PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENT AT GP PRACTICE
Prescribing and Assessing For Asthmatic Adult at GP Practice
Paige J is a joyous mother of three. She is from the Hispanic ethnic group who works as a receptionist at a five-star hotel. Paige J has a huge passion for cats, and she was diagnosed with asthma in the last five years.
Paige J claims that what triggers her Asthma is the exposure to dust, pollen, and animals like dogs and cats, which she likes spending time with when at home. When Paige spends some minutes or hours with her cat, for example, she ends up waking up at the night hours with terrible Asthma and tightness of the chest. She does not talk during asthma attacks because talking makes her struggle a lot. She uses mostly her rescue inhaler, and just in case she does not have it, she tries to get some fresh air or drink some chocolate. She also has prescribed medicine, which she uses in case of an attack. Her attacks happen during the night. Paige denies being a smoker. Her asthma is classified as mild persisted, where the symptoms can reveal themselves twice in a week, but not more than one is a day. Paige J has been referred to me as a general practitioner because I have a good past medical history of treating patients with asthma.
Past Medical history
Paige J Asthma manifested itself in the last five years. She has been using an inhaler in case of attacks. Most of her attacks happen during the night. She has been using inhaled corticosteroids (Qnasi, Qvar). She also medicated with long-acting beta-agonists serevent. She has never used allergy medications
Wheezing-high pitched whistling sound when breathing out, airway obstruction syndrome, she experienced panic fear, and she had fatigue signs. After an asthma attack, she is not able to work the following day and do her daily chores. She cannot do tasks that her demanding, and she has added significant weight.
Paige J complains that she has been to many health Centres, and she has not got any significant help, which has increased her psychological problems like stress, anxiety with some point of depression. Paige J also complains that the medication, which she has been using (with long-acting beta-agonists Serevent), has not helped despite spending large amounts on the drugs.
More tests were needed to measure Paige lung function to find out how air moved in and out during breathing. The spirometry test was 69%. The normal range should be more than 80% Paige reacted to methacholine in the first lung function test. The nitric oxide test indicated 50 parts per billion. A normal range should be 25-30 parts per billion. Sputum eosinophils were at 5%. The normal range should be 3%. From observation, she had hives and itchy skin. Her skin was a bit swollen. From the result, Paige had mild intermittent asthma.
Assessment – Medicines Optimization
The drug-related problems (DRPs) identified in this case were:
- The Qvar inhaled corticosteroids made Paige have stomach upsets, stuffy nose, sore throat nausea at some times. The long-acting beta-agonists (Serevent) have little impact on Paige.
- There was a need to pre-describe both Qvar inhaled corticosteroids and the long-acting beta-agonists (Serevent).
Change of medicine was needed and the immediate start of allergic medication. I prescribed her Ipratropium (Atrovent) medicine, which acts quickly to immediately relax airways and make it easier to breathe. For long-term medication, I prescribe Paige J the flunisolide inhaled corticosteroids, which have reduced the risk of side effects when used for a very long time. For her allergy medication, I prescribed her allergy shots immunotherapy, which is very best in reducing the immune system reaction to dust, cats and pollen allergens. The only side effect of allergy shots is swelling at the point of injection. The allergy shots are outstanding in treating allergies, and they consequently prevent the development of new allergies. Paige J had no problems adhering to the medication instructions. The previous medication had been inappropriately prescribed to Paige since it was not helping her. This was because Qvar inhaled corticosteroids, and Serevent long-acting beta-agonists both solve a similar problem and used together; the result interaction can lead to reduced absorption of either the drugs.
Ipratropium (Atrovent) medicine
Henderson (2017) does a research on 66 asthmatic patients indicated that Ipratropium bromide Atrovent had pharmacology effects leading to a high degree of activity and a specific bronchoselectivity if administered intravenously. Evidence indicates that it is the best for routine administration with small doses, which lead to the opening of airways without resulting in anticholinergic side effects. The pharmacology properties of this drug are that it “blocks the muscarinic cholinergic receptor in the smooth muscles of the bronchi in the lungs.” This medicine would work for Paige to improve her lung function, which had a Spirometry test which very low than normal. Patients with other co-morbidities like diabetes can use this medication.
Flunisolide inhaled corticosteroids
Evidence indicates that flunisolide is very useful in preventing, controlling asthma symptoms especially the wheezing, and the shortness of breath, which results from asthma (Choby & Lee, 2015). The drug works closely with lungs making breathing easier. “American Academy of Allergy Asthma & Immunology” (AAAAI) has a set guide for the use of this drug. The pharmacological properties of Flunisolide are that it undergoes very quick and intensive first-pass metabolism (Watts et al. 2019).
Allergy shots immunotherapy
Evidence-based studies indicate that allergy shots were effective for treating all year round and indoor allergies (Schroer & Aalberse, 2018). AAAAI has set out the guidelines used for this medication.
I recommended Paige to stop using her previous medication immediately once she begins using the new prescribed drugs. I also recommend that she should have more air conditioners in her house. I also recommended that she should avoid her cat even though she has a huge passion for cats. The change in asthma symptoms has to monitor closely in the first month and medicine adherence. I agreed with Paige J to have weekly visits at her home as one way to follow up. Phone calls would also be used to determine her progress.
Paige was happy with this treatment plan, especially the idea of treating her allergic conditions, which she never thought was a significant issue that needed medication. This treatment plan was much more than she expected. I kept Paige’s medical chart for a future treatment plan. We agreed that she should call me whenever she had any questions or issue regarding her asthmatic condition. Paige did not have team-based care since she did not have comorbidities related to her asthma.
Choby, G. W., & Lee, S., 2015. Pharmacotherapy for the treatment of asthma: current treatment options and future directions. In International forum of allergy & rhinology (Vol. 5, No. S1, pp. S35-S40).
Henderson, L. 2017. Prehospital use of ipratropium bromide paired with salbutamol as treatment for shortness of breath. [Online] https://emspep.cdha.nshealth.ca/ProtocolImages/LHenderson%20CAT.pdf. Accessed 28 October 2019
Schroer, B. and Aalberse, R.C., 2018. Clinical Allergy at the Interface of Sticky Dust Particles and Crystal-Clear Proteins. The Journal of Allergy and Clinical Immunology: In Practice, 6(6), pp.1866-1868.