Jessica is a 37-year-old female diagnosed with mild persistent asthma. During her visit today, she reports having to use her albuterol 4 days per week over the past month
SCENARIO 2
Allen is a 49 year-year-old man seeking evaluation for “a burning sensation in my chest,” often after eating and worse at night. He has frequent feelings of bloating and occasional nausea. Allen consumes a diet high in fatty foods and caffeine. He drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. His current medications include prn albuterol, metformin 1000 mg po BID, nifedipine ER 60 mg po daily. How would you improve his drug therapy plan? What changes would you make? What is your working diagnosis and what medication would you prescribe? What information would you provide to the patient at his visit?
SCENARIO 3
Jessica is a 37-year-old female diagnosed with mild persistent asthma. During her visit today, she reports having to use her albuterol 4 days per week over the past month. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough five nights during the last month. Her current medications include: fluticasone HFA 44 mcg, two puffs BID, albuterol MDI two puffs Q 4–6 H PRN shortness of breath, Medrol Dosepak, metformin 500 mg PO BID, Inderal LA 160 mg po daily.
How would you step up therapy for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan? What patient teaching would you provide?
Expert Answer and Explanation
Respiratory Case Study
Scenario 2: Allen’s Chest Burning and Medication Plan
Allen, a 49-year-old man, presents with a burning sensation in his chest, particularly after eating and at night, as well as bloating and occasional nausea. His diet, high in fatty foods and caffeine, and his weekend alcohol consumption likely exacerbate these symptoms. Considering his medical history of asthma, diabetes, and hypertension, the most likely diagnosis is gastroesophageal reflux disease (GERD) (Thélin & Jacobs, 2023).
GERD symptoms are often worsened by certain dietary habits, alcohol, and comorbid conditions such as obesity and asthma. To improve his drug therapy plan, adding a proton pump inhibitor (PPI) like omeprazole 20 mg once daily before breakfast would help reduce stomach acid production and relieve his symptoms of burning and bloating (Al Abdulqader, 2023).
Considering Allen’s comorbidities, it is important to ensure his medications do not interact or exacerbate his symptoms. His use of albuterol PRN for asthma should continue as prescribed, but his caffeine intake may aggravate his asthma and contribute to GERD, so patient education on limiting caffeine and fatty foods is crucial (Nadpara et al., 2023).
Allen should also be counseled on lifestyle changes, such as avoiding large meals before bedtime, reducing alcohol consumption, and elevating the head of the bed to prevent nocturnal reflux. Monitoring Allen’s blood glucose and blood pressure levels regularly is important to ensure that his diabetes and hypertension remain well-controlled alongside his new treatment.
Patient education would focus on dietary modifications to manage GERD. Allen should be informed about avoiding trigger foods like caffeine, spicy foods, and fatty meals, which can worsen his reflux (Nadpara et al., 2023). Encouraging small, frequent meals and avoiding late-night eating would help manage his symptoms. Allen should be instructed to monitor his symptoms and report any persistent or worsening signs of GERD, such as regurgitation or difficulty swallowing, which may indicate the need for further evaluation.
Scenario 3: Jessica’s Asthma Management and Medication Adjustment
Jessica, a 37-year-old woman diagnosed with mild persistent asthma, reports increased albuterol use, needing it four days a week and at least once daily over the past week. Additionally, she has been awakened by coughing five nights during the last month. According to asthma guidelines, her symptoms fall into the category of moderate persistent asthma, and stepping up her therapy is necessary to prevent further exacerbations (Mosnaim, 2023). Increasing her inhaled corticosteroid (ICS) dose is a key part of her management plan. Switching to fluticasone HFA 110 mcg, two puffs BID would provide better control of inflammation and reduce her reliance on albuterol.
Additionally, Jessica should be started on a long-acting beta-agonist (LABA) such as salmeterol in combination with the increased ICS. Combining a LABA with an ICS helps achieve better long-term asthma control, especially in patients who experience frequent exacerbations like Jessica (Laitano et al., 2024). The combination of fluticasone and salmeterol (Advair Diskus 100/50 mcg BID) would be an appropriate choice. The Medrol Dosepak she is currently using should be reserved for acute exacerbations and not relied on for chronic management.
Patient teaching for Jessica should focus on the proper use of inhalers and recognizing asthma triggers. It’s essential to explain the difference between her maintenance and rescue inhalers, emphasizing the regular use of her ICS/LABA combination (fluticasone/salmeterol) and only using albuterol as needed for acute symptoms (Reddel et al., 2023). Given Jessica’s increasing reliance on albuterol and her nocturnal symptoms, her current asthma therapy requires stepping up. As discussed, increasing her ICS dose to fluticasone 110 mcg two puffs BID, along with adding a LABA, would address both her airway inflammation and bronchoconstriction.
References
Al Abdulqader, A. (2023). Gastroesophageal Reflux Disease (Gerd). Journal of Pharmaceutical Negative Results, 1383-1388. https://doi.org/10.47750/pnr.2023.14.S01.188
Laitano, R., Calzetta, L., Matino, M., Pistocchini, E., & Rogliani, P. (2024). Asthma management with triple ICS/LABA/LAMA combination to reduce the risk of exacerbation: an umbrella review compliant with the PRIOR statement. Expert Opinion on Pharmacotherapy. https://doi.org/10.1080/14656566.2024.2366991
Mosnaim, G. (2023). Asthma in adults. New England Journal of Medicine, 389(11), 1023-1031. https://doi.org/10.1056/NEJMcp2304871
Nadpara, N., Malik, Z., & Gyawali, C. P. (2023). Understanding esophageal symptoms: Dysphagia, heartburn, and chest pain. In Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions (pp. 3-18). Academic Press. https://doi.org/10.1016/B978-0-443-13911-6.00008-6
Reddel, H. K., Brusselle, G., Lamarca, R., Gustafson, P., Anderson, G. P., & Jorup, C. (2023). Safety and effectiveness of as-needed formoterol in asthma patients taking inhaled corticosteroid (ICS)-formoterol or ICS-salmeterol maintenance therapy. The Journal of Allergy and Clinical Immunology: In Practice, 11(7), 2104-2114. https://doi.org/10.1016/j.jaip.2023.03.046
Thélin, C. S., & Jacobs, J. W. (2023). Gastroesophageal Reflux. Gastrointestinal and Liver Secrets E-Book: Gastrointestinal and Liver Secrets E-Book, 7.
Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.
Limited Offer: NEW30 to Get 30% OFF Your First Order
