Aquifer Case Study Week 1 Pediatrics 13 Moderate Persistent

Aquifer Case Study Week 1 Pediatrics 13 Moderate Persistent Asthmauni

This case study describes a six-year-old girl, Sunita Patel, presenting with persistent cough symptoms that have lasted for eight weeks. She has a history of eczema, nasal congestion, and family history of asthma. The clinical picture suggests a working diagnosis of moderate persistent asthma, supported by her clinical signs, history, and physical examination findings. Differential diagnoses such as allergic rhinitis and chronic sinusitis are considered but appear less likely based on her presentation.

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Introduction

Sunita Patel, a six-year-old girl, presents with an eight-week history of persistent cough, worse at night and triggered by cold air and exercise. Her history of eczema, nasal congestion, and family history of asthma predispose her to a diagnosis of asthma, specifically the moderate persistent type. The goal of this paper is to analyze her case comprehensively, considering all relevant diagnostic and therapeutic approaches, supported by current evidence-based guidelines. The main diagnosis is supported by her clinical presentation, while differential diagnoses such as allergic rhinitis and chronic sinusitis are evaluated and ruled out based on specific findings.

Clinical Evaluation and Differential Diagnoses

The clinical history indicates a chronic cough with nocturnal exacerbation, end-expiratory wheezing, and associated eczema—all classic features of asthma. Physical examination reveals pale, edematous turbinates with nasal congestion, which might suggest allergic rhinitis, a common comorbidity but not the primary pathology. The absence of fever, shortness of breath, or wheezing outside the trigger contexts diminishes the likelihood of pneumonia or other infections. Her family history of asthma further supports the asthma diagnosis.

The differential diagnoses considered include allergic rhinitis and chronic sinusitis. Allergic rhinitis is characterized by nasal congestion, sneezing, and an allergic mucosa, which fits her presentation. Chronic sinusitis typically involves persistent nasal discharge and facial tenderness, which are not evident here. However, her symptoms are most consistent with asthma, especially given the nocturnal and exercise-related triggers, and the clinical response to asthma medications confirms this.

Diagnostic Plan

The primary diagnostic tool for asthma in children older than five is spirometry, which measures airway obstruction and reversibility after bronchodilator use. This aligns with guidelines by the Global Initiative for Asthma (GINA) (GINA, 2023). An initial chest X-ray can rule out other pulmonary conditions, especially if atypical features or suspicion of foreign body or infection arise. Allergy testing can identify specific sensitivities, supporting environmental trigger reduction strategies (Cash & Glass, 2020). Blood tests like a complete blood count (CBC) can assess eosinophilia, which correlates with allergic asthma. Peak expiratory flow measurements may also help in monitoring her lung function over time.

Key tests include:

• Spirometry to assess airflow limitation and response to bronchodilators (Ghezzo et al., 2020).
• Allergy skin or blood testing to identify triggers (Cash & Glass, 2020).
• Chest X-ray to exclude other pulmonary causes if indicated (Ghezzo et al., 2020).
• Pulse oximetry during episodes if symptoms worsen.

Treatment and Management Plan

The cornerstone of asthma management involves a stepwise approach tailored to severity. For moderate persistent asthma, inhaled corticosteroids (ICS) are first-line controllers, with a short-acting beta-agonist (SABA) like albuterol for symptom relief (GINA, 2023).

Medications include:

• Inhaled corticosteroid (e.g., Budesonide) 90 mcg inhaled BID—this reduces airway inflammation effectively (Agabegi & Agabegi, 2020).
• Rescue inhaler: Albuterol (Ventolin HFA) 90 mcg, 2 puffs q4-6 hours as needed, with proper spacer use education (Cash, Glass, & Mullen, 2021).

In addition, the plan must include:

• Patient and family education on trigger avoidance—pets, cold air, dust, and scents (Agabegi & Agebegi, 2020).
• Establishing an asthma action plan based on symptom severity, utilizing the NIH three-zone system—green, yellow, and red zones (CDC, 2020).
• Regular follow-up to monitor lung function and adherence, with adjustment of medication step according to control levels (GINA, 2023).

Environmental control involves reducing exposure to allergens like pet dander, dust mites, and mold, which are exacerbated by her domestic environment with carpets and a dog. Education on correct inhaler and spacer techniques ensures proper drug delivery. Seasonal or environmental triggers should be avoided as much as feasible.

Conclusion

In summary, Sunita Patel’s clinical presentation is most consistent with moderate persistent asthma, supported by her history, examination, and response to therapy. The diagnostic approach includes spirometry and allergy testing, which will further confirm the diagnosis and guide targeted management. A comprehensive treatment plan focusing on pharmacotherapy, trigger avoidance, patient education, and regular follow-up aligns with current guidelines and offers the best prognosis for symptom control and quality of life improvement.

References

• Agabegi, S., & Agabegi, E. (2020). Step-up to medicine (5th Ed.). Wolters Kluwer.
• Centers for Disease Control and Prevention. (2020). Asthma action plans.
• Cash, J. C., Glass, C. A., & Mullen, J. (2020). Family practice guidelines (5th ed.). Springer Publishing.
• Ghezzo, H., et al. (2020). Pulmonary function testing in asthma diagnosis. Journal of Respiratory Medicine, 114, 107-114.
• Global Initiative for Asthma (GINA). (2023). GINA Report, Global Strategy for Asthma Management and Prevention.
• Ghezzo, H., et al. (2020). Pulmonary function testing in asthma diagnosis. Journal of Respiratory Medicine, 114, 107-114.
• Kellams, A. (2020). Breastfeeding: Parental education and support. Pediatrics, 145(2), e20193587.
• Cash, J. C., & Glass, C. A. (2020). Clinical guidelines for the management of asthma. Journal of Pediatric Nursing, 55, 25-30.
• GINA. (2023). Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma.
• Ghezzo, H., et al. (2020). Pulmonary function testing in asthma diagnosis. Journal of Respiratory Medicine, 114, 107-114.