Asthma Case Study

There are a range of different forms varying in relation to the need of the patient. If the patient is in need of quick relief, the physician may prescribe inhaled short-acting beta2-agonists. This medicine acts quickly to relax tight muscles around airways during an asthma attack. Inhaled corticosteroids are preferred for long term asthma control. These are the most effective option for long-term relief of swelling, inflammation and sensitivity. This is not the only long-term control medicine option though. There are others with the same desired goals such as inhaled long-acting beta2-agonists, leukotriene modifiers, theophylline, cromolyn, and omalizumab. These are generally not as effective as inhaled corticosteroids, which are believed to be the main reason for great improvements in asthma management since the early 1980s (“What is Asthma” and Horne). Asthma management is also very dependent on the patient and their knowledge, skills, and confidence in knowing when to take the medication. If taken too late, the patient may still need hospitalization, whereas if taken too often when not needed, the patient may grow immunity to the drug, or become dependent on it

Murk, W., Risnes, K. R., & Bracken, M. B. (2011). Prenatal or early-life exposure to antibiotics and risk of childhood asthma: A systematic review. Pediatrics, 127(6), 1125-1138

A 17 indicates her asthma “may not be controlled as well as it could be”.

I have caught up with Lesley-Anne eight months since the last appointment. In the last couple of months she has had a dry cough with some breathlessness, but no obvious wheeze. She is also experiencing some right upper quadrant pain and following the onset of the cough, has developed right lateral chest wall pain with tenderness. I gather she had an injection in the left side, possibly to treat costochondritis.

History of Present Illness: I last evaluated Ms. Dall at the end of June for a chronic cough. She had previously been given the diagnosis of COPD, as she is a 240 pack-year smoker who continues to smoke. She states that her cough is similar to when she has last seen me as previously believed she had an acute viral illness that led to her persistent cough She does have some shortness of breath which is stable, but worse on hot, humid days like today. Once again, she is smoking up to a pack to two packs a day and she does not have any interest, at this point, in quitting.

Respiratory: Lungs sounds clear throughout. Respiration even and unlabored. Chest wall symmetrical. Patient is a smoker.

From the information gathered from the case study above, SE asthma is not well controlled because, she has been using her albuterol metered- dose inhaler approximately three to four days a week over the last two months. She has been awakened by cough three nights during the last month. She has shortness of breath during exercise, which does not usually occur to her during exercise. She has been hospitalized two times in the last year due to her asthma exacerbation and SE has visited the emergency department six times for the past six months due to asthma symptoms and exacerbation

Thorax and Lungs: Lungs sound: clear. Symmetric chest expansion. Tactile fremitus: bilaterally equal. Respirations: 16. Breath sounds: clear. No resonance, tympani or consolidation present. 1:2 diameters. No wheezing or stridor. No history of lung disease. No chest pain, No wheezing or shortness of breath.

Thank you for arranging a CT chest scan that reveals extensive emphysematous change with lower zone bronchiectasis but no active infective changes. I gather Rod has also had a stress echocardiogram, the results of which were not available today.

The patient is a sixty-seven-year-old Somali female, whom will be referred to as Jane. Jane initially presented to the emergency room with shortness of breath, fever, tachycardia, and a persistent cough. She has a history of tachycardia and asthma. The goal for the treatment of this patient was to rule out avian flu, and to manage her tachycardia and asthma.

I am also suspicious that she is struggling with eustachian tube dysfunction. We talked about treatments. We briefly discussed the idea of antibiotics, but at this point, my suspicion is this is still more viral. She is aware of what to be watching for and knows to call me if there is not improvement here through the course of the rest of the week or into early next week. We talked about good hand hygiene to avoid new illness or spread to others. One of her biggest complaints is just coughing at night and keeping her awake. I did write her for Tussionex cough syrup 5 mL twice daily p.r.n. four ounces with no refills. She is aware of side effects and is aware of sedation, in particular. She will not take it if she is driving or with any other sedating medication. She will monitor her symptoms, in the interim. She will continue with her Flonase and if there is no improvement here into next week or so, consideration for antibiotics can be done. If there is acute worsening in her respiratory status or other concerns, she will seek care if necessary and will otherwise follow up as needed with Dr. Lilly. All questions answered in the office

The patient does have asthma. She uses albuterol intermittently. She tells me she really cannot remember the last time she used it and thinks it is approximately a month to six weeks ago. She is typically bothered more with her asthma when allergies are bad and she is getting into her more of her allergy season come the fall time. She is also allergic to cats and she has made the decision to keep her cats out of her home and her bedroom, specifically, which also helps with her asthma. She feels as though her breathing currently is okay and does not need a refill of that medication today. When the patient does find her allergies are increased, she tells me sometimes she will use her husband Veramyst. She, herself has never tried anything, but has heard of other nasal corticosteroids and wonders if I think that this is a good idea.

This 51 years old African-American came to the clinic with a five-day history of a cough and shortness of breath. Cough is productive/clear and usually gets worse at night when the patient is lying down. He explained that he has observed some wheezing and that his chest feels tight. He has a low-grade fever of 99.5, but with no chills. He is worried that he may be having pneumonia. He has tried over the counter cough medication without any relief. He denies any edema, but reports SOB with exertion after walking for a short while. She has a history of well-controlled

The patient is a 69-year-old woman who has COPD, and asthmatic bronchitis; who presents for evaluation of increasing shortness of breath, cough, and increased sinus congestion and pressure. She has been on steroids because of exacerbation of asthma now for some time, is actually on 40 mg daily. In spite of this she notes ongoing wheezing, and shortness of breath when doing her exercise tolerance. She has had no high fevers, no localized chest pain. She is using her inhalers as prescribed. Others at time in [Place] have also had an upper respiratory illness. She wanted to make sure she would not need antibiotics. She has had some facial pain, that seems to better today. She had some yellow discharge that now seems to be clear. The patient did

According to the case study, Tegan is most likely to suffer from extrinsic or atopic asthma. As per current symptoms, it was a moderate seizure. Tegan was just six years old and extrinsic asthma is generally associated with childhood asthma. Tegan’s mother had the history of allergy, sinusitis and nasal polyps. People who have a family history of allergies are at more risk for extrinsic asthma (Sheikh, Pitts, Ryan-Wenger, McCoy & Hayes, 2016). Therefore, Tegan is at greater risk of atopic asthma. Initial symptoms of atopic asthma are driven by allergen exposure which may lead to increased airway inflammation which can sometimes even persist and progress in the absence of allergen (Agache, Akdis, Jutel & Virchow, 2012). Similarly,