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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Classify asthma severity

  • Assess the existing treatment regimen and proper inhalation technique

  • Develop a therapeutic plan (including treatment and monitoring) using patient-specific data that maximize patient response while minimizing adverse drug events and other drug-related problems

  • Discuss proper instructions that are to be provided to a patient prescribed asthma medications

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PATIENT PRESENTATION

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Chief Complaint

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Desiree Adams is a 36-year-old African American female who presents to a family medicine clinic for follow-up after a recent emergency department (ED) visit for an "asthma attack."

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History of Present Illness

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DA reports having asthma as a child but was told by her mother that she grew out of it. She believes it was around the seventh grade when she stopped using an inhaler. She does not recall the name of the medication she used. On discharge from the ED, the patient was provided with a prescription for prednisone 20 mg daily for 1 week and an albuterol inhaler, but she is not sure if she is using the inhaler correctly. DA reports she finished the 7 days of prednisone a few days ago and is having less difficulty breathing than when she presented to the ED; however, she complains of a cough that she thinks appeared when she began working a second job (about 6 months ago). The patient experiences SOB most days of the week, which is sometimes accompanied by wheezing and a funny feeling in her chest. DA denies any nighttime symptoms. She is concerned because she is not able to run around with her kids when she gets home from work like she used to. She notices on her days off from the dry cleaning business, she is usually symptom free unless she is around cats or mowing the yard. In addition to her respiratory complaints, the patient tells you she is experiencing heartburn several times per week, which she has been self-treating with Tums.

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Past Medical History

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Allergic rhinitis (allergic to cat dander and pollen per intradermal allergy testing) × 20 yr

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Asthma (diagnosed at age 5 years, no treatment since approximately the age of 12 yr)

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HTN × 3 yr

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Family History

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Both parents have HTN; father and younger sister have asthma and allergic rhinitis.

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Social/Work History

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Single mother of three living in a house with no pets. Her primary job is working as a cashier at a grocery store, but she also works a second job at a family-owned dry cleaning business.

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Tobacco/Alcohol/Substance use

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She denies current tobacco and alcohol use.

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Allergy/Intolerance/Adverse Event History

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Sulfamethoxazole/trimethoprim—rash

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Medication History

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Albuterol HFA 90 mcg ...

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