The purpose of this post is to discuss the medications appropriate to address symptoms of asthma in John, a 21-year-old male who is interested in running. The clinical problem is that John suffers from asthma in the form of a dry non-productive cough that is observed for about twelve weeks and worsens at night. Clinical goals include reducing a night cough and preventing asthma attacks when running. In this case, non-pharmacological interventions include avoiding secondhand smoke, viral infections, and allergens that could provoke asthma when John was a child. Exercising, including running, should be controlled and modified according to John’s needs.
Clinical practice guidelines selected for managing asthma symptoms were developed by specialists of the National Asthma Education and Prevention Program’s expert panel supported by the U.S. Department of Health and Human Services and the National Heart, Lung, and Blood Institute, and they were revised in 2012. The conclusions provided in the guidelines are based on the results of a systematic review of clinical trials (National Heart, Lung, and Blood Institute, 2012). The evidence is strong, and these clinical guidelines can be applied to treating children and adults.
While considering the patient’s age, comorbidities, the interest in running, and the frequency and severity of asthma symptoms, it is possible to propose using low-dose inhaled corticosteroids (ICSs) on a regular basis (Bårnes & Ulrik, 2015). The prolonged character of symptoms indicates that the patient requires long-term control medications, and fluticasone propionate is an effective ICS for this case (Lee et al., 2015). Flovent HFA (fluticasone propionate) is selected as a medication for John because it guarantees controlling and preventing asthma symptoms (Teodorescu et al., 2014). As a result, the frequency of symptoms will decrease significantly, and the quality of John’s life will increase. For this case, the use of short-acting beta2-agonists (SABAs) is inappropriate because the patient requires preventing and controlling his day and night cough (Woo & Robinson, 2016). The appropriate dosage is 88 mcg (two puffs) twice a day. It is a starting low and safe dose to prevent any side effects (Daley‐Yates, 2015). Flovent HFA (44 mcg) costs about $120, and it can be bought at Walmart and Target.
During the first two weeks, it is possible not to observe significant positive changes in the patient’s state. If there are no improvements after two weeks, it is important to increase the dose to 110 mcg per actuation. Side effects of Flovent HFA are minimal, and they include throat irritation, dry mouth, and headache. These symptoms are not prolonged. Still, if the patient reports skin rash, oropharyngeal candidiasis, increases in the heartbeat, white patches in his mouth, and wheezing, it is important to change the medication (Daley‐Yates, 2015; Teodorescu et al., 2014). Fluticasone propionate cannot be used with immunosuppressants and steroids because of drug-drug interactions.
Before taking Flovent HFA, the patient should be educated regarding the following points:
- After orally inhaling the substance, it is important to rinse the mouth to avoid the development of oropharyngeal candidiasis;
- The symptom relief can be unobserved during 1-2 weeks from starting the medication;
- The patient can continue running, but he should use a SABA (a rescue inhaler) to prevent asthma attacks and receive a quick relief (Bårnes & Ulrik, 2015).
Bårnes, C. B., & Ulrik, C. S. (2015). Asthma and adherence to inhaled corticosteroids: Current status and future perspectives. Respiratory Care, 60(3), 455-468.
Daley‐Yates, P. T. (2015). Inhaled corticosteroids: Potency, dose equivalence and therapeutic index. British Journal of Clinical Pharmacology, 80(3), 372-380.
Lee, L. A., Yang, S., Kerwin, E., Trivedi, R., Edwards, L. D., & Pascoe, S. (2015). The effect of fluticasone furoate/umeclidinium in adult patients with asthma: A randomized, dose-ranging study. Respiratory Medicine, 109(1), 54-62.
National Heart, Lung, and Blood Institute. (2012). Asthma care quick reference: Diagnosing and managing asthma. Web.
Teodorescu, M., Xie, A., Sorkness, C. A., Robbins, J., Reeder, S., Gong, Y.,… Hind, J. (2014). Effects of inhaled fluticasone on upper airway during sleep and wakefulness in asthma: A pilot study. Journal of Clinical Sleep Medicine, 10(2), 183-189.
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). Philadelphia, PA: F. A. Davis Company.