Part I—The Grandparents Arrive

Dave pulled the cell phone out of his pocket, cursing himself for not putting it on vibrate. The children, Jason and Laura, were both asleep, and he knew that the rest of the day would not be fun if they were awakened from their naps.

“Hi, Dave. We’re just a few minutes away,” said his father.

“OK, see you soon.”

Dave looked at his wife Jen, who smiled. “Come now, Dave, you know your Mom and Dad. There’s no stopping them once they get going; driving 1200 miles in one day. I guess they’re impatient to see their granddaughter. Mom never got over the fact that her hip replacement was scheduled at the same time that Laura was born.”

“I know, Jen. She takes being the only grandmother very seriously.”

A car pulled into the driveway and Dave and Jen went out to greet their visitors. They all crept into the house and sat in the kitchen quietly drinking coffee. His mother was breathing heavily, which made Dave recall his childhood and what it had been like to grow up with an asthmatic mother.

“Hi Grandpa,” said Jason, as he ran into the kitchen in his pajamas.

“Hi, big guy. Wow, you’ve grown. How old are you, now?”

Jason smiled as he held up four fingers. He extended both arms so that his grandfather could lift him onto his lap. He stood on his grandfather’s legs and looked over his shoulder for presents.

Everything stopped when they heard crying from upstairs.

“Let’s wait and see if she goes back to sleep.”

They all sat quietly, but the crying got worse. Both women stood up.

“I’ll get her, Mom. She is beginning to recognize faces, and I don’t want to start you off on the wrong foot.”

“Come on, buddy, let’s go out to the car and see what we brought you from Florida.”

Dave watched his father and son walking hand-in-hand out the front door, as his wife and daughter come into the kitchen. His mother’s arms went out and he could see the pleasure in her eyes when she held her granddaughter. Laura was holding a stuffed toy bear in her arms.

“My goodness, is that your old bear, Dave?”

“Yes. We found it in one of the boxes you gave me, and Laura latched onto it. It’s a bit dusty, but we’ve been afraid to wash it because it may fall apart.”

Laura giggled as her grandmother cooed to her while carrying her around the kitchen.

“Should you be doing that?” Dave asked his mother. “With your hip and all.”

“I’m fine, just a little breathless. Guess I’m a little out of shape for babies.”

She gave Laura back to her mother and sat down. Her breathing was labored, and Dave recognized the signs of an oncoming asthma attack. He rushed to the door and shouted to his father to get the nebulizer.

Dave could hear his mother’s wheezing as she tried to breathe out. He never understood why it was more difficult for asthmatics to breathe out than breathe in, and why exhaling took so much longer than inhaling. His father calmly placed the liquid medicine into the nebulizer cup, plugged in the machine, and turned on the compressor. He helped his wife hold the mask to her face.

Soon, her breathing was regular; deeper than normal, but regular.

Jen noticed that Jason was alarmed, and she wondered whether he had forgotten that his grandmother had had some attacks during their last visit.

“It’s okay, Jason,” she said. “Grandma sometimes has a problem with her breathing. But you can see that her medicine makes her better quickly.”

Jason looked relieved and smiled.

Questions

1. What factors can trigger an asthmatic episode?
2. What do you think triggered the asthmatic episode in this case?
3. Imagine that you are performing a lab in which you are monitoring breathing in a student volunteer. Draw a graph, with time on the horizontal axis and breathing movements on the vertical axis. Draw a line to show the results you would expect for a healthy student, assuming that inhaling produces an upward deflection of the line and exhaling produces a downward deflection of the line.
4. Draw a second line to show the results you would expect from someone having an asthmatic episode. Pay close attention to the slopes of the lines (the rate of air movement) and the amplitude of the waves (the amount of air flowing in and out of the lung during each breath).
5. Which of the airways (trachea, bronchi, and bronchioles) do not contain rings of cartilage, and are therefore more likely to collapse?
6. Why is air flow restricted during an asthmatic episode?
7. Why is wheezing usually worse when asthmatics exhale?

Date Posted: December 30, 2008.

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