Final group 3 a case presentation on asthma Causea of asthma Symptoms of asthma Diagnosis of asthma Management of asthma

1. A CASE PRESENTATION ON
ASTHMA
Group 3
1

2. PRESENTATION OUTLINE
• PATIENT’S PROFILE
• TREATMENT REVIEWS
• PHARMACEUTICAL CARE ISSUES
• RECOMMENDATIONS AND MEDICATION ASSESSMENT
• TREATMENT OUTCOME
• REFERENCES
2

3. PATIENT’S PROFILE
PATIENT’S INITIALS A.F
AGE 10years
SEX M
DOB 21-09-2012
ADMISSION DATE 21-08-2023
WEIGHT 27KG
3

4. Patient Profile cont’d
• Presenting complaint
1. chest pain
2. difficulty breathing
4

5. History of Presenting Complaint
• Patient was diagnosed of asthma at the age of 8. He has been on
salbutamol inhaler reliever for 1 year and Seretide inhaler for 6 months
• He was recently admitted to the facility at least 7 times this month with
the said presenting complaint and was nebulized each time with
salbutamol + ipratropium bromide + Pulmicort.
• Patient was admitted 5 days ago and was managed as an acute asthma
exacerbation induced by pneumonia.
5

6. ODQ
The following were present ;
1. Chest pain
2. Difficulty breathing
6

7. Patient History
Social history : Patient lives with the parent
Past medical history : Asthma
Family history : NIL
Past drug history: salbutamol inhaler, seretide, cefixime, susp Azithromycin, tab
omeprazole, prednisolone, symbicort
Allergies: No known allergies
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8. PHYSICAL EXAMINATION VALUES / RESULTS FLAG
SpO2- 98% Normal
Respiration Rate 25 CYCLES Per Min Normal
Pulse 61BEATS Per Min RECHECKED IS 57 Normal
Temperature 36.7℃ Normal
Respiratory examination No chest wall deformities, air entry was
adequate. Bilaterally breath sounds
vesicular with no added sounds.
Normal
Abdominal examination Abdomen moves with respiration, full,
soft, nontender, the two kidneys were not
bimanually ballotable. Bowel sounds were
present and at good pitch.
Normal
8

9. Investigations cont’d
Full Blood
count
Results Reference Unit Flag
HB 14.4 11.5-17.0 g/dl Normal
HCT 42.0% 37-54% % Normal
MCV 86.1 80-100 fl Normal
Total WBC 7.13 4.0-10.0 106/µL Normal
PLt 158 150.0-500 /µL Normal
9

10. Investigations
Result Reference Unit Flag
BUE+ CR
SODIUM
134 [135 - 145] mEQ/L low
POTASSIUM 3.3 [3.5 - 5.0] mmol/L low
Urea 5.6 [45.0 -
115.0]
mmol/L low
BF No MPS
Seen
10

11. Medical Problems
• Asthma
• Pneumonia
11

12. Current Medications
Medication
& strength
Route of
administrati
on
Start date Dose Indication End date
Tab Cefixime
200mg
oral 21/08/2023 200mg BD 7/7 Community
acquired
pneumonia
27/08/2023
SUSP
Azithromycin
300mg
oral 21/08/2023 300mg OD for
2/7
Community
acquired
pneumonia
22/08/2023
Tab
omerprazole
20mg
oral 21/08/2023 20mg OD 3/7 - 23/08/2023
Susp Nugel O Oral 21/08/2023 5ml BDS 7/7 - 27/08/2023
12

13. CURRENT MEDICATIONS CON’D
MEDICATION
AND STRENGTH
ROUTE OF
ADMINISTRATIO
N
START DATE DOSE, DOSAGE INDICATION END DATE
Oral
Prednisolone
27mg
oral 21/08/2023 27mg OD 3/7 To control
symptoms of
asthma
23/08/2023
Symbicot Orally inhaled
route
21/08/2023 160mg/4.5mcg As a reliever and
a controller of
asthma
symptoms
27/08/2023
Ventolin Orally inhaled
route
- PRN To relieve acute
exacerbation of
asthma
-
13

14. Pharmaceutical Care Issues
• Medication without indication - Tab Omeprazole 20mg, Susp Nugel O
• Inappropriate selection of medication- Cefixime for pneumonia
• Non-compliance to the Seretide inhaler medication
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15. PHARMACEUTICAL CARE
PLAN
(SOAPO)
15

16. OPTIMIZING THE TREATMENT OF ACUTE
EXACERBATION OF ASTHMA
SUBJECTIVE DATA
• Chest pain
• Difficulty breathing
OBJECTIVE DATA
• Patient is a known asthmatic
16

