Question

What I need is for you diagnose, Tell me why you chose that diagnosis. Signs, Symptoms, Age, lifestyle, any other factors to lead you to your conclusion. Give some diagnostic tests to confirm your Dx. Then a treatment plan.

Patient presents no symptoms occurring at visit. Patient states he has started training for a marathon but has to stop due to tightness in chest and coughing. Patient does not know if there is any wheezing as he runs with an Ipod and never turns of the music or takes out the ear buds during an episode so he never hears any wheezing. Upon further questioning patient admits to having asthma as a child but states he outgrew it by the time he was 9, however he does admit to being an inactive video game kid until he was a teenager. As a teenager he started swimming and swam competitively in college. He never had any problems with breathing as a swimmer. Patient says now after about maybe a half an hour of running he has to stop running, and the symptoms continue to get worse for about 10 to 15 minutes after he stops running. In an hour the symptoms are gone and he feels O.K. Patient is a 26 year old male who grew up in a house of smokers but never smoked himself; he is a native of Los Angeles.

Answer 1

The patient symptoms delicts that the patient is having the disease of asthma. The diagnosis is asthma. This is been confirmed on the basis of the following data ragarding the patient. And the supporting data are :

● patient is a passive smoker ( because he lives in a home were others smoke) it increases the risk for respiratory diseases

● Previous history of asthma ( it triggers the chance of reoccurrence of disease )

● symptoms of chest tightness and cough during or after exercise.( it is the classical symptoms of asthma)

● patient live as inactive (sedentary life style) in the teenage period ( it triggers the occurance of disease conditions and health alterations)

● And also patient resides in the area of los angeles. This is area has the  air pollution at a high rate. ( This can worsen the symptoms of the patient)

From these above data we can conclude the patient symptoms as the diangnosis of asthma.

The diagnostic tests that should be conducted for specific diagnostic confirmation are:

1)Detailed history collection ( data regarding previous illness, history of smoking, age , gender, lifestyle, familial factors , prescence of allergy, medication history etc........)

2) Physical examination ( assess for the wheezing sound/ whistling sound while breathing, assess for the skin allergic symptoms like eczema, assess for the symptoms)

3) Conduct lung function test such as

* spirometry test

* Methacholine challenge test

* peak flow test measures

* exhaled nitric oxide tests

4) chest X-ray

5) pulmonary function test

6) bronchial challenge test

7) bronchoscopy

8) allergic test

9) vital capacity test

These are the common methords that can be utilized for the confirmation of the disease condition of asthma.

Treatment for asthma include:

● Identify the triggering factors and avoid them as far as possible

● self care

* avoid chances of exposure of smoking

* sedentary lifestyle should be modified

* daily excercises should be done

● Medication include

* Bronchodilators ( to facilitate the opening of airway)

* Steroids ( it prevents the symptoms of asthma by modifying and simulating hormone activity and effect)

* Anti- inflammatory agents( it reduces the swelling of tissues and facilitates the easier relaxation and breathing)

* immunotherapies for allergy

* Anticholinergic agents

* Oral and intravenous corticosteroids

* Biologics medications like omalizumab , resiluzumab. Etc.....

INHALERS :

■Long term asthma treatment includes.

- inhalation of corticosteroids

- leukoterine modifying inhalers

- theophyline inhalers

■ Quick relief effect treatment  

- short acting beta agonists ( albuterol, levalbuterol. Etc...)