Subjective Data Assessment
An 8-year-old child presents for continuous wheezing during the last year. The mother of the child states that they were not able to visit a doctor earlier because of the lack of money. The child as well as the mother appears disordered and anxious. During the examination, it is reported that the patient experiences dyspnea regardless of physical activity or other conditions. This paper is expected to provide differential diagnoses, treatment options, and an education plan for the given patient.
Differential Diagnoses
The primary diagnosis that can be specified for the patient is atopic asthma. According to Delfino et al. (2013), it is a chronic disease caused by the inflammation of the respiratory tract and, as a result, spasm of the bronchi, which begin to release a large amount of mucus. This prevents the normal flow of the air through the respiratory tract of a child. Asthma has the following characteristic symptoms: frequent breathing, complaints of contraction or pain in the chest area, wheezing during inspiration or exhalation, and strong retractions in the lungs (Delfino et al., 2013). The pathogenesis of atopic asthma includes dust, animal dander, pollens, food, et cetera, which leads to hypersensitivity mediated by type I immunoglobulin E (IgE). Since the majority of the above symptoms are detected in this patient, it is possible to diagnose asthma.
Two more differential diagnoses may be identified as chronic obstructive pulmonary disease (COPD) and chronic allergy. Due to the deterioration of the environment and a significant increase in respiratory infections, childhood immunity is significantly reduced (Ribeiro & Fischer, 2015). Because of this, children’s bronchial asthma and various allergic reactions are becoming more common. In order to assist the patient in overcoming the specified health condition, it is essential to focus on both short- and long-term treatment planning.
Treatment Options
Goals
Griffiths and Ducharme (2013) consider that the paramount goal of managing asthma in children is the control of their breathing by means of medications as well as the prevention of chronic complications. The elimination of wheezing and passiveness of the child should also be targeted.
Prescriptions
For short-term option, the combined anticholinergics and short-acting beta2-agonists (SABA) compose an evidence-based decision that proved to be effective (Griffiths & Ducharme, 2013). In particular, ipratropium bromide inhalation (250 mcg 3 doses per day) should be performed to alleviate the current dyspnea. As for the long-term treatment, long-acting beta2-agonists (LABA) – Albuterol 4 mg every 12 hours – is a safe and effective option (Billington, Penn, & Hall, 2016). Unlike the first group, they do not have an immediate effect on the removal of bronchial spasm and do not relieve suffocation, while aiming at minimizing inflammation in the bronchi, suppressing it, as well as reducing the number of asthma attacks or leading to their complete cessation (Xia et al., 2013).
Adverse Reactions
Deterioration of the immune system, increased heart rates, headache, and anxiety.
Interactions: Drug-Drug
The administration of Albuterol to patients receiving disopyramide should be cautious as this may potentiate the risk of developing ventricular arrhythmia increases (Billington et al., 2016).
Drug-Food
Tobacco inhalation may trigger breathing complications.
Second-Line Therapy
In case of Albuterol ineffectiveness, Indacaterol should be prescribed (Xia et al., 2013).
Educational Plan
Patient Information
To reduce the number of asthma attacks, it is necessary to minimize contacts with provoking allergens. First of all, it is critical to find out which allergens may affect this child. To do this, allergic skin tests should be performed, or the blood should be tested for antibodies to allergens. At the same, additional history should be collected to have a full picture. As noted by Delfino et al. (2013), many children develop asthma because of air pollution or continuous exposure to tobacco smoke. Avoiding factors that can provoke an attack of bronchial asthma and suffocation should be considered. Such measures as frequent cleaning in the house, removal of dust, and washing window curtains may be useful.
The education of patients and their families is an ongoing process designed to teach achieving and maintaining control over the disease. The interaction of the patient with medical specialists should be provided in order to achieve commitment to the prescribed therapy. The ability to independently use an inhaler for emergency care in case of an attack of bronchial asthma is essential for this patient. The mother should receive basic knowledge about the use of inhalers. Gradually, she should educate her child to use it independently if required. Therefore, this child should have an inhaler with a bronchodilator drug as the attack can arise suddenly.
Dietary / Lifestyle Recommendations
In addition to medical treatment, there are also other methods of asthma treatment in children. For example, physical training and breathing exercises with the use of special equipment may be used. A child suffering from bronchial asthma needs dietary nutrition. Parents can keep a special diary where all the foods eaten by the child during the day will be recorded. Comparing the food received and the appearance of seizures, it will be possible to identify any food allergens affecting the child.
References
Billington, C. K., Penn, R. B., & Hall, I. P. (2016). β 2 Agonists. In C. P. Page & P. J. Barnes (Eds.), Pharmacology and Therapeutics of Asthma and COPD (pp. 23-40). London, UK: Springer.
Delfino, R. J., Staimer, N., Tjoa, T., Gillen, D. L., Schauer, J. J., & Shafer, M. M. (2013). Airway inflammation and oxidative potential of air pollutant particles in a pediatric asthma panel. Journal of Exposure Science and Environmental Epidemiology, 23(5), 466-473.
Griffiths, B., & Ducharme, F. M. (2013). Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Paediatric respiratory reviews, 14(4), 234-235.
Ribeiro, J. D., & Fischer, G. B. (2015). Chronic obstructive pulmonary diseases in children. Jornal de Pediatria, 91(6), 11-25.
Xia, Y., Kelton, C. M., Xue, L., Guo, J. J., Bian, B., & Wigle, P. R. (2013). Safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma. Therapeutic Advances in Drug Safety, 4(6), 254-263.