Case 012: Chronic Asthma

PATIENT PRESENTATION

Chief Complaint

“I haven’t been sleeping well at night.”

History of Present Illness

Ada Banks is a 9-year-old female seen by her pediatrician with complaints of nighttime awakenings and shortness of breath despite daily use of albuterol. Her mother reports that Ada’s peak flow results have been in the red zone recently.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. How would you assess the patient’s level of asthma symptom control?

   Hint: See Table 15-8 in PPP

2. What types of non-pharmacologic interventions could help to improve this patient’s asthma control?

   Hint: See Treatment and Table 15-1 in PPP

3. How should the patient’s current asthma treatment be modified?

   Hint: See Treatment and Table 15-9 in PPP

4. What are important counseling points for optimizing metered-dose inhaler technique?

   Hint: See Treatment in PPP

5. When should the patient be re-assessed after changes to her asthma medication regimen?

   Hint: See Treatment in PPP

FOLLOW-UP

6 weeks later the patient returns to clinic for follow-up. She is sleeping better through the night and enjoying playing outside more. She now uses her reliever inhaler every day before gym class to prevent symptoms, and reports shortness of breath about twice per week. What changes, if any, would you make to her current asthma treatment?

Hint: See Tables 15-8 and 15-9 in PPP

CASE SUMMARY

Global Perspective

Asthma most commonly develops in childhood, though it can develop at any stage of life. According to the Centers for Disease Control and Prevention, approximately 6 million children in the United States are diagnosed with asthma, and 44.3% of these children had 1 or more asthma attacks in 2019.¹ It is estimated that 50% of children with asthma have uncontrolled asthma.¹ Globally, asthma costs are increasing and are driven by the cost of hospitalization, medications, and loss of work and school days.² Treatment guidelines for childhood asthma often call for the use of multiple medications for management of moderate and severe disease, increasing the risk for pediatric polypharmacy and adverse effects.³ Thus, it is imperative to assess adherence to and administration of asthma medication prior adjusting therapy.