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Chapter 45: Asthma

JB is started on fluticasone 220 μg MDI two puffs bid, albuterol MDI two puffs every 4 to 6 hours prn cough, montelukast 10-mg one tablet at bedtime, and lortadine 10 mg daily. The patient returns 1 month later with dysphonia and was recently treated for thrush.

Which medication is most likely to cause the patient’s current side effects?

a. Fluticasone

b. Loratadine

c. Montelukast

d. Albuterol

Answer a is correct. The most common side effects of low- to medium-dose inhaled