of the bronchoconstriction…This can lead to a ventilation-perfusion mismatch; areas that are ventilated in the lung are not getting enough perfusion.” Thus, there is insufficient oxygenation to the bloodstream. On the other hand, there can be circulation but no ventilation; in this condition, if the bronchoconstriction is not relieved, the patient will become exhausted. The patient may also become dehydrated, and this can lead to total alveolar ventilation failure, and the patient may present with cyanosis (blue or purple discoloration of the skin showing signs of bad perfusion in the blood). This condition is life-threatening, so it is important to catch asthma in patients as soon as possible. (Capriotti, 2024) Conclusion “Asthma is a common disease that affects more than 300 million people worldwide, including 25 million Americans.” Patients will present with a persistent cough, wheezing, chest tightness, and shortness of breath, and are generally diagnosed through PFT’s (spirometry). Allergy testing is also preferred for those with allergic-type asthma. In treating asthma, it can be controlled through stepwise treatments and medications (controller and reliever). Inhaled corticosteroids and formoterol are typically combined to help. When asthma is difficult to control, different tracks are recommended (track 1 being the most recommended), and combinations of certain inhalers and therapies are typically recommended to give additional control. If not assessed carefully and correctly, a patient can develop complications with asthma, such as status asthmaticus, which is threatening to life. Thus, management of asthma is critical to preventing any further severe outcomes. (O’Keefe, Connors, Ling, & Kim, 2025) (Capriotti, 2024). References McDuffie, E. L., Panettieri, R. A., & Scott, C. P. (2024). G12/13 signaling in asthma. Respiratory Research, 25(1), 295. https://doi.org/10.1186/s12931-024-02920-0Links to an external site. Borrelli, R., Brussino, L., Lo Sardo, L., Quinternetto, A., Vitali, I., Bagnasco, D., Boem, M., Corradi, F., Badiu, I., Negrini, S., & Nicola, S. (2025). Sex-Based Differences in Asthma: Pathophysiology, Hormonal Influence, and Genetic Mechanisms. International Journal of Molecular Sciences, 26(11). https://doi.org/10.3390/ijms26115288Links to an external site. O’Keefe, A., Connors, L., Ling, L., & Kim, H. (2025). Asthma. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 20(Suppl 3), 81. https://doi.org/10.1186/s13223-025-00949-4Links to an external site. Capriotti, T. (2024). Davis Advantage For Pathophysiology: Introductory Concepts and Clinical Perspectives (3rd ed.). F.A. Davis Company
Which оf the fоllоwing is chаrаcteristic of people with obsessive-compulsive personаlity disorder?
While Phil wаs reаding the chаpter оn persоnality disоrders, he reflected on his 26 years of life and saw so many patterns and evidence that seemed to prove to him that he probably suffers from obsessive compulsive personality disorder, schizotypal personality disorder, and avoidant personality disorder. He may even have a few more disorders that he hasn’t figured out yet. It is most likely that Phil is experiencing: