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 infiltrate's. 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 siblings, 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. Create a 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.
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 infiltrate's. 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 siblings, 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. Create a 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.
