Asthma Case Study: Management and Interventions for Uncontrolled Asthma in an 8-Year-Old Female

QUESTION

I need help with this case study. (please include in text references/literature).

Asthma Case Study: Mary is an 8-year old female African American girl who presents to the clinic with a 2-day history of fever, malaise, and nonproductive cough. Her mom gave her acetaminophen and ibuprofen to control her fever. Mom stated that ” a lot of other kids in her class have been sick this month.” Mary states having trouble breathing this morning. At that time her mother gave her albuterol, 2.5 mg via nebulizer twice within one hour. Mary still sounded wheezy to her mother after the albuterol, and Mary stated it was “hard to breath.” Mary asthma was previously well controlled. Previous clinic notes reported symptoms during the day only with active play at school or at home, with rare nighttime symptoms. Mary uses prn albuterol to help with symptoms after playing. Her assessment revealed Mary to have labored breathing, such that she could only complete four to five work sentences. She had subcostal retractions, tracheal tugging with tachypnea at 54 bpm. Her other vital sign were HR 160/min, BP 115/59, T 101F. The initial O2 SAT was 94%. Bilateral inspiratory and expiratory wheezes noted on exam. A CXR revealed hyperinflation, no infiltarates. PMH: Asthma, last hospitalization 4 years ago, and last course of oral corticosteroids over a year ago. FH: Asthma on father’s side of the family. SH: Lives at home with mother, father, and 2 sibilings, both have asthma. There are 2 cats and a dog in the home. Father is a smoker, but states that he tries to smoke outside and not around the children. She is in second grade and is very active. On Exam: VS – BP 125/60, HR 120, RR 40, T 100.4F, Wt. 101 lbs, Ht.48″. Medications: fluticasone HFA 44 mcg, 2 puffs bid, albuterol 2.5 mg via nebulizer q 4-6h prn for wheezing, acetaminophen 160 mg/5 mL – 10 mL 14h prn for fever, ibuprofen 100 mg/5mL – 10 mL q6h prn for fever. No allergies. PE: Alert and oriented, in mild distress with difficulty breathing, Skin: no rashes. HEENT: PERRLA, neck supple, no cervical lymphadenopathy. Chest: wheezes throughout all lung fields, still with subcostal retractions. Abd: sort, NT/ND. Extremities: no clubbing or cyanosis. Neuro: no focal deficits. Assessment: Exacerbation of Asthma. Based on the case study:

1. list of the patient’s drug therapy problems, and why?
2. Provide 3 differential diagnoses along with rationale and ICD codes.
3. What factors may have contributed to this patient’s uncontrolled asthma. How would you class this patient’s level of asthma according to NIH guidelines?
4. What are the goals of pharmacotherapy in this case?
5. What feasible pharmacotherapeutic alternatives are available for treatment for this patient? What nonpharmacological therapies might be useful?
6. Discuss the impact chronic inhaled corticosteroids may have on growth and development of the pediatric patient.
7. Describe the information that should be provided to the family regarding medication delivery technique and possible asthma triggers, along with maintenance assessment.

ANSWER

Asthma Case Study: Management and Interventions for Uncontrolled Asthma in an 8-Year-Old Female

Introduction

This case study presents Mary, an 8-year-old African American girl, who presents to the clinic with an exacerbation of her asthma symptoms. The goal of this analysis is to identify her drug therapy problems, differential diagnoses, contributing factors to uncontrolled asthma, treatment goals, pharmacotherapeutic alternatives, and nonpharmacological therapies. Additionally, we will discuss the impact of chronic inhaled corticosteroids on pediatric growth and development, as well as the essential information to provide to the family regarding medication delivery technique and asthma triggers.

Drug Therapy Problems

Inadequate asthma control: Mary’s asthma exacerbation suggests that her current drug therapy is not effectively managing her symptoms.

Frequent albuterol use: Mary is relying on frequent albuterol use to manage her symptoms, indicating inadequate long-term control of her asthma.

Suboptimal asthma education: There may be gaps in the patient and family’s understanding of asthma management, leading to suboptimal adherence to the prescribed medications.

Differential Diagnoses

Acute bronchitis (ICD-10 code: J20.8): Since Mary presents with fever, malaise, and nonproductive cough, acute bronchitis is a potential differential diagnosis.

Viral respiratory infection (ICD-10 code: J06.9): Given the prevalence of illnesses in Mary’s class, a viral respiratory infection could contribute to her respiratory distress.

Pneumonia (ICD-10 code: J18.9): The fever and labored breathing raise the possibility of pneumonia as a differential diagnosis.

Contributing Factors and Asthma Severity

Mary’s uncontrolled asthma may be attributed to several factors, including exposure to allergens (cats and dogs at home), her father’s smoking, and lack of adherence to the prescribed medication regimen. Based on NIH guidelines, her asthma can be classified as severe persistent due to her frequent albuterol use, persistent symptoms, and suboptimal lung function (NIH, 2007).

Goals of Pharmacotherapy

The primary goals of pharmacotherapy for Mary’s asthma include achieving and maintaining asthma control, reducing symptom severity, preventing exacerbations, and improving her overall quality of life (GINA, 2021).

Pharmacotherapeutic Alternatives and Nonpharmacological Therapies

Pharmacotherapeutic alternatives may include increasing the dose of inhaled corticosteroids or adding a long-acting beta-agonist to achieve better asthma control. Nonpharmacological therapies such as allergen avoidance, smoking cessation by Mary’s father, and proper inhaler technique education can also complement her treatment plan.

Impact of Chronic Inhaled Corticosteroids on Growth and Development

Chronic use of inhaled corticosteroids may pose a risk of reduced growth velocity in pediatric patients, but the benefits of controlling asthma outweigh this potential risk. The use of low-dose inhaled corticosteroids is generally considered safe, and regular height monitoring is recommended (National Asthma Education and Prevention Program, 2007).

Information for the Family

The family should be educated on proper medication delivery techniques, including the use of inhalers with spacers, nebulizers, and peak flow meters. Asthma triggers, such as pet dander and smoking, should be discussed, and strategies for allergen avoidance should be implemented. Regular maintenance assessment, symptom monitoring, and asthma action plans should be provided to ensure proactive management.

Conclusion

Mary’s case underscores the importance of comprehensive asthma management, involving both pharmacological and nonpharmacological interventions. Identifying and addressing drug therapy problems, understanding differential diagnoses, and providing patient and family education are crucial components in achieving optimal asthma control for pediatric patients like Mary.