[Solved] HG is a 28-year-old male that comes into your office because of chronic cough. He says that he coughs and wheezes around 3 days a week and has symptoms 3-4 nights – Fast, Quality and Affordable Assignment Expert

HG is a 28-year-old male that comes into your office because of chronic cough. He says that he coughs and wheezes around 3 days a week and has symptoms 3-4 nights

Module 4 Discussion

What severity of asthma does HG have? What medication(s) do you prescribe? What are the most common side effects of the medication(s)? What counseling points would you give to HG?

Instructions: Respond to the case discussion questions above in a 3-5 minute video [via VoiceThread, Canvas Studio, Zoom, etc]. Your video should be recorded as if you were discussing treatment with the patient. Be sure to include how you would instruct the patient on their diagnosis, medication prescribed, and key counseling points. Please post a link to your video no later than Thursday at 11:59 pm EST. Please make sure to be specific in the medication(s) you select including name of medication, dose and frequency.  

Expert Answer and Explanation

Severity of Asthma

HG, a 28-year-old male, presented with a chronic cough and wheezing that occurred approximately three days a week, with nighttime symptoms occurring about 3-4 nights per month. He had been experiencing these symptoms on and off for about a year, with exacerbations during the spring and fall and worsened symptoms during exercise. Clinical examination revealed expiratory wheezing, a common finding in asthma patients. He had no known allergies and was not on any medications. Based on his clinical presentation, HG was diagnosed with asthma.

In addition to HG’s presenting symptoms, further evaluation included a thorough medical history and physical examination. The detailed clinical assessment aimed to rule out any underlying conditions that might mimic asthma and helped to confirm the diagnosis. Spirometry and peak flow measurements were performed to assess lung function, providing valuable data to support the diagnosis. These objective measurements are essential in gauging the severity of asthma and serve as critical benchmarks for monitoring treatment efficacy.

Medication

In terms of asthma severity, HG’s symptoms fell under the category of mild persistent asthma. According to the Global Initiative for Asthma (GINA) guidelines, this classification applies to individuals who experience symptoms more than twice a week but less than daily (Tchen et al., 2023). It also aligns with his seasonal exacerbations and exercise-induced symptoms. The recommended treatment plan for HG includes both quick-relief and long-term control medications. To address acute symptoms like wheezing and shortness of breath, HG was prescribed a short-acting beta-agonist (SABA) inhaler, such as albuterol.

This medication provides rapid relief during asthma attacks (de Las Vecillas & Quirce, 2023). However, for ongoing management and to reduce airway inflammation, HG was also prescribed an inhaled corticosteroid (ICS) like fluticasone (Tchen et al., 2023). ICS medications are considered the most effective long-term control treatment for asthma. They help reduce airway inflammation, prevent asthma symptoms, and improve overall lung function.

Common Side Effects of the Medication

Common side effects associated with inhaled corticosteroids are typically mild and include a sore throat or hoarseness. These side effects can be minimized by rinsing the mouth after each use of the inhaler. It’s essential for HG to understand that these medications should be used as prescribed (Tchen et al., 2023). The SABA inhaler is used as needed when symptoms occur, while the ICS inhaler should be used daily, even when HG is feeling well, to maintain asthma control and prevent symptom exacerbations.

Counseling

In the management of asthma, patients should be diligent in monitoring their symptoms and maintaining a record of rescue inhaler usage. Regular follow-up appointments will be scheduled to ensure that the individual’s asthma remains well controlled. It is advisable for patients to proactively identify and steer clear of potential triggers that may exacerbate their symptoms, including common allergens or exposure to cold air (Muneswarao et al., 2019). If, at any point, concerns arise or there is a noticeable deterioration in symptoms, patients are strongly encouraged to promptly contact their healthcare provider.

This collaborative effort aims to effectively control asthma, thereby enhancing the individual’s overall quality of life and ensuring their well-being (Boulet et al., 2019). By actively involving HG in his care and equipping him with the knowledge and tools needed for effective self-management, the aim was to improve his overall quality of life and minimize the impact of asthma on his daily activities and well-being.

In conclusion, HG’s asthma diagnosis aligns with the mild persistent category, given the frequency and nature of his symptoms. The treatment plan, which includes both a SABA inhaler for quick relief and an ICS inhaler for long-term control, is tailored to his specific needs. It is essential for HG to adhere to this treatment regimen to effectively manage his asthma, reduce symptoms, and improve his overall quality of life. Education and regular follow-ups with his healthcare provider will be crucial to ensure proper asthma control and monitor any potential side effects or changes in his condition.

