A 48-year old female patient presented with breathlessness, chest tightness, and cough with expectoration for one day. Her medical history noted these symptoms for 7 days. On examination, she had an elevated pulse, respiratory rate, hemoglobin, red blood cell count, white blood cell count, and eosinophils. A spirometry test found her FEV1 to be 62% of expected. She was diagnosed with an acute exacerbation of asthma and prescribed bronchodilators, antibiotics, leukotriene inhibitors, and vitamins supplements over 5 days.

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+clavul
anicacid)
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.
Plenty 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.