17. ASSESSMENT
CONFIRMATION OF DIAGNOSIS
• According to the GINA Guideline(2023), Asthma causes respiratory
symptoms such as wheezing, shortness of breath, chest tightness and
cough that vary over time, including their frequency and intensity.
• The patient is a known asthmatic since age 8 and from the subjective
data of difficulty breathing and chest pain, the diagnosis of asthma
can be confirmed
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18. ASSESSMENT OF MEDICATION
AZITHROMYCIN 300mg OD for 2 days
• Azithromycin is a macrolide antibiotic indicated for treatment of community-
acquired pneumonia due to implication with atypical organisms such as
Chlamydophila pneumonia, Mycoplasma pneumoniae, or Legionella pneumonia.
• Azithromycin binds to 50S ribosomal subunit of susceptible microorganisms and
blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-
dependent protein synthesis.
• According to the GINA guidelines(2023), Azithromycin is also given as an
add on therapy to control acute exacerbations of Asthma
• According to the STG (2017), the dose of Azithromycin for children is
10mg/kg once daily hence the dose, frequency and route of
administration is appropriate.
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19. ASSESSMENT OF MEDICATIONS CONT’D
CEFIXIME 200MG BD FOR 7DAYS
• Cefixime is a third- generation oral cephalosporin with broad activity against
sensitive gram-negative and gram positive bacteria; by binding to 1 or more
penicillin-binding proteins, it arrests bacterial cell-wall synthesis and inhibits
bacterial growth.
• According to the Standard Treatment Guideline (STG) Cefixime is not indicated as
the first line treatment for the management of Community Acquired Pneumonia
hence the choice of medication is not appropriate.
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20. CONT’D
SYMBICOT 160MG/ 4.5MCG
• Symbicort is composed of an inhaled corticosteroid( budesonide) and long-acting beta2-
agonist(formoterol) indicated for the management of asthma. The formoterol has a fast
onset with a long duration and the budesonide act as the inhaled corticosteroid hence it
is used as a reliever and a controller
• From the GINA guidelines(2023), possible controller options include taking ICS
whenever SABA is taken and from research has shown fewer exacerbations compared to
SABA alone treatment of asthma.
• According to the STG (2017), for children, Salbutamol nebulized is given at 2.5-5 mg
every 2-4 hours until symptoms improve hence the dose, frequency and route of
administration is appropriate.
20

21. CONT’D
IPRATROPIUM BROMIDE
• Ipratropium is an acetylcholine antagonist via blockade of muscarinic
cholinergic receptors.
• Ipratropium bromide helps to open up the airways, reduce inflammation
and provide rapid relief from symptoms hence its use as an emergency
treatment for the relief of acute exacerbations of asthma
• According to the Standard Treatment Guideline (2017), nebulized
ipratropium is used to treat acute asthma. The dose and regimen is
appropriate.
21

22. MEDICATIONS CON’D
PARACETAMOL
• Paracetamol is used as a supportive treatment in patients with
asthma and pneumonia due to its ability to reduce fever and provide
pain relief.
• According to STG 2017, paracetamol is used in the management of
asthma amidst pneumonia and it's dosage and frequency provided is
appropriate.
22

23. PLAN
• GOALS OF THERAPY
To optimize control of asthma symptoms and reduce the risk of
asthma exacerbation.
1. To relieve chest pain
2. To relieve dyspnea
23

24. INTERVENTIONS/RECOMMENDATIONS
NON-PHARMACOLOGICAL MANAGEMENT
1. The child should be made aware of his triggers and minimize contact
with them.
2. The parent and child should be educated on adherence to the
medications.
3. The child should always have his inhaler with him all the time.
4. The child should report to the hospital for regular checkup.
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25. PHARMACOLOGICAL MANAGEMENT
• Replace cefixime with Amoxicillin
• According to the STG, the evidence based treatment for community
acquired pneumonia in children is Amoxicillin 500mg 8 hourly for
7days and Azithromycin 10mg/kg daily for 6days
• Omeprazole and Nugel O should be discontinued
25

26. MONITORING
MEDICATIONS EFFICACY TOXICITY
SYMBICORT To relieve and control asthma
attacks
Oral thrush
TAB AZITHROMYCIN To treat atypical organisms
implicated in pneumonia
Nausea, abdominal discomfort and vomiting
IPRATROPIUM BROMIDE Relax airway muscles and improve
breathing
Dry mouth, throat irritation,
PARACETAMOL To treat mild to moderate pain and
fever associated with pneumonia
Liver damage
OMEPRAZOLE Acid suppression in the GI Hip fracture, abdominal pain, acid regurgitation.
SUSP NUGEL O To manage dyspepsia Dry mouth, constipation.
CEFIXIME Bronchitis Abdominal pain, dizziness
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27. COUNSELLING
The child’s parent should be educated on;
• The child’s triggers and how to avoid them
• The need to carry short-acting inhalers at all times
• Appropriate procedure in administering the inhaler
• Adherence to all given medications
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28. OUTCOME
• Patient is not in any respiratory distress
• Patient has a normal breathing pattern
• Patient airway is patent and clear
• The patient has been discharged
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29. REFERENCES
• Standard Treatment Guideline (2017). Ministry of Health (6th Ed.). Ghana National Drug
Program. Pages 176-178.
• BNF (2019). British National Formulary (Vol. 76): Royal Pharmaceutical Society,.
• Reddel HK,Bacharier LB,Bateman ED,et al.Global Initiative For Asthma(GINA) Strategy 2023-
Executive Summary and Rationale For Key Changes.Eur Respir J 2023;in
press(https://doi.org/10.1183/13993003.02730-2021)
• DIPIRO J., TALBERT R. L. Pharmacotherapy: A Pathophysiologic Approach, 7thEdn., McGraw-Hill
Prof Med/Tech, 2011 ISBN: 0071784993, 9780071784993. Chapter 28, pp. 463-49
• The global asthma report(2014). Aukland, New Zealand: Global Asthma Network; 2014. 92.
retrieved from https://www.globalasthmareport.org/resources on 09/02/2023 at 4:53pm
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30. GROUP MEMBERS
NAMES INDEX NUMBERS
SENYO COURAGE EDEM UHAS20204898
OWUSU JACQUELINE UHAS20208311
OSEI TONY KOFI UHAS20200839
GYAN MARY UHAS20207626
BOTWE PRINCE KWABENA UHAS20205098
OWUSU SARAH POKUA UHAS20202258
AMOAH GODFRED UHAS20206622
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