Reference no: EM133380243
Case Study: Jerome is sitting in his athletic training suite just after a strenuous workout for the football team. He moved from Southern California to play football at Northern Minnesota University (NMU) after being recruited by the university. He was really doing well during practices for the team. Then Jerome came down with a miserable cold. The cold rans its course and he soon recovered. Now, however, he has this lingering dry cough and has difficulty catching his breath any time he exerts himself - a daily occurrence while on the football team! As football season approached and the weather turned colder, Jerome noticed his coughing "fits" were causing shortness of breath. To make things even worse, Jerome feels and looks like he's out of shape. The football coach is concerned.
Jerome takes time to tell the head athletic trainer at NMU about his cough. "I'm thinking my cold is coming back or something else is wrong with me. When I'm just handing out, I feel fine. But as soon as I start football practice, I get winded and can't stop coughing." The head trainer listened to Jerome's breathing sounds with his stethoscope. The athletic trainer listens to Jerome's breathing, noting a wheeze in between coughs. The team physician, Dr. Pauling, happens to be there and performs a complete physical exam. He also does pulmonary function tests with Jerome using spirometry, including a forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). He instructs Jerome to take a maximal inhalation and then exhale as forcefully and maximally as possible into the spirometer.
Based on his findings, Dr. Pauling tells Jerome he is experiencing cold-induced asthma which is made worse when he exercises. When Jerome exercises in the cold autumn afternoons of Minnesota, his airways temporarily constrict, causing the wheezing, coughing and shortness of breath. "This type of asthma is almost always a reversible condition," says Dr. Pauling. He then prescribes two puffs of an inhaler to be used 10 minutes before a bout of exercise in the cold.
The doctor explains to Jerome that his recent upper respiratory infection probably inflamed his airways, making them hypersensitive and reactive to irritants such as cold and physical exertion.
Questions: Short Answer Questions:
1. Asthma can be triggered by factors in the body (intrinsic) or by factors from outside the body(extrinsic). From the case history above, where are Jerome's triggers coming from?
2. Is this a hypersensitivity response? Explain your answer.
3. Describe the normal mucosal lining of the conducting airways. How has this lining changed in Jerome's case?
4. There are three important physical factors that influence the efficiency of pulmonary ventilation. Name and briefly describe each factor.
5. Which one of the physical factors is affecting Jerome's efficiency of breathing?
6. There are three pressures that must be maintained appropriately for normal pulmonary ventilation. Name and briefly describe each pressure.
7. What does Jerome have to do to maintain air flow during inhalation when he is having one of his asthma attacks? Describe what must happen to his intrapulmonary pressure and in what way(s) can Jerome make the change in intrapulmonary pressure. Remember, Jerome hasn't yet been prescribed any medications to alleviate his symptoms.
8. When Jerome is experiencing an asthma attack, his forced vital capacity (FVC) is 63% and his FEV1 is 62%. Are these values normal? Knowing how one performs FVC tests, describe these two test results in Jerome's case. (Assume that Dr. Pauling performed an accurate test.)
9. Albuterol is a selective beta-2 adrenergic agonist which means it specifically activates beta-2 adrenergic receptors on smooth muscle in the airways. What are adrenergic receptors and what neurotransmitter binds to these type of receptors?
10. In what ways does albuterol improve Jerome's asthma?