Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezingfor the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan 's mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough and wheezing appear worse today, according to the mother. He had difficulty taking deep-enough breaths to inhale this morning's dose of albuterol, even using the spacer.Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler.Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild retractions. Pulse oximetry readings have been 93% of oxygen saturation.What is the appropriate pharmacological therapies to be prescribed for Johnathan?Johnathan’s mother did a great job at initially administering albuterol metered-dose inhaler and gave two treatments, but when there was no relief she brought him in to be seen. The mother reports that the patient started showing symptoms of an upper respiratory infection 2-3 day ago, and that he has a significant history of asthma. Several studies have shown that individuals with asthma have an increased risk of developing numerous upper respiratory infections in their lifetime (American Academy of Allergy Asthma & Immunology, 2019). I would diagnosis Johnathan with an asthma exacerbation that would initially brought on by the upper respiratory infection. He will be prescribed a rescue inhaler that will be a short acting bronchodilator, Albuterol. It will be prescribed as 90 mcg, 2 puffs every 4-6 hours as needed for asthma exacerbations. Johnathan would need to be immediately started on oral corticosteroids that would work systemically. I would prescribe Pediapred (prednisolone), 10 ml (2 tsp) for 5 days orally (liquid form).
- Fall '16