A case study on bronchial asthma

It may serve the academic needs of medical & pharmacy students

1. BY 09408103 3-04-2014 CASE STUDY ON ASTHMA

2. A 48 yrs old female patient was admitted in the hospital with C/O breathlesness severe for the past one day Chest tightness Cough with expectoration HISTORY OF PRESENT ILLNESS Breathlessness since 7days Cough with expectoration since 7days PAST MEDICAL HISTORY Nil

3. PHYSICAL EXAMINATION Patient is conscious,oriented,dyspenic O/E Temp-98.6F Pulse-120 beats/min BP-90/70mmHg RR-25 breaths/min SYSTEMIC EXAMINATION CVS-S1S2+ RS-Wheeze+ CNS-NFND+ P/A-Soft

4. LAB INVESTIGATIONS Hb 16.0( ↑ ) 12-15.5g/dl RBC 5.6*× 10ᶺ 6( ↑ )/UL 4.2-5.4×10ᶺ6/UL ESR 25( ↑ ) 5-15mm/hr TOTAL WBC 15.00×10ᶺ9/L( ↑ ) 4.0-11.0×10ᶺ9/L DC N-71 L-23 E-10( ↑ ) 1-6%

5. OTHER TESTS Spirometry IMPRESSION 62% of FEV1 was detected DIAGNOSIS Acute exacerbations of Asthma

6. DRUG DOSE ROA FREQUENCY DURATION T.UNICONTINE (Theophylline) 1 tab PO BD 5days INJ.AUGMENTIN ( Amoxicillin+clavulanicacid ) 1.2gm IV BD 3days T.MONTAK LC ( Monteleukast + Levocetirizine ) 4 mg+2.5 mg PO BD 5days NEB.IPRAVENT (Ipratropium bromide) 1resp PN TDS 5days T.LYCOLUT ( MV,Ca,Fe+FA ) 1tab PO OD 5days T.MAHACEF ( Cefixime ) 200mg PO BD 2days

7. CRITICAL ANALYSIS OF PRESCRIPTION MEDICATION ERRORS No medication errors were found DRUG INTERACTIONS Theophylline↔Food ( Caeffine containing food)- May increase the serum concentrations of theophylline PHARMACIST INTERVENTION Patient was advised to avoid co-administration of theophylline with caeffine containing foods ..like coffee

8. PATIENT COUNSELLING REGARDING DISEASE ASTHMA-  is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm  Symptoms include wheezing, cough, chest tightness, and shortness of breath. 

9. REGARDING DRUGS Full course of antibiotics should be taken Don’t miss any dose Avoid taking theophylline with caeffine Any seizures ,nausea ,coughing up of blood etc if seen are side effects of theophylline and if she experienced it should be stopped While inhaling ipratropium bromide, it should be prevented from going into eyes,since it can cause irritation and blurred vision. After inhalation the patient should clean her mouth to avoid throat irritation and dry mouth.

10. REGARDING LIFE STYLE MODIFICATION Avoid vigorous exercises,and cool places since can cause asthma. P lenty of water should be taken since they keep body’s cells functioning properly, and helps keep the mucus in the airways loose. Eight glasses of water a day is recommended.

11. Healthy food choices include: adding more fruits and vegetables,avoid spicy and cold food, fried items as they can cause cough. When you feel out of breath, or become tired, stop what you’re doing and sit down. Rest helps to keep your airways relaxed, and allows you to breathe easier. Exercises like morning walk and yoga should be done regularly as they can improve breathing. Avoid getting in contact with substances like dust,flowers,animal,cigarette smoke,fog etc.

12. SOAP NOTES S A 48 year old female patient was admitted in hospital with complaints of breathlesness,cough,chest tightness O On examination patient was dyspenic and pulse rate,Hb,RBC,TWBC,Eosinophills were found to abnormal.Spirometry was done and found to have 62% FEV1 A Based on the above findings and spirometry test, the patient was assessed to have Acute exacerbations of asthma P Patient was treated with Bronchodilators,antibiotics,leukotriene inhibitors and vitamin supplements.