Question

A 28-year-old comes to your office with a chronic cough. The cough and wheeze have been present two to three days a week with two to three nights a month as well. This has been going on for approximately a year intermittently with treatment for bronchitis for which there have been antibiotics and cough suppressants. It never seems to get better. There is no SOB or difficulty speaking noted during the exam. On auscultation, you hear expiratory wheezes, high pitch, throughout all fields. There are no medication allergies or environmental allergies. You suspect asthma.

1. Based on guidelines, how would this asthma be classified? Why?
2. Using rational drug selection, what pharmacological agent/s would you begin with and why?
3. Discuss teaching related to possible side effects.

Answer 1

#. Based on the guidelines, the patient is having intermittent asthma because :-

Intermittent Asthma symptom frequency

2 or less days per week

Intermittent Asthma nighttime awakenings

2 or less times per month

#. Treatment:-

Short Acting beta 2 agonists (Inhaled forms for acute episodes and prevention of exercise-induced bronchospasm)

-Oral or i.v. corticosteroids (prednisone or prednisolone): oral for acute asthma exacerbations, and i.v for status asthmaticus (severe acute attack refractory to SABAs)

Rationale - provide measures for prompt relief of sporadically occuring symptoms .

#. Health teaching related to possible side effects are :-

- strict adherence to medications

- have 2-3 liters of fluids

- corticosteroid cause hyperglycemia ,so monitor blood glucose regularly

- corticosteroids cause candidiasis so, maintain good Orla hygiene , do mouth care regularly

- follow up with physiciy for any adverse reactions