asthma case report final

7/26/2019 Asthma Case Report Final

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Case reportIntroductionAsthma is a reversible, chronic infammatory disorder o the airways which is

associated with the airway hyper-responsiveness that leads to episodes o

widespread but variable airfow obstruction.(1) he characteristic !ey eatures that

su""est hi"h possibility o asthma are presence o whee#e, diurnal pattern o airway

obstruction, tri""er-related symptoms, interval symptoms, individual or amily

history o an atopic disease and positive response to asthma therapy.($)

%aniel is a & year old boy who lives with parents. 'is ather wor!s as a actory

wor!er and his mother is a housewie. %aniel ust started to attend !inder"arten in

the anuary and did not have any issues in the new environment. 'owever, he had

been absent to school very oten because o his illness.

*irth history and %evelopment+ince %aniels mother had impendin" eclampsia, he was delivered by lower

se"ment Caesarean section (+C+) at "estational a"e o $ wee!s with birth wei"ht

o /0 milli"rams. 'e was admitted to IC2 and dischar"ed without any

complications ater a period o & months. %ue to admission to IC2, %aniel was not

breasted. Accordin" to a recent study, children who are born beore &$ wee!s o

"estation have estimated & olds increase in ris! o developin" asthma compared to

those children who born at ull term.(&) 3ther than that, breasteedin" is su""ested

to be one o the protective actors o childhood asthma.(4) 5rematurity and e6treme

low birth wei"ht may e6plain the hi"h possibility o asthma in this case.

%aniels developmental milestones are consistent with his a"e. Accordin" to his

mother, he is able to wal! up steps with alternatin" eet. 'e can hold a pencil

properly and do some s!etchin" and drawin". *esides that, he can ollow some

simple commands li!e pic!in" up some stu7 and put thin"s into a bo6. 8or speech

and social interaction, he can involve in interactive play with other children and

communicate to others by usin" & to words sentences.

Current presentin" complaint%aniel had been cou"hin" or three days. he cou"h is non-productive cou"h and it

is more re9uent at ni"ht which has brou"ht sleep di:culty to %aniel. It is alsoassociated with runny nose with clear dischar"e. here was no ever, diarrhea and

vomitin", and any urinary symptoms. ;ith absence o ever, %aniels mother was

not worried so much because she thou"ht it will be resolved spontaneously ater a

ew days. 2nortunately, %aniel became breathlessness until di:cult to tal! on the

day &. 'is breathin" pattern was very ast and accompanied by


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vital si"ns. 36y"en, salbutamol and oral prednisolone were "iven and %aniel

responded well to these treatments.

=edical history (personal and amily)%aniel had an episode o severe breathlessness durin" > month old which had been

relieved by a sin"le dose o nebuli#er at the emer"ency department. 8rom > monthold onwards, %aniel had several episodes o mild breathlessness with runny nose

but all were resolved spontaneously at home. %aniels condition was deteriorated

and he had visits to the clinic in the past 4 months. %aniel has re9uent cou"h and

runny nose ollowed by breathlessness. 3ne to two doses o salbutamol with o6y"en

by nebuli#er could resolve the breathlessness. 3ther than this, %aniel does not have

any paediatric-related medical conditions and no history o hospital admission. 'e

has no !nown aller"ies to any medications or ood. ?e"ardin" amily history,

%aniels ather developed ec#ema at the a"e o $. here is no amily history o

atopic asthma. he immuni#ation is up-to-date.

%i7erential dia"nosis8our di7erential dia"nosis would be considered in %aniels case.

1. @arly onset o asthmahere are several points that support the dia"nosis o asthma. 'istory o

recurrent whee#in", cou"h and breathlessness. In addition, respond well to

asthma therapy and amily history o ec#ema. he diurnal variation o

symptoms and tri""ers should be elicited to urther support this dia"nosis.

$. iral induced whee#eIt is common amon" the children which is mostly caused by viral inection

durin" the Brst & years o lie. It may be associated with low "rade ever and

runny nose.

&. 5neumonia'istory o breathlessness, cou"h and whee#e su""est the picture o

pneumonia. 'owever, absence o productive cou"h and ever reduce its

possibility. Clinical e6amination o respiratory system by auscultatin" or end-

inspiratory coarse crac!les and chest -ray or the presence o consolidation

have to be done to rule out pneumonia.

4. *ronchopulmonary dysplasiaChec! or any history o o6y"en-dependent in the Brst $D days o lie and

abnormal chest -ray to support this dia"nosis.

Investi"ationhe dia"nosis o childhood asthma is by clinically based on the characteristic

symptoms without any other diseases which may e6plain the symptoms.()

Althou"h the dia"nosis o asthma is clinically based, other tests may still be


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36y"en

E Aia facemas!Fnasal pron"s to correct the o6y"en saturation

*$ a"onistbronchodilators

E Inhaled b$ a"onists are the Brst line treatment for acute asthma

+teroidtherapy

E $0m" oral prednisolone

re9uired to conBrm the dia"nosis or to rule out other possible diseases. In %aniels

case, the only investi"ation has been done is ull blood count to e6clude the

possibility o any inections speciBcally pneumonia where the white cell count is

li!ely to be raised.

