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PATIENT PRESENTATION

Chief Complaint

“I can’t breathe so good”

History of Present Illness

Millie Mouse is a 7 year old female with a history of asthma, who presents to the emergency room with increased work of breathing that was unrelieved by albuterol treatments at home overnight and reports a week long history of increased symptoms including rhinorrhea and non-productive cough, attributed to allergies.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What is Millie’s acute asthma exacerbation severity?

    Hint: See Treatment and Table 15-10 in PPP

  2. What initial therapy should Millie receive in the emergency department?

    Hint: See Treatment and Table 15-10 in PPP

  3. What adjunctive medication(s) could be considered if a patient has minimal improvement with initial therapy?

    Hint: See Treatment and Table 15-10 in PPP

  4. What parameter(s) should be monitored to ensure successful treatment of Millie’s acute asthma exacerbation?

    Hint: See Outcome Evaluation in PPP

  5. What medications and patient education should be included in Millie’s treatment plan upon discharge?

    Hint: See Treatment and Outcome Evaluation in PPP

FOLLOW-UP

Millie comes to her pediatrician 6 months later. In the last year, she has had a total of 3 hospital admissions for acute asthma exacerbations and has required step up of her long-term control medication to now a medium dose ICS-LABA. The medical intern asks you if Millie is eligible for a biologic agent for her asthma. Which are possible options and what additional labs or parameters should be assessed to determine which may be most appropriate?

Hint: See Treatment and Table 15-4 in PPP

CASE SUMMARY

Global Perspective

Asthma affects 14% of pediatric patients in the United States and is the most common reason for childhood emergency room visits, hospitalization, and absenteeism from school. Those diagnosed with asthma about 80% report disease onset prior to 6 years of age and only a minority will have persistent symptoms in adulthood. Unfortunately, childhood asthma prevalence worldwide is increasing, despite improvements in the management and pharmacologic therapy. Management strategies for acute asthma exacerbation in pediatric patients is to prevent invasive mechanical ventilation as it has predicted high mortality rates in children upwards to 4%.

1. +
Liu,  A. H., Spahn,  J. D., Sicherer,  S. H. (2020). Childhood Asthma. In R. M. Kliegman (Ed.), Nelson Textbook of Pediatrics (1st ed., pp. 1186–1209). Elsevier Inc.
2. +
Roberts,  J. S., Bratton,  S. L., Brogan,  T. v. (2002). Acute severe asthma: Differences in therapies and outcomes among pediatric intensive care units*. Critical Care Medicine, 30(3), 581–585. ...

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