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Management of the Asthma Patient

It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.

You are seeing a 16-year-old patient previously diagnosed with mild persistent asthma for a routine follow-up visit.

She is currently taking beclomethasone dipropionate (Qvar) MDI 40mcg/inhalation one puff twice daily for asthma maintenance and using albuterol (ProAir HFA) MDI 90mcg/inhalation 2 puffs every 4 hours as needed for shortness of breath or wheezing.
In the last two months she reports using her albuterol inhaler during daytime hours an average of three times per week.
She reports awakening at night with asthma symptoms about twice per month.
She does not feel that she has any limitations to her activity due to asthma symptoms.
Upon examination today her blood pressure is 110/76, heart rate is 68, respiratory rate is 18, O2 saturation is 96% on room air, and temperature is 97.8. Her lung sounds are clear, heart rhythm is regular, and skin is pink and dry.
Please develop a discussion post that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion post:

Provide your diagnosis.
Discuss how you would manage the patient’s current asthma regimen and provide a rationale supported by scholarly reference for your treatment plan.
Include your specific prescription(s) for the patient. (This must include the medication name, dose, route, and frequency as well as any special instructions that apply as you would include when writing a prescription).
Describe the patient education you would provide in relation to your treatment plan.
Provide your plan for follow-up and/or referral (if indicated)

Sample Answer

Diagnosis: Based on the patient’s symptoms, she is currently experiencing mild persistent asthma with inadequate control. While her initial diagnosis was mild persistent asthma, her current report of using albuterol three times per week during the day and nocturnal awakenings twice per month indicates that her asthma is no longer well-controlled. According to the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (EPR-3) guidelines for the diagnosis and management of asthma (still largely foundational, though newer guidelines exist, they build upon these principles), using a short-acting beta-agonist (SABA) more than twice a week (excluding exercise-induced bronchospasm) and experiencing nocturnal symptoms more than twice a month are indicators of uncontrolled asthma, even if she perceives no activity limitations (National Heart, Lung, and Blood Institute, 2007). The Global Initiative for Asthma (GINA) guidelines further reinforce that SABA use

Full Answer Section

Management of Current Asthma Regimen and Rationale: The patient’s current regimen of beclomethasone dipropionate (Qvar) MDI 40mcg one puff twice daily, combined with frequent albuterol use, indicates a need to step up her therapy. Her current inhaled corticosteroid (ICS) dose is low. The goal is to regain asthma control by reducing rescue inhaler reliance and nocturnal symptoms.

I would increase her inhaled corticosteroid (ICS) dose. The rationale for this is rooted in current asthma management guidelines. ICS are the cornerstone of long-term asthma control, reducing airway inflammation and hyperresponsiveness (GINA, 2024). Increasing the dose of her maintenance medication is the most appropriate next step given her persistent symptoms despite current therapy. This approach aligns with a step-up in therapy for uncontrolled asthma, as recommended by both NAEPP and GINA guidelines (National Heart, Lung, and Blood Institute, 2007; Global Initiative for Asthma, 2024).

Specific Prescription(s):

Beclomethasone Dipropionate (Qvar Redihaler) MDI 80 mcg/inhalation
- Dose: 1 puff
- Route: Inhalation
- Frequency: Twice daily (every 12 hours)
- Special Instructions: Inhale deeply and slowly. Rinse mouth with water and spit after each use to prevent oral thrush. Do not shake.
Albuterol (ProAir HFA) MDI 90 mcg/inhalation
- Dose: 2 puffs
- Route: Inhalation
- Frequency: Every 4 hours as needed for shortness of breath or wheezing.
- Special Instructions: For quick relief of symptoms only. If requiring use more than twice per week (not for exercise-induced symptoms) or experiencing increasing frequency of symptoms, contact the clinic.

Patient Education: I would educate the patient on the importance of consistent use of her Qvar Redihaler as a preventative medication, even when feeling well. I would explain that it reduces inflammation in her airways, which is the underlying problem in asthma, and that it’s not a rescue inhaler. We would review proper inhaler technique for both Qvar and albuterol, potentially using a demonstration inhaler and asking her to demonstrate back. I would emphasize the increased dose of Qvar and the need to rinse her mouth after each use to prevent side effects like oral thrush. We would discuss that the albuterol inhaler is for rescue only, and frequent use (more than 2 times per week, excluding pre-exercise use) indicates her asthma is not well controlled and she needs to call the clinic. We would also discuss identifying and avoiding asthma triggers and the importance of having an up-to-date Asthma Action Plan.

Plan for Follow-up and/or Referral: I would schedule a follow-up visit in 4-6 weeks to reassess asthma control, review symptoms, and check adherence to the new medication regimen. During this visit, we would evaluate her albuterol usage, nocturnal awakenings, and any activity limitations. We would also review her inhaler technique again. If symptoms remain uncontrolled despite the increased ICS dose, referral to an asthma specialist or pulmonologist would be considered for further evaluation and management, potentially involving the addition of a long-acting beta-agonist (LABA) or other advanced therapies.

References:

Global Initiative for Asthma. (2024). Global Strategy for Asthma Management and Prevention. Retrieved from https://ginasthma.org/gina-reports/

National Heart, Lung, and Blood Institute. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3). National Institutes of Health. Retrieved from https://www.nhlbi.nih.gov/health-topics/guidelines-diagnosis-management-asthma

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