Given Brian’s acute condition, it is unlikely that restarting his inhalers alone will be sufficient. Although his respiratory rate is within the normal range, and he has no dyspnea, he is exhibiting worsening cough and wheezing. In addition to his current inhalers I would prescribe an oral, systemic corticosteroid, such as prednisone, with the following prescription as it has been shown to improve symptoms and make it less likely to become severe requiring hospitalization (Alangari, 2014): -Prednisone 2mg/kg/tablet, take 1 tablet, once a day in the morning, for 5 days. References
Alangari, A. (2014). Corticosteroids in the treatment of acute asthma. Annals of Thoracic Medicine, 9(4), 187. doi:10.4103/1817-1737.140120 Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier Cushny, A. (2013). Acute asthma exacerbation. Nursing Standard , 27 (52), 59-59. doi:10.7748/ns2013.08.27.52.59.s46 Dougherty, R. H., & Fahy, J. V. (2009). Acute exacerbations of asthma: Epidemiology, biology and the exacerbation-prone phenotype. Clinical & Experimental Allergy , 39 (2), 193-202. doi:10.1111/j.1365-2222.2008.03157.x Mayo Clinic. (2016, October 20). Asthma attack. Retrieved from - 20354268 Meissner, H. C. (2016). Viral Bronchiolitis in Children. New England Journal of Medicine, 375(12), 1204-1204. doi:10.1056/nejmx160031 National Heart, Lung, and Blood Institute. (n.d.). Bronchitis. Retrieved from
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