References

Boulet, L. P., Reddel, H. K., Bateman, E., Pedersen, S., FitzGerald, J. M., & O’Byrne, P. M. (2019). The global initiative for asthma (GINA): 25 years later. European Respiratory Journal, 54(2).

de Las Vecillas, L., & Quirce, S. (2023). Landscape of short‐acting beta‐agonists (SABA) overuse in Europe. Clinical & Experimental Allergy, 53(2), 132-144.

Muneswarao, J., Hassali, M. A., Ibrahim, B., Saini, B., Ali, I. A. H., & Verma, A. K. (2019). It is time to change the way we manage mild asthma: an update in GINA 2019. Respiratory research, 20(1), 1-6.

Tchen, S., Vu, T., Fleischman, M., Ward, J., Trapp, C., & Hu, K. (2023). Assessing prescriber adherence with Global Initiative for Asthma (GINA) guideline-recommended reliever therapy. Internal and Emergency Medicine, 1-8.

Module 5 Discussion

1. Why would a clinician have changed KG to Chlorthalidone from Hydrochlorothiazide?
2. What blood pressure goal do you give to KG?
3. What specific medication changes do you recommend to KG’s regimen to reach the determined goal?
4. Any counseling points and monitoring parameters for KG’s plan of care?

Expert Answer and Explanation

KG Hypertension Case Study

Changing Hydrochlorothiazide to Chlorthalidone

The clinician likely changed KG from Hydrochlorothiazide to Chlorthalidone due to the difference in their duration of action and potency. Chlorthalidone has a longer duration of action compared to Hydrochlorothiazide (Agarwal, 2022). As a result, Chlorthalidone meant that it can be taken once daily, enhancing medication adherence. Additionally, Chlorthalidone is considered more potent and effective in lowering blood pressure for some individuals, especially in those with more severe hypertension. This change may have been made to achieve better blood pressure control and reduce the risk of cardiovascular events. The change of medication also ensures improved patient compliance and that the frequency of medication intake.

Blood Pressure Goal

The blood pressure goal for KG would depend on his overall cardiovascular risk and any specific comorbidities he may have. However, a commonly recommended goal for individuals with hypertension is to achieve a blood pressure of less than 130/80 mm Hg, particularly if they have additional cardiovascular risk factors (Agarwal, 2022). Given KG’s current blood pressure readings, the goal should be to reduce his blood pressure to below 130/80 mm Hg. The goal would improve the overall health of the patient and encourage physical activities.

Medication Changes

Different medication changes may be recommended to help KG reach the determined blood pressure goal of 130/80 mm Hg. The most preferred medication change would be the increase of dosage for the Chlorthalidone medication (Agarwal, 2022). In like manner, the clinician may consider increasing KG’s Chlorthalidone dosage to achieve better blood pressure control. An adjustment in dosage may be necessary to reach the target goal while monitoring his potassium levels closely.

Be that as it may, the other medication that can be used to help achieve the blood pressure goal is the addition of antihypertensive medication. Depending on KG’s response to the increased Chlorthalidone dosage, the clinician may recommend adding another antihypertensive medication. Common choices include ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, or beta-blockers (An, et al., 2021). The choice of medication will depend on individual factors, including any contraindications or side effects.

Counseling Points and Monitoring Parameters for KG

There are various components that can be used a counseling points and monitoring parameters for the case of KG. The main forms of counseling models and monitoring parameters include Medication Adherence, and Diet or Lifestyle (Nkhoma et al., 2021). The use of medication adherence makes use of the importance of taking medications as prescribed, including the timing and dosage instructions.

Discuss any potential side effects or concerns KG may have. Recommendations on diet and lifestyle reinforce the benefits of a low-sodium diet and regular exercise in managing hypertension. Encourage KG to continue his current healthy lifestyle practices (Tam et al., 2020). Monitoring parameters for KG’s plan of care may include regular blood pressure checks to assess his response to medication changes and ensure he is reaching the target goal.

References

Agarwal, R. (2022). Hydrochlorothiazide Versus Chlorthalidone: What Is the Difference?. Circulation, 146(22), 1641-1643.

An, J., Wei, R., Zhou, H., Luong, T. Q., Gould, M. K., Mefford, M. T., … & Reynolds, K. (2021). Angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers use and COVID‐19 infection among 824 650 patients with hypertension from a US integrated healthcare system. Journal of the American Heart Association, 10(3), e019669.

Nkhoma, D. E., Soko, C. J., Banda, K. J., Greenfield, D., Li, Y. C. J., & Iqbal, U. (2021). Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: systematic review and meta-analysis. BMJ health & care informatics, 28(1).

Tam, H. L., Wong, E. M. L., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: an integrative review. International journal of environmental research and public health, 17(7), 2513.

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