Investigations Reasons8ull blood count and C?5 o rule out inectionasopharyn"eal swab o detect presence o bacteria or virus

in the upper respiratory tractChest -ray o rule out bronchopulmonary dysplasia

o chec! or hyperinfation o the lun"

(hyperlucent lun" and fattened

diaphra"m)+!in pric! test o screen or common aller"y and Bnd

out possible tri""ers o asthma

=ana"ement

3n admission


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Inhaled b$a"onist

E 2se asre9uiredE Inha le r

techni9ueshould betau"ht toparents

E 8re9uencyand dosa"e

E + ee ! fo rm edical help

if asthm aworsen

Asthma diary

E ?ecord thefre9uency ofasthmaattac!s

E Asthm asymptoms

E ri""erfactors

ifestylemodiBcation

E A lle r"enavoidance if!nown

E *ew are o fe6ercise-inducedasthma

E Avoidance o ftobaccosmo!e

%ischar"e

+tepwise mana"ement o asthma*y usin" asthma diary to record the episode o asthma attac!s, the severity and

control o asthma can be monitored as well as step up the mana"ement when

necessary. (+ee Appendi6 $)

@7ectFproblemsAsthma is a chronic disease that can a7ect an individuals lie in the biopsychosocial

aspects. *iolo"ically, asthma has a "reat impact on the 9uality o lie. %aniel maye6perience di:culty sleepin" durin" acute e6acerbation o bronchial asthma.

5hysical activity mi"ht be also a7ected as e6ercise can e6a""erate the asthma

symptoms. In term o preventin" deterioration o pulmonary unction, ade9uate

asthma mana"ement should be provided promptly to prevent permanent narrowin"

o the bronchial tubes.

5sycholo"ical problems will be more si"niBcant as %aniel "rows up especially at the

period o schoolin". here mi"ht be issue about %aniels sel-consciousness as

dependence on the inhaler mi"ht ma!e him eel that he is abnormal compared to

his riends or classmates. @ventually, reluctance o usin" inhaler will precipitate

asthma and also increase the re9uency o admission.

8rom the social aspect, recurrent clinic visit has brou"ht e6tra wor!load to %aniels

parents particularly his mother who is ta!in" care o him. 'is mother has to learn

when to "ive salbutamol inhaler to %aniel by usin" the correct techni9ue when it is

necessary. In addition, re9uent visit to clinic may also cause Bnancial burden to the

amily.


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%iscussionhe deBnitive dia"nosis o asthma re9uires history o recurrent respiratory si"ns

that shows symptoms o asthma. hereore, early detection o asthma is almost

impossible as youn" a"e children with other respiratory diseases can mimic asthma-

li!e symptoms. ;ith the actual dia"nosis o asthma, prophyla6is treatment or

asthma can be "iven and this will eventually avoid unnecessary admission to clinicor hospital. *y doin" so, Bnancial burden to the amily as well as the community can

be "reatly reduced. 8rom the aspect o health, early interventions in asthma may

secure the pulmonary unction and also improve the 9uality o lie.

Asthma 5redictive Inde6 (A5I)(G)

Castro-?odri"ue# A, et al. conducted a lon"itudinal study that shows children who

had a positive result o A5I at the a"e o below & are more li!ely to be dia"nosed

with asthma ater G year old. +i"niBcantly, >/H o the children with ne"ative result

o A5I did not have asthma ater G year old. A5I may be considered to aid the early

dia"nosis o asthma.

(/)

(1&D>

words)

?eerences1. %avidsons 5rinciple J 5ractice o =edicine. @lsevierK $010. p. GG$.

$. issauer , Clayden L. Illustrated e6tboo! o 5aediatrics. $01$. p. $D->&.&. 'ealth @ditor. 5remature *irth in!ed to Asthma, ;hee#in" in Childhood $014Mcited $01G $D AprilN. Available romO httpOFFnews.health.comF$014F01F$>Fpremature-birth-lin!ed-to-asthma-whee#in"-in-childhoodF.4. %o"aru C=, y7ene""er %, 5escatore A=, +pycher *%, Puehni C@.*reasteedin" and Childhood AsthmaO +ystematic ?eview and =eta-Analysis.American ournal o @pidemiolo"y. $014.. +cottish Intercolle"iate Luidelines etwor!. *ritish "uideline on themana"ement o asthma. $014.G. Chan" +, emans!e ?8, Luilbert ;, Lern @, Coen =', @vans =%, et al.@valuation o the =odiBed Asthma 5redictive Inde6 in 'i"h-?is! 5reschool Children.

he ournal o aller"y and clinical immunolo"y in practice.

$01&K1($)O10.101GF.aip.$01$.10.00D./. van de Pant P%, ansen =A, Plaassen @=, van der Lrinten C5, ?i!ers L,=uris ;, et al. @levated infammatory mar!ers at preschool a"e precede persistentwhee#in" at school a"e. 5ediatr Aller"y Immunol. $01$K$&(&)O$>-G4.
http://news.health.com/2014/01/29/premature-birth-linked-to-asthma-wheezing-in-childhood/http://news.health.com/2014/01/29/premature-birth-linked-to-asthma-wheezing-in-childhood/http://news.health.com/2014/01/29/premature-birth-linked-to-asthma-wheezing-in-childhood/http://news.health.com/2014/01/29/premature-birth-linked-to-asthma-wheezing-in-childhood/


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Appendi6 1

+everity o asthma

Appendi6 $

+tepwise mana"ement in children less than years

asthma case report final

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