Discussion paper on Asthma

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Introduction:
The case study presented above highlights a 16-year-old female with a history of eczema, exposure to second-hand smoke and cockroaches, presenting with symptoms of dry cough, shortness of breath on exertion, and nasal congestion. The patient is diagnosed with Asthma. The following discussion paper will address the questions posed in the prompt, using evidence-based literature and national guidelines.

1. Describe Asthma:
Asthma is a chronic inflammatory disease of the airways causing recurrent episodes of wheezing, chest tightness, shortness of breath, and coughing. The inflammation leads to excess mucus production, bronchoconstriction, and airway hyperresponsiveness, which makes breathing difficult. Asthma exacerbations can be triggered by allergens, pollution, exercise, infections, and emotions.

2. Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why?
Current evidence does not support the use of antibiotics for the treatment of asthma. Antibiotics have no effect on the underlying inflammation, and their use can lead to bacterial resistance, adverse effects, and increased healthcare costs. Moreover, the majority of asthma exacerbations are caused by viral infections, which do not respond to antibiotics. Therefore, a limited use of antibiotics is recommended, only when there is a confirmed bacterial infection or a strong suspicion of bacterial superinfection in an asthmatic patient.

3. What are the standards regarding the use of antibiotics in pediatric population? What assessment findings would warrant prescribing an antibiotic for Asthma symptoms?
The American Academy of Pediatrics recommends a cautious and targeted approach to the use of antibiotics in children, given the potential harms and risks of antibiotic overuse. Antibiotics should only be prescribed for bacterial infections, and not for viral illnesses or asthma exacerbations. Assessment findings that may warrant prescribing an antibiotic for Asthma symptoms include fever, productive cough with purulent sputum, localized wheezing, and clinical suspicion of bacterial superinfection.

4. Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.
The National Asthma Education and Prevention Program (NAEPP) has developed evidence-based guidelines for the diagnosis and management of asthma. An Asthma Action Plan for this patient would include the following steps:
– Assess asthma control with symptoms, lung function, and use of rescue medication
– Establish treatment goals with the patient and family
– Initiate daily controller medication based on severity and age-group (e.g. inhaled corticosteroid or leukotriene modifier)
– Educate the patient and family on asthma triggers, avoidance measures, and proper inhaler technique
– Schedule follow-up visits to assess asthma control and adjust treatment as needed
– Provide written instructions and emergency contacts for severe exacerbations

5. Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not?
The etiology, diagnosis, and management of a child who is wheezing can vary according to the child’s age. Infants and young children are more likely to have viral-induced wheezing, whereas older children and adolescents may have allergic asthma or exercise-induced asthma. The diagnosis of asthma in young children is challenging due to the lack of reliable lung function tests and the overlapping symptoms with viral respiratory infections. Moreover, the management of asthma in young children requires careful consideration of growth, development, and safety concerns regarding medication use. Therefore, age-specific guidelines and recommendations should be followed to optimize the diagnosis and management of wheezing in children.

6. Which objective of the clinical findings will guide your diagnosis? Why?
In this case, the objective clinical findings that guide the diagnosis of asthma are the presence of bilateral wheezing, decreased breath sounds, and exertional shortness of breath, which are consistent with airway obstruction and hyperresponsiveness. Moreover, the history of eczema, exposure to second-hand smoke and cockroaches are risk factors for asthma and allergic sensitization. The combination of symptoms and risk factors supports the diagnosis of asthma, which requires further confirmation with lung function tests, bronchodilator response, and allergen testing.

7. When is a chest x-ray indicated in this case?
Chest x-ray is not routinely indicated in the evaluation of asthma unless there is suspicion of complications, such as pneumonia, pneumothorax, or foreign body aspiration, which can cause wheezing and shortness of breath. In this case, the absence of fever, localized chest findings, or clinical suspicion of complications makes chest x-ray unnecessary. Instead, pulmonary function tests, such as spirometry, and exhaled nitric oxide measurement should be performed to confirm and monitor the diagnosis of asthma.