Asthma: Case Study
Chronic inflammatory disease of the breathing airways is called asthma. Asthma causes narrowing of the airways and decreasing in the air supply which may lead to breathing difficulty, coughing and wheezing.
Asthma can be a problem that affect patient’s daily activities and can’t be cured, but symptoms can be controlled. Although, asthma consider as a minor condition in some cases, other affected patients can get a life-threatening asthma attack.
Asna 6 years old girl comes to ER with her mum, she has symptoms of shortness of breath, cough, sneezing and even cannot say one complete sentence. Asna diagnosed with asthma two years ago and since two month she got recurrence symptoms of asthma. According to her mother, Asna got flu symptoms since three days ago and this may trigger her asthma and she is getting worse today. Her mother gave here Ventolin (nebules) by nebulizer twice daily but without effect. 2 month ago doctor prescribed inhaled corticosteroid to Asna, she used it for few days only because difficulty while using inhaler, and she couldn’t inhale medication properly.
Auscultation: wheezing, chest tightness
Skin test: redness and rough (mild eczema) at the arm.
Stated below just the abnormal value
Iron serum 28 ug/dl (low) (28-93)
Hemoglobin 9 g/dl (low) (9.60 14.80)
IgE 130.3IU/ML (high) 0-60
Vitamin D 25 OH 50.8 nmol/l (low) (75- 25)
Asna came to the ER with exacerbate (uncontrolled) Asthma despite of using SABA.
After checking lab results, it was discovered that she has vitamin D deficiency and mild anemia.
Initiate inhaled corticosteroid, bronchodilation salmeterol mixed with O2 gas to relief her lungs and reduce symptoms of SOB.
She discharged three hours later with new plan treatment.
- Initiate oral corticosteroid (prednisolone 15mg) syrup 4 ml twice daily for three days. Then Continue with inhaled fluticasone 125microgram one puff twice daily for 3 months. ICS reduce inflammation (reduce frequency and severity of asthma symptoms).
- Bronchodilation salbutamol (albuterol) 100 microgram/dose inhalation first three days every 4-6 hours. Then used as needed. (Relief her airways and well breathing).
- Initiate Montelukast 5 mg once daily for 3 month chewable tablet strawberry flavor (to treat and prevent asthma).
- Nasal ocean spray 1 puff 2-3 times for 5 days.
- Ferrouse sulphate 20mg/day 5 ml twice daily for the treatment of iron deficiency.
- Liquid vitamin D3 (5 drops daily).
- Avoid triggers (cold weather, perfume, second hand smoking, dust mite, cockroach).
- Encourage using inhaler properly with help of spacer tool better delivered medicine to the lungs and should rinse mouth with water after using inhaler to avoid fungal infection.
- Avoid using of nonsteroidal anti-inflammatory drugs.
The goal of treatment:
Relive symptoms and prevent recurrence and controlling asthma, time frame for asthma attack is 3-7 days.
After one week to check her lungs, then every 3 month. If she doesn’t response to these treatment or she needs SABA for every two hours, patient should seek for specialist.
- Patient with diagnose of chronic asthma with periodic attacks.
- Asthma symptom appears usually when the patient getting a flu, at that time the patient need treatment to control asthma.
- One must try to avoid trigger factors.
- The patient should be monitored to prevent serious complications.
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