October Week 4: Asthma




Part One: You are seeing a 7 year old boy for a sick visit at 8:00 am on a Friday morning for cough. Mom states that he has had chronic, dry cough for the past 2 months. She notices his cough when he gets home from playing after school. He has had no congestion/rhinorrhea, fevers, decreased oral intake or vomiting. She has taken him to urgent care several times, and been told he has a virus. On exam, he has equal breath sounds and is clear to auscultation bilaterally without wheezes, crackles or rhonchi.

What additional information would you want to know?

After additional questioning you find that he playing less during recess, and after school because he feels tired and is having trouble catching his breath. There is a strong family history of asthma on paternal side, but the patient has never wheezed before.

1. What is in your differential diagnosis for wheezing?
2. What would you recommend for this child? What follow up would you give them?
3. What changes to home environment might you discuss?
4. What are the different classifications of asthma, and how do you differentiate them?
5. At what point would you escalate medical therapy, and with what?

Part Two: Your patient initiates treatment and is doing well. Several months later his mother calls and says he seems to be having coughing episodes again, now they are occurring in the night as well, about once a week to once every other week.

6. Would you make any changes to his management?
7. Do you know how to input an asthma action plan into a Centricity chart?
8. What is the risk of death in asthma?