CASE STUDY: ASTHMA CRITIQUE 2
Ms. Byrd’s analysis of this case study thoroughly addressed the patient’s clinical
presentation. The analysis addressed FC’s current medications, recognized FC was having an
acute asthma exacerbation, and outlined her plan of care very clearly. Ms. Byrd also recognized
FC’s asthma was not being controlled with the Proventil inhaler she was prescribed. Ms. Byrd’s
addition of a short course of oral corticosteroid (OCS), an inhaled corticosteroid (ICS), and a
long-acting beta-2 agonist (LABA) is a great regimen. As Ms. Byrd stated, this combination of
medications will decrease work of breathing, allow the patient to have better control of her
asthma long-term, and FC will have fewer asthma exacerbations.
As Ms. Byrd stated, oxygen should be given to relieve hypoxia (Burchum & Rosenthal,
2019). A systemic glucocorticoid, such as Solu-Medrol, should be given IV to reduce airway
inflammation, and a high dose short-acting beta-2 agonist, such as Proventil, should be used next
as an aerosol treatment to relieve airflow obstruction every 20 minutes for 3 doses (Burcham &
Rosenthal, 2019) (Wells et al., 2017). An anticholinergic, such as Ipratropium, can be used to
reduce bronchoconstriction if needed (Burchum & Rosenthal, 2019).
Since FC is overweight, has a family history of asthma, and her roommate smokes and
has a cat, she is at risk for long-term asthma complications. Akinbami & Fryar (2016) found that
women with an increased BMI (body mass index) are at risk for asthma. She will need to ask her
roommate to smoke outside since second-hand smoke is a trigger for asthma attacks (Burchum &
Rosenthal, 2019). The roommate may also possibly have to get rid of the cat as pet dander is
also a trigger for an acute asthma attack (Burchum & Rosenthal, 2019). Ms. Byrd recognized that
FC was overusing her Proventil inhaler due the repeated hospitalizations, sign/symptoms of
asthma getting worse over time, and asking for a Proventil refill early. FC needs to be educated
about lifestyle changes, asthma triggers, management of acute asthma attacks, and when and how
CASE STUDY: ASTHMA CRITIQUE 3
often to use her Proventil inhaler. FC will also need education on how to take her new
medications, and how often. FC will have to ensure that she if taking these medications exactly
as prescribed.
Ms. Byrd’s home medication regimen of Ellipta, Prednisone (short course), and Serevent
will hopefully work to keep FC’s asthma at bay. FC will continue to use Proventil as needed for
acute asthma attacks as well. Prednisone is an OCS and will manage acute asthma exacerbation
by suppressing inflammation (Wells et al., 2017). Ellipta is an ICS and will decrease
inflammation in the airways as well by binding to glucocorticoid receptors (Wells et al., 2017).
Serevent is an LABA and cause bronchodilation for 12 hours while binding to beta-2 receptors
(Wells et al., 2017). An LABA should always be taken a few minutes before and ICS so that
when the airway passages are expanded, the ICS can work on more lung tissue (Burchum &
Rosenthal, 2019). Salmeterol can be used for the prevention of exercise-induced bronchospasm
(EIB) (Adams & Nguyen, 2020). One inhalation of 50 mcg 30 minutes before exercise can
protect against EIB ensuring the next scheduled dose is 12 hours from that dose (Adams &
Nguyen, 2020). According to a recent study by McKinney (2020), a Proventil inhaler of 90 mcg
was approved by the U.S. Food and Drug Administration to be used as a prevention of EIB.
The most common side effect of OCS medication is weight gain and/or edema in the
lower extremities (Wells et al., 2017). Hypertension and confusion are other common side effect
of OCS (Wells et al., 2017). Weighing daily and monitoring blood pressure at home is a must
when on this type of medication. The patient must notify the physician if any of these side effects
begin after starting an OCS. The most common side effect of ICS medication is candidiasis of
the oral mucosa (Burchum & Rosenthal, 2019). The patient should always rinse their mouth with
water after taking this medication to minimize the effects of getting candidiasis (Burchum &
CASE STUDY: ASTHMA CRITIQUE 4
Rosenthal, 2019). Side effects of LABA medication are hypokalemia and hypoglycemia
(Burchum & Rosenthal, 2019). Signs/symptoms of hypokalemia are cramping of the hands,
fingers, and legs and cardiac arrythmias (Burchum & Rosenthal, 2019). Hypoglycemia signs and
symptoms are shakiness, fatigue, and headache (Burchum & Rosenthal, 2019). Any of these
signs and symptoms should be reported to the physician promptly. The physician will also
monitor blood work for hypoglycemia and hypokalemia as well.
Ms. Byrd’s analysis and plan of action, pharmacologically and non-pharmacologically, is
outstanding. The long and short-term goals set for FC are on point. FC will have to do her part in
her plan of care to ensure this regimen works. Daily weights, weight loss, removing triggers,
keep lab appointments, monitoring blood pressure daily, promptly reporting signs/symptoms of
adverse effects, and taking her medications as prescribed. If FC does everything correctly, and
this regimen does not work for her, the regimen can be changed. “I will instruct you and teach
you in the way you should go; I will counsel you with my eye upon you.” (Psalm 32:8, ESV).
CASE STUDY: ASTHMA CRITIQUE 5
References
Adams, B.S. & Nguyen, H. Salmeterol. [Updated 2020 Jun 2]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK557453/.
Akinbami, L.J. & Fryar, C.D. (2016). Current asthma prevalence by weight status
among adults: United States, 2001-2014. NCHS data brief, no 239. Hyattsville,
MD: National Center for Health Statistics. 2016.
https://www.cdc.gov.nchs/products/databriefs/db239/htm.
Burchum, J.R. & Rosenthal, L.D. (2019). Lehne’s pharmacology for nursing care (10th
ed.). Elsevier.
Wells, B.G., Schwinghammer, T.L., DiPiro, J.T., & DiPiro, C.V. (2017).
Pharmacotherapy handbook (10th ed.). McGraw-Hill.
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