Dyspnea And Asthma Case Study

History of Present Illness: Ms. Dahlberg is a very pleasant 69-year-old woman who suffers from poorly controlled asthma. She has a recent exacerbation requiring hospitalization at Anna Jaques Hospital in June. Since discharge, she states that she has done well. She has stable dyspnea on exertion. She does feel that perhaps it might be slightly worse given the heat and humidity. She is not complaining of any cough. She is compliant with her bronchodilator regimen.

Task analysis is the process of obtaining information about a job by determining the duties, tasks, and activities involved and the knowledge, skills, and abilities required in performing each task. There can be broken down into six

History of Present Illness: Mr. Olson is a very pleasant 57-year-old gentleman with multiple medical problems to include severe COPD, who is here today for an initial consultation for his shortness of breath. He is followed by a pulmonologist Dr. William Goodman, at the Veteran Affairs Administration. His last evaluation there was in February 2015. Mr. Olson states he has had ongoing dyspnea on exertion over the last two years. He complains of minimal cough. He does note some sinus problems for which he is on Flovent. In the past, he has had pulmonary function testing that did demonstrate reversible airflow obstruction, therefore he likely has some component of asthma overlay. He states that occasionally has chest tightness and chest heaviness. He has gained about 25 pounds over the last year. He is currently using Spiriva, albuterol as needed as well as Symbicort. He is also using supplemental oxygen at 2.5L per minute at night as well as on an as needed basis during the day. Mr. Olson admits to continued tobacco use with about a half pack to a pack a day. He states that when he is feeling depressed, he will smoke more.

R.J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing.

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Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

History of Present Illness: Ms. Manock is a very pleasant 60-year-old woman with a history of severe COPD. She was previously seen by Elvira Aguila, MD. Her last office visit was in February 2015. Since that time, she states that over the last few weeks, she feels her dyspnea has worsened which is a result of increased humidity, which is normal for her. She has had a stable cough over the last six months, which is intermittently productive of sputum. She is using her supplemental oxygen at 2 L/minute with exertion and with sleep. She also notes postnasal drip, which is related to seasonal allergies.

History of Present Illness: Mr. Magnuson is a very pleasant 77-year-old gentleman who was previously seen in this office by Elvira Aguila, MD for COPD and hypoxic respiratory failure. He is here today for routine followed up. He was last evaluated in January 2015. Since that time, he states that his dyspnea is worse. He feels that it is related to the weather. He does state that he works around the house, although he does have significant functional limitations because of shortness of breath. His wife also confirms that he is able to do less and less. He has a stable, minimal cough. He is using 4L of oxygen at night as well as, as needed throughout the day. He continues to smoke three to four cigarettes on

History of Present Illness: Ms. Babula is a very pleasant 76-year-old woman who was previously seen in this office by Elvira Aguila, MD for moderate COPD by pulmonary function testing in 2010. She is currently on monotherapy with Atrovent p.r.n. and she has not used her bronchodilators for quite some time. She does have some stable dyspnea on exertion, which does not limit any of her activities. She does take care of an 18-month-old child as well. She denies any cough, though she does feel that she has some chest congestion in the morning. She denies any chest pain or wheezing.

An individual cannot predict when an asthma attack happens. They do not have the inhaler with them in an emergency. They go to their phone to open the Inhaler App to find their inhaler. The situation is dire. They decide to call 911 through the app. The app sends a text to 911 with the GPS location and an automated message.

Mr. Bishop is here for routine followup of his chronic illness. He is treated with Alvesco 160 mcg two puffs twice daily, Atrovent two puffs three times daily and Ventolin as needed for his COPD. He reports good compliance and uses these inhalers as prescribed. He generally uses his Ventolin with exercise. He reports that he is running 1-2 miles a day and also doing a step tape daily and reports good exercise tolerance. He does not wake at night coughing or feeling short of breath. For his hypertension, he takes hydrochlorothiazide 25 mg, and amlodipine 5 mg, and simvastatin 20 mg for his hyperlipidemia. He takes these as prescribed and denies any side effects. He denies

History of Present Illness: Ms. Johnson is a very pleasant 66-year-old woman who was previously evaluated in this office by Elvira Aguila, MD for the diagnosis of asthma. She was last seen in January 2015. She states that overall, she has done well. However, over the last two to three weeks, she has noticed increasing shortness of breath as well as productive cough, rhinorrhea and postnasal drip. She states that she has been using her rescue inhaler above and beyond what is normal for her up to 10 times a day yesterday and she states that she has had some improvement in her symptoms with her short acting bronchodilator. She denies any fevers or chills.

Asthma Case Study Questions 1.How have the factors that trigger an asthma attack changed since the 1900s? As a researcher, how would you put together the clues given here to explain the emerging epidemic? 2.Why do you think Europeans-and especially the English- are most affected by asthma? Responses 1.Asthma triggers have greatly increased since the 1900’s due to more pollutants in the air and all around us. Denser CO2 emissions, those of industrial complexes, cities and highways full of cars have skyrocketed in the last few decades leading to an massive growth in those with asthma.

Asthma is a chronic lung disease characterized by episodes in which the bronchioles constrict due to oversensitivity. In asthma, the airways (bronchioles) constrict making it difficult to get air in or out of the lungs. Breathlessness is the main symptom. The bronchi and bronchioles become inflamed and constricted. Asthmatics usually react to triggers. Triggers are substances and situations that would not normally trouble an asthma free person. Asthma is either extrinsic or intrinsic. Extrinsic is when the inflammation in the airway is a result of hypersensitivity reactions associated with allergy (food or pollen). Intrinsic asthma is linked to hyper responsive reactions to other forms of

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right