Asthma Case Study

2.6

hours

Continuing Education

By Susan Corbridge, PhD, APN, ACNP, AE-C, and
Thomas C. Corbridge, MD, FCCP

ASTHMA in Adolescents and Adults

Guideline-based diagnosis and management.

A

24-year-old woman presents to an
NP, reporting a two-year history of episodic cough, chest tightness, and shortness of breath. (This patient is a composite of several cases we’ve encountered in our practice.) Over the past three months, episodes have become slightly more frequent, occurring on an average of once a month, with weekly nighttime episodes that awaken her from sleep. Between episodes she feels completely well. Symptoms are precipitated by stress and exposure to cigarette smoke and are slightly worse in the spring and fall.
The patient had
This article outlines current guideline recommendations for asthma and reviews what clinicians need to teach patients about its pathophysiology, pharmacotherapy, self monitoring, and environmental control. The authors discuss the classic clinical presentation of the disease, describe how to assess severity and control, and explain how such assessments can guide management. course of action? Were the medications she prescribed sufficient? Did she address the issues most important to asthma control? This article seeks to answer these questions. ASTHMA’S IMPACT
In the United States, more than 16 million adults and about 7 million children have asthma.1 Annually, it’s responsible for roughly 11 million outpatient visits,
2 million ED visits, nearly 500,000 hospital admissions, and close to 4,000 deaths.1-3 It’s a common rea­son for school absenteeism among children, and causes adults to lose more than 10 million workdays each year.1, 4 Although asthma is more common in boys than girls, it’s more common among women than men.5 Prevalence, hospitalization, and mortality rates have stabilized over the past decade or so but had been on the rise in both sexes and across all age and racial groups from 1977 through 1996.6, 7
They must be taken every day, even when you are feeling well. They’re not for quick relief. Rescue medications, on the other hand, relax the muscles around the

airways to relieve symptoms quickly. They don’t treat asthma inflammation and, therefore, can’t provide long-term control. If you find yourself needing your rescue medication with increasing frequency, then your asthma is not well controlled.”
When discussing medication, be sure to address potential adverse effects. Patients who use inhaled corticosteroids, for example, should be instructed to rinse the mouth with water and spit after each use to prevent oral candidiasis and throat irritation. Because these drugs are usually prescribed for use twice daily, you might suggest that patients use them immediately before morning and nighttime toothbrushing.
Patients who use a metered dose inhaler might also use a spacer to reduce the amount of medication swallowed and absorbed.
Parents may express concern over the safety of inhaled corticosteroid use in children and the potential for subsequent delayed growth. It may be