Case Study 1
Clinical scenario:
Julia is a 31 -year old mother of 2 with a history of asthma that had previously been well controlled by a low-dose inhaled corticosteroid (ICS) and an as-needed short-acting inhaled 0-agonist, She presents now with symptoms of cough, wheezing, and shortness of breath occurring daily and increased nocturnal awakenings a few times a week. She also reports that she has had some limitations in her normal activities of daily living because of these symptoms. She has been using her rescue therapy on an almost daily basis, She also complains of nasal congestion, sneezing, and itchy eyes.
The patient reports that her nasal symptoms and asthma began to worsen a few months ago --after a bout with bronchitis that was successfully treated with antibiotics.
Current medications: albuterol inhaler 2 puffs q 4-6 hrs as needed, fluticasone 110 mcg 1 puff twice a day
Allergies: sulfa
Physical examination:
Vital signs BP 110/70 HR 76 RR 16 T 98.6 lit 65” Wt 130
• HEENT: Boggy basal turbinates and clear drainage in posterior pharynx. Tympanic membranes clear.
• Neck: no lymphadenopathy
• Chest: Wheezing, use of accessory muscles of resp iration
• CV: RRR without murmur
Spirometry sho wed that the ratio of forced expiratory volume in 1 second (FEVi) to forced vital capacity (FVC) was 65%.
Questions (discuss among your:group and agree on an answer):
1. According to current expert, guidelines how would you classify her asthma? Support your answer.
2. According to the guidelines in answer 1, what would be the preferred treatment for Julia?
3. What are the goals of therapy prescribed in answer 2?
4. What possible adverse drug effects could arise and hpw would you best detect them on her follow-up visit to the clinic?
5. If Julia becomes pregnant again would your recommended therapy change?