Asthma CD

Patient Journey Form/ GP and public health block
Patient demographic
Nada Al.boshi , 26 y/o Saudi female patient, graduated student, single, live in AL Madinah.
Patient background
Known case of asthma since childhood on Ventolin (blue) and Seretide (purple) inhalers.
Case introduction: Shortness of breath for 2 hours
Possible differential diagnosis

 Bronchiectasis, Bronchiolitis
 Upper Respiratory Tract Infection
 Chronic Obstructive Pulmonary Disease (COPD)
 Foreign Body Aspiration
 Anaphylaxis
 Heart Failure
 Pulmonary Embolism
Diagnosis Asthma exacerbation
Key point in history:

 She was healthy and doing well until she wake up this morning , 2 hour earlier when she expose to
a cold and dusty weather then she start to have shortness of breath, sudden onset, progressive and
continuous associated with dry cough and chest whizzing , she said her symptoms always worse
early in morning especially after rainy weather or if she exposed to strong orders or animals or was
doing vigorous exercise, but it usually relived by inhalers. No other associated symptoms and she
denial any prolong upper respiratory tract infection.
 No chest pain, sputum production, orthopnea, PND, hemoptysis or nasal discharge, no palpitations,
syncope or ankle swelling.
Past medical history

 She was asthmatic for 9 years, attacks comes once every 2 months. Last attack of asthma was one
month ago when she goes to a bookstore and she exposed to dust she admitted to ER because of
that and takes oxygen.
 No history of other chronic illness or Atopic disease like eczema or allergic rhinitis and she had her
flu vaccine for this year.
 She takes Seretide inhaler 2 times a day and salbutamol if needed, Adherence to the medication
and know how to use it, she had regular follow up every month.
 No surgical history.
 No history of blood transfusion.
Family History:
 Her brother has asthma.
 Both parents have HTN and DM
Social history:
 Graduated Student.
 Non-smoker
 Good financial state.
 Living in Al Madinah with her parents.
 No recent travel history.
ICE-E
The patient thought her condition is exacerbate because of the weather she had no concerns and she want to
take oxygen session.
Physical examination:
Patient conscious, alert and oriented, she looks ill , in respartory distress , Deep breathing pattern and use of
acssory musle of respiration , not pale or cynosised , Average body built , no candida in the oral cavity .
Vital signs: BP 128/79 , Temperature 36.9 , spo2 96% RA , Pulse 89 , RR 20
Chest ex:
On palpation Equle chest expantion , trachia centrlized no divation , normal apext beat
On precussion chest was Resonans
On ascultation Equle bilateral air entry , vascular breathing with prolonged expiration and expiratory Ronchi
(wheezing )
Red flags:
1. Status asthmaticus— does not respond to standard medications
2. Acute respiratory failure (due to respiratory muscle fatigue)
3. Pneumothorax, atelectasis, pneumomediastinum
Investigation:
NOT DONE
See Further investigation in management
Problems list: Asthma

Management plan in steps
1) Reassurance
2) Advice : Educate the patient about hazards factors that lead to asthma exacerbation.
3) Prescribing drugs
- Ventolin nebulizer 0.3cc in 3cc normal saline for 15 min with 2L Oxygen
- Monitor SpO2, HR and RR. Assess chest whizzing and the patient general look for
improvement.
- If the patient didn’t improve repeat nebulizer session up to 3 time in 1 hour.
- Discharge with oral steroids (prednisolone 30 mg) for 5 days with the previous
inhalers she use (Seretide and salbutamol) .
4) Further investigation if needed

1. Pulmonary function tests (PFTs) obstructive pattern: decrease in EFR, decreased FEV1,
and decreased FEV1/FVC ratio (<0.70).
2. Spirometry before and after bronchodilators
3. peak expiratory flow rate
4. Chest x-ray: Normal in mild cases; severe asthma reveals hyperinflation
5. ABGs , Hypocarbia is common. Hypoxemia may be present.
5) Referral /sick leave

- Referral to Respiratory clinic within 4wks
6) Observation &Follow up
- GP appointment within 1wk
7) Prevention :
- Insure that she takes the inhaler at home in right way.
- Peak flow meter to monitor PEF twice a day
- Vaccination

Asthma CD

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Asthma CD

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Patient Journey Form/ GP and public health block

Case introduction: Shortness of breath for 2 hours

Possible differential diagnosis

Key point in history:

Past medical history

Problems list: Asthma

4) Further investigation if needed

5) Referral /sick leave

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