(Answered) Emmanuel and his mother live in an urban community housing complex

(Answered) Emmanuel and his mother live in an urban community housing complex

(Answered) Emmanuel and his mother live in an urban community housing complex 150 150 Prisc

Emmanuel and his mother live in an urban community housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Emmanuel is 5 years of age and has suffered from asthma for the last 2 years. One evening, his mother poured him some milk and put him to bed. Shortly afterward, Emmanuel woke up wheezing and coughing. As he gasped for air, he became more and more anxious. His mother ran for his inhaler, but he was too upset and restless to use it. Emmanuel’s skin became moist with sweat, and as he began to tire, his wheezing became quieter. His mother called 911 and waited anxiously for the ambulance to arrive.
Why does someone with severe asthma become physically fatigued during a prolonged attack? What are the physiological events that occur during an attack?
One of the complications of respiratory fatigue is the development of hypercapnia. How does the body compensate for an increase in CO2? What are the effects of hypercapnia on the central nervous system?

Sample Answer

Why Does Someone with Severe Asthma Become Physically Fatigued During A Prolonged Attack

During an asthma exacerbation, also referred to as an asthma attack, the airways of an individual become inflamed and swollen. The airway muscles contract and produce mucus resulting in narrowing of the bronchial tubes. During the attack, the body works hard to breathe, resulting in fatigue. The body struggles to compensate and supply more oxygenated blood from the lungs to the other parts of the body results in fatigue. The body may also become weak and fatigued due to constant wheezing during the flare-up and persistent bouts of coughing characterized by the use of accessory muscles. Labored breathing and shortness of breath can be exhausting, especially when it occurs in a prolonged period. Fatigue can also be a sign of low oxygen levels in the body that occurs during the attack (Van Herck, et al., 2018). Severe asthma is usually common at night and is associated with exposure to allergens, being in a reclining position, and cooling the airways. In Emmanuel’s case, fatigue would be linked to labored breathing as he woke up and became anxious, restless, and upset.

The Physiological Events That Occur During an Attack

The abnormal response of the immune system to certain triggers is the heart of respiratory symptoms linked to asthma. The immune system of the body releases chemicals into the bloodstream when a person is exposed to certain triggers causing the lung to function abnormally. The response of the lungs is characterized by the tightening of muscles around the airways resulting in less air entering into the lungs. The tightening of the muscles is referred to as bronchoconstriction. Excess mucus is produced, clogging the air passages. The air passages also become inflamed. These psychological events result in coughing, wheezing, shortness of breath, chest tightness, symptoms experienced during an asthmatic attack (Sinyor & Perez, 2020).

The autonomic nervous system, which is responsible for reflexes, regulates the size of the air passages. The system achieves that by releasing a chemical known as acetylcholine. The nerve endings release acetylcholine when stimulated by cold air, dust, or other asthma triggers. The chemical acts on the cells of smooth lung muscles resulting in bronchial spasm. Inflammation, on the other hand, is caused by a different process that involves an antigen-presenting cell (APC), a cell that determines the safety of the body in the presence of any foreign particle. In a person with asthma, the cell mistakenly identifies certain particles as threats resulting in the transformation of the cell to a defensive cell referred to as TH2. The defensive cell signals the immune system for defense, resulting in inflammation. Inflammation in the absence of a disease results in the overproduction of mucus due to enlargement of mucosal cells, thickening of air paths leading to restriction of airflow, and hyperreactivity of the tissues around the airways triggering further spasms (Sinyor & Perez, 2020). If not properly treated, the events can result in airway remodeling, which refers to permanent and irreversible damages caused by progressive scarring of the lung tissues (King, et al., 2018).

How The Body Compensate for an Increase in CO2

Hypercapnia refers to a situation where the level of CO2 in the arteries becomes elevated due to inadequate alveolar gas exchange in individuals with chronic and severe acute lung diseases, including asthma. Hypercapnia in a patient with asthma indicates a more severe airflow obstruction. The PH modulating impact of hypercapnia can be reduced through reabsorption of bicarbonate in the kidneys. The COdissolved in the bloodstream is neutralized by the bicarbonate to form carbonic acid, a weak acid. During acute hypercapnia, the shielding capacity of the blood is not adequate to handle high levels of CO2, leading to acute respiratory acidosis. Hypercapnia results in an increase in airway contractility, promote adipogenesis, and impairment of innate immune response (Shigemura, Homma, & Sznajder, 2020).

The Effects of Hypercapnia on The Central Nervous System

Hypercapnia activates a series of adaptive mechanisms in vital organs such as the heart and the brain for the preservation of tissue oxygenation and perfusion. Hypercapnia can result in cerebrovascular vasodilatation resulting in a rise in intracranial pressure by increasing the volume of blood in the brain. There have been reports of patients with asthma developing subarachnoid hemorrhage and cerebral edema (Shigemura, Homma, & Sznajder, 2020). Myocardial response to the condition is characterized by an impairment in contractility as a result of acute respiratory acidosis. A severe asthma attack is associated with untreated asthma, which increases the risk of the adverse impact of asthmatic patients.


Asthma can be managed using rescue inhalers such as controller inhalers and others depending on how recommended by the health care provider. Acute asthmatic attacks may have a negative impact on the body, especially the central nervous system. A condition referred to as hypercapnia results from a severe asthmatic attack and is characterized by increased levels of CO2.  The body compensates for increased levels of CO2 through the reabsorption of bicarbonate through the kidney.