Question

HPI: Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using every 3-4 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid. He can’t recall which one. He said he ran out a few weeks ago and has not had time to obtain a refill. He denies cigarette smoking, but his clothing smells like smoke.

PE: Patient is sitting by himself. His parents are in the room during the visit. No purse lip breathing noted. Occasional nonproductive coughing during the interview.

PULM: You note prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea.

Answer 1

In the present scenario, Brian is a 24-year-old known asthmatic, but he presents a worsening cough and shortness of breath within the past 2 days. He has the history of using a long-acting inhaled corticosteroid.

In the physical examination, there is no purse lip breathing and occasional non-productive coughing during the interview

In the pulmonology examination, the patient presents prolonged expiration and wheezes in all lung fields and there are no signs of dyspnea

From the history and physical examination, we can see a sudden exacerbation of a worsening cough and shortness of breath within the past two days and as well as he was on the long-acting inhaled cortico-steroid few weeks ago and in the physical examination reveals a prolonged expiration and wheezes in all lung fields

From all these findings and history, we can conclude that the most likely diagnosis is asthma exacerbation and (or) mild asthma exacerbation.

Here the reason for the asthma exacerbation may be due to denies of long-acting inhaled corticosteroid a few weeks ago and in the history collection, he says that he denies cigarette smoking but his clothes smell like smoke.

Here we can say the asthma exacerbation may be due to non-specific triggers such as denies of long-acting corticosteroid and (or) may be due to smoking.

Prevention:

* Minimization of triggers

*Adherence to preventive medications

*Use of an asthma action plan

It can be early identified by:

*Peak flow monitoring  

#Pharmacotherapy effective for reversing airflow obstruction:

*Albuterol

*Short-acting beta-2 agonist

# Pharmacotherapy for exacerbation:

*Corticosteroid

*Albuterol

In mild or acute exacerbation:

*Antibiotics are not recommended unless fever or pneumonia

*Excessive hydration

*Chest physiotherapy

*Mucolytics

*Sedation