Personalize Asthma Treatment Essay
Personalize Asthma Treatment Essay
- Classify JR’s Asthma Severity and Control Based on Signs and Symptoms Before ER Admission?
JR is suffering from moderate persistent asthma because he experienced an asthmatic attack that persisted despite using his albuterol inhaler. He uses albuterol to assist him when he feels an attack coming on and tends to use it daily. Personalize Asthma Treatment Essay
- Classify JR’s exacerbation severity based on PEF and symptoms?
JR’s asthmatic attack was exacerbated by smelling burning thing that caused shortness of breath and wheezing that worsened despite using an inhaler. The symptoms worsened upon arrival because he presented with tachycardia, tachypnea, and use of accessory muscles (Corren, et al, 2019). The cause of asthma on a daily basis especially in the morning could be due to cat fur or cold air.
- Identify the various triggers in JR’s life that may exacerbate asthma and prevent control?
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JR’s asthmatic triggers are his cats that sleep next to him every night. These cats have fur that causes allergy and blockage hence the shortness of breath. He is a passive smoker when his neighbor smokes therefore affecting his state. At his work place he inhales dust from the timber therefore worsening the allergy (Mohammod, et al, 2019). JR should avoid animal fur and exposing himself to smoke and dust
- Which step should JR have been on before ER based on severity and current medications? Step 1-SABA PRN, taking Low dose of ICS, giving the patient a low dose of ICS in addition to LABA. The fourth is a medium-dose ICS+LABA. The fifth is high dose ICS + LABA, and lastly is a high dose of ICS +LABA and also an oral corticosteroid (Holgate, et al, 2019).
- Which medications are dosed incorrectly and/or inappropriate for JR’s asthma severity? Ipratropium bromide MDI 2 puffs QID, Lovastatin 20 mg PO HS, Lisinopril 10 mg PO QD
- Would a short-burst of the oral corticosteroid be indicated at this time? If so, what dose and duration?
Yes, it would be used at this stage under steps six—20 to 300 mg a day.
- How would you assess that JR is well-controlled?
JR’s assessment will be based on severity if it has gone down, and I will consider the effects on his quality of life. Personalize Asthma Treatment Essay
- If JR is well-controlled, how would you step down in therapy?
400 micrograms/day of beclomethasone dipropionate (BDP) for four weeks
JR is a 56 yo man with h/o asthma, HTN and hyperlipidemia. He presents to the ER today with h/o shortness of breath for 45 minutes at rest. He reports that he was feeling well and in his usual state of health until about an hour ago, when he smelled something burning. 20 minutes later, he began to feel short of breath and was wheezing. He tried using his albuterol inhaler without success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, using accessory muscles and hypertensive. His last admission for an asthma attack was 2 months ago. He denies a recent cold or URI and says the albuterol usually helps him when he feels an attack coming on and tends to use it on a daily basis. He generally has wheezing and shortness of breath on a daily basis. JR reports poor sleep due to waking about 2 times a week for shortness of breath. He has 2 cats, which sleep next to him on his pillow and he lives in an apartment complex. JR does not smoke, but his neighbor smokes. JR is a carpenter by occupation. He monitors his peak flow once a week at home. He reports that his peak flow generally runs about 325 L/min and his personal best is 480 L/min. His current peak flow is 175 L/min. Medication Prior to Admission: Albuterol MDI 2 puffs BID-QID PRN Salmeterol Diskus 1 inhalation QID Ipratropium bromide MDI 2 puffs QID Lovastatin 20 mg po HS Lisinopril 10 mg po QD Questions: Classify JR’s asthma severity and control based on signs and symptoms prior to this most recent exacerbation and visit to the ED. Classify JR’s exacerbation severity based on PEF and symptoms. Identify the various triggers in JR’s life that may exacerbate asthma and prevent control. Which step should JR have been on prior to ER based on severity and current medications? Which medications are dosed incorrectly and/or inappropriate for JR’s asthma severity? Would a short-burst of oral corticosteroid be indicated at this time? If so, what dose and duration? How would you assess that JR is well-controlled? If JR is well-controlled, how would you step down in therapy? Personalize Asthma Treatment Essay
References
Corren, J., Castro, M., Chanez, P., Fabbri, L., Joish, V. N., Amin, N., … & Eckert, L. (2019). Dupilumab improves symptoms, quality of life, and productivity in uncontrolled persistent asthma. Annals of Allergy, Asthma & Immunology, 122(1), 41-49.
Holgate, S. T., Walker, S., West, B., & Boycott, K. (2019). The future of asthma care: personalized asthma treatment. Clinics in chest medicine, 40(1), 227-241.
Mohammod, K., Kunsongkeit, W., & Masingboon, K. (2019). Factors related to self-care practice in asthmatic patients at rajshahi in Bangladesh. Bangladesh Journal of Medical Science, 18(1), 57-62. Personalize Asthma Treatment Essay
