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Case Study on Asthma

SN is a 25-year-old female who is admitted to the emergency department.

PMH: asthma
DH: Salbutamol inhaler two puffs three times daily
Beclometasone 200 g/puff inhaler two puffs twice daily
PC: Chest Tightness, exhaustion
O/E: Pulse >110 bpm
Respiration rate >25 breaths/minute
Diagnosis: Exacerbation of asthma
SN was hospitalized and the following therapy started:
Oxygen 60%
Salbutamol nebuliser 2.5 mg four times daily
Hydrocortisone intravenous 200 mg every 6 h
Cefuroxime intravenous 750 mg every 8 h
Clarithromycin tablets 500 mg twice daily
Beclometasone inhaler two puffs twice daily

Directions: These questions involve cases. Read the case description or patient profile
and answer the questions. For each of the questions below, ONE or MORE of the
responses is (are) correct. Decide which of the responses is (are) correct. Then choose:
A. if i, ii and iii are correct
B. if i and ii are correct
C. if ii and iii are correct
D. i only
E. iii only

1. In an asthmatic attack the following condition(s) occur(s)

I. bronchospasm
II. increased airways resistance
III. inflammation
2. Inflammatory mediators that are released in an asthmatic attack include:
I. histamine
II. leukotrienes
III. prostaglandins

3. Drugs that may provoke an asthmatic attack in SN include:

I. Diclofenac
II. atenolol
III. timolol
4. Signs and symptoms in SN of an acute severe asthma attack include:
I. Tachycardia
II. Tachypnoea
III. Exhaustion
5. Salbutamol nebuliser is used in combination with oxygen because:
I. It may mask symptom severity
II. Aggressive treatment is required
III. It may cause arterial hypoxaemia
6. Parameters that require monitoring in SN include:
I. Urinary flow
II. Blood gases
III. Plasma-potassium concentration
7. If SNs condition does not improve after 30 minutes, the following may
be added to the drug therapy:
I. nebulised ipratropium
II. intravenous aminophylline
III. nebulised amoxicillin
8. Intravenous hydrocortisone is indicated in SN:
I. To avoid anaphylactic shock
II. For its mineralcorticoid effects
III. To inhibit the production and release of pro-inflammatory Agents
After 24 h SN is reviewed and the following changes are made to the drug
Stop hydrocortisone intravenous
Start prednisolone tablets 20 mg daily
Change frequency of administration of salbutamol nebuliser to three times daily
9. Prednisolone:
I. Should replace beclometasone inhaler
II. Suppresses cortisol secretion
III. Has predominantly glucocorticoid activity
10. When administering prednisolone:
I. It should be taken after food
II. Enteric-coated formulation is preferred
III. Dose should be divided into twice daily administration

11. Nebulisers:
I. are devices producing an aerosol from an aqueous solution
II. should be washed out to avoid microbial growth
III. salbutamol injection solution is used to administer salbutamol by nebulisation
12. Beclometasone inhaler:
I. is more effective than budesonide
II. may be used to control an attack
III. may cause oral candidiasis
13. Long-term inhalation of high doses of beclometasone may predispose
Patients to:
I. Osteoporosis
II. hoarseness
III. Hypertension
14. Salmeterol:
I. is longer-acting than salbutamol
II. may be used in combination with beclomethasone
III. could replace salbutamol use

15. SN could be counseled on signs indicating exacerbation of the Condition. She could
be advised to report:
I. Decrease in exercise tolerance
II. Increased requirements for salbutamol inhaler
III. Increasing peak expiratory flow