Question

please type no hand written answer

Respiratory Disease Case Studies Case 1 KL is a 26-year-old man with asthma. His symptoms have been well controlled with inhaled fluticasone and salmeterol. This morning he went for a short run and is now in the emergency department with an acute asthma attack that was not responsive to either of his inhalers. He is wheezing audibly, RR is 28, and O2 sats are 86% on room air. What is the cause of wheezing during an asthma attack?! Why were the inhalers ineffective in aborting the attack? Which medication should K.L. be prescribed to abort asthma attacks? How should K.L. be reminded to use his inhalers on a daily basis? What are the major teaching points?

Answer 1

1. In asthma, there is Narrowing of airways due to inflammation, mucus secretion and muscle spasms in walls of airways, so as the air moves through these narrow airways, that results in wheezing i.e. whistling sound.

2. Fluticasosone(corticosteroid) and salmetrol(long acting bronchodilators) are not effective as they are just rescue inhalers to prevent asthma attacks . They dont work in asthmatic attack as fast acting bronchodilator is required at that time.

3. Quick relief inhalers like salbutamol should be administered in asthma attack.

4. Ways of reminding AJ to use his inhaler on daily basis are:

• linking inhaler use with any daily activity like brushing etc
• keep inhaler within his sight
• use sticking notes as reminder
• using phone for inhaler alerts

teaching points must include:

• inhalers should be used on daily basis with correct technique
• avoid smoking or second hand smoke
• avoid exercising in cold dry air, cough, asthma attack, during high pollen conditions and in environment with airborne irritants