Question

patient is 9 years old and female presents with her mother complaining of a dry cough that “wakes up everyone in the house” each night for the last 2 weeks. Denies prior hx of the same.

• For the case you have chosen:

• Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
• In SOAP format, list:
  • Pertinent positive and negative information
  • Differential and working diagnosis
  • Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Answer 1

History collection and physical examination is one of the key elements to find the diagnosis of patient . From the above scenario the diagnosis may be asthma. It is more common in children. This is the condition that the airways is narrowed due to inflammation and collection of exudate Possible questions we should ask to the patient include,

:ask about present condition of patient such as pattern of symptom, aggravating factors, signs of infection and ask about history of exacerbation .

In pattern of symptoms we should ask about it is perennial or seasonal or both, continuoul or episodic or both and duration, onset ,frequency and diurnal variation of symptoms.

:ask whether patient experience high pitched whiziling sound when breathing out.

:ask about at which time the cough worse.

:ask about the aggravating factors of symptoms such as exercising, climate change, environmental allergenic exposure, viral infection and stress etc,

:ask about family history of asthma, sinusitis and allergies .

:ask about socioeconomic background of patient.

Physical examination

We should clearly examine the upper respiratory tract ,chest and skin

Upper respiratory tract ___examine whether the patient have nasal polyp, mucosal swelling, increased nasal secretion.

Chest___inspect the expansion of thorax and using of accessory muscle, auscultate lung sound whether the patient have wheezing during normal breath. Percussion of lung for consolidation or mass.

Skin__examine the skin for sign of topic dermatitis.

Further testing needed for diagnose the condition

:pulmonary function test__assess the lung function in the presence of irritant help to identify lung function.

:spirometry

:peak flow meter

Differential diagnosis of asthma

Correct diagnosis and controlling of symptoms is one of the goal of asthma treatment. Many disease condition may confuse the diagnosis that is ,

Upper airway disease :allergic rhinitis and sinusitis

Obstruction in large airway :foreign body obstruction, vocal cord dysfunction, vascular ring, laryngeal tracheomalacia, tumor.

Small airway disease :viral broncheolitis, cystic fibrosis ,bronchopulmonary dysplasia and heart disease.

Comorbidities associated with asthma include gastrointestinal esophageal reflex disease, obstructive sleep already and bronchopulmonary aspergillosis.

Treatment plan of asthma

The goal of treatment plan include control the symptoms and prevent complication.

Pharmacotherapy

Long term control medication

:inhaled corticosteroid_help to reduce inflammation ,drugs include budesonides, beclomethasone, mometasone etc,

:leukotrine modifiers _eg:montelukast,zafurlukast

:combination inhalers_inhaled corticosteroid plus a long acting beta agonise. Eg:fluticasone plus salmeterol

:theophylline_it is bronchodilator help to open the the airways.

:biologics

:short acting bronchodilator _help to relieve symptom suddenly eg:albuterol

Complimentary therapy

:acupuncture

:yoga and relaxation techniques.

:breathing exercise.

:nutritional supplementation.

:massage.

:ayurveda and homeopathic medicine.

Preventive measures for asthma in children

:avoid exposure to aggregating factors like allergenic, stress etc,

:avoid smoking around the child.

:maintain healthy weight in children

:prevent the insurance of heart burn.

:see the doctors when necessary.