Case n pmh eczema allergic rhinitis n fh mom age 34

Case
n
PMH: Eczema, allergic rhinitis
n
FH: Mom, age 34, CEO, with allergic
rhinitis; Dad, age 36, movie star, with
asthma; 1 pet dog
n
Allergies: NKDA
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Medications: fexofendadine 30mg PO
twice daily and hydrocortisone 0.25% lotion,
thin film applied twice daily PRN eczema
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Immunizations: up to date

What are the factors most likely
influencing the development of
asthma in this patient?

Describe the most likely triggers
for this patient’s asthma.

What are the 3 main components
of the pathophysiologic
processes of asthma?

Describe signs and symptoms of
chronic asthma.

What options are available to
diagnose this patient?

What questions could we ask
this patient to help make a
diagnosis?

Sample Questions for the Diagnosis
and Initial Assessment of Asthma
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A “yes” answer to any question suggests that an asthma diagnosis is
likely.
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In the last 12 months…
¡
Have you had a sudden severe episode or recurrent episodes of coughing,
wheezing (high-pitched whistling sounds when breathing out), chest tightness, or
shortness of breath?
¡
Have you had colds that “go to the chest” or that take more than 10 days to get
over?
¡
Have you had coughing, wheezing, or shortness of breath during a particular
season or time of the year?
¡
Have you had coughing, wheezing, or shortness of breath in certain places or when
exposed to certain things (e.g., animals, tobacco smoke, perfumes)?
¡
Have you used any medications that help you breathe better? How often?
¡
Are your symptoms relieved when the medications are used?
n
In the past four weeks, have you had coughing, wheezing, or shortness
of breath…
¡
At night that has awakened you?
¡
Upon awakening?
¡
After running, moderate exercise, or other physical activity?
Kell HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 7th
ed. New York: McGraw Hill Medical; 2008. P. 463-72.

What changes would we expect
to see with spirometry?

List 3 airway cells involved in airway
inflammation.

May shed which may result in
heightened airway responsiveness,
altered permeability of the airway
mucosa, and loss of enzymes
responsible for breaking down
proinflammatory mediators.
1.
Eosinophils
2.
Epithelial cells
3.
Mast cells
4.
Lymphocytes
5.
Alveolar macrophages

Once activated by an allergen via an
IgE receptor, these cells initiate the
release of histamine, chemotactic
factors, leukotrienes, prostaglandins,
and platelet activating factor
1.
Eosinophils
2.
Epithelial cells
3.
Mast cells
4.
Lymphocytes
5.
Alveolar macrophages

Increased in numbers in the
airways of those with asthma and
release inflammatory mediators
such as leukotrienes and granule
proteins to injure airway tissue
1.
Eosinophils
2.
Neutrophils
3.
Fibroblasts
4.
Alveolar macrophages
5.
Mast cells

High numbers found in the
airways of patients who died from
sudden onset fatal asthma and in
those with severe disease, but
role in asthma unclear.