CHEST CLINICAL COPD & ASTHMA IMMERSION PROGRAM - AUGUST 14, 2024-Severe Asthma PBL

Severe Asthma PBL

Pdf Summary

This Problem Based Learning exercise focuses on understanding asthma phenotypes and identifying patient characteristics and biomarkers relevant for phenotyping asthma patients. The case involves a 54-year-old Black woman referred for uncontrolled asthma symptoms. Her condition worsened over the past two months, with increased frequency of albuterol use and nocturnal symptoms. Despite a recent prednisone course, her symptoms persist.<br /><br />Key points to consider:<br />- She was diagnosed with asthma at age 45.<br />- Symptoms include productive cough, dyspnea, and chest tightness, with no clear triggers, though environmental changes (e.g., new carpet and neighbors' cat) could be factors.<br />- Co-morbidities: hypertension and hypothyroidism managed with ARBs and levothyroxine.<br />- Family history: her mother and son also have asthma.<br />- Recent stress due to job loss and family conflicts.<br /><br />Physical examination findings:<br />- Afebrile with normal vitals, O2 saturation at 97%.<br />- Clear nasal turbinates, erythematous posterior oropharynx, and bilateral mild expiratory wheezing.<br />- Blood tests show a WBC count of 7.0 and an absolute eosinophil count of 180.<br /><br />Pulmonary function tests:<br />- Prebronchodilator FEV1/FVC ratio of 63.<br />- Prebronchodilator FEV1 improved from 72% to 88% post-albuterol.<br /><br />Discussion points include:<br />1. Additional history inquiries about symptom triggers, past medical treatments, environmental factors, and medication adherence.<br />2. Physical examination findings to note (e.g., signs of oral/pharyngeal erythema, wheezing).<br />3. Interpretation of pulmonary function tests suggesting reversible airway obstruction, typical in asthma.<br />4. Importance of family history emphasizing potential genetic predisposition.<br />5. Recommendations for additional testing, including allergy testing, IgE levels, and potentially a chest X-ray or high-resolution CT to rule out other conditions.<br /><br />Additional testing for comprehensive asthma management could include fractional exhaled nitric oxide (FeNO) for airway inflammation, sputum eosinophils, and consideration of a biologic therapy based on phenotype. Addressing environmental control (e.g., allergen reduction), stress management, and medication review may help reduce exacerbations.

Keywords

asthma phenotypes

patient characteristics

biomarkers

uncontrolled asthma

environmental factors

pulmonary function tests

family history

allergy testing

biologic therapy

stress management