A patient who has been feeling more anxious since the recent and unexpected death of his wife is experiencing an acute asthma attack. Rank the following events in the most likely order of occurrence
Choice 1. The patient states, "I feel like my throat is closing off and I can't breathe very well."
Choice 2. The patient is allergic to aspirin but unknowingly ingested a product with aspirin among its ingredients.
Choice 3. The patient's respiratory rate is 32 breaths per minute and his oxygen saturation level falls from 94% to 89%.
Choice 4. Inflammatory mediators are released and inflammatory cells are activated.
Choice 5. The patient is taken to the hospital via an ambulance and treated with medication.
Correct Answer: 2, 4, 1, 3, 5
Aspirin-containing products are a common pharmacologic trigger for acute asthma attacks. When a trigger is present, an acute or early response develops in the hyperreactive airways predisposed to bronchospasm. Sensitized mast cells in the bronchial mucosa release inflammatory mediators such as histamine, prostaglandins, and leukotrienes. These events lead to bronchoconstriction, airway edema, and impaired mucociliary clearance. Airway narrowing limits airflow and increases the work of breathing; trapped air mixes with inhaled air, impairing gas exchange. Hospitalization may be required to prevent the complications of an asthma attack, which include acute respiratory failure, dehydration, respiratory infection, atelectasis, pneumothorax, and cor pulmonale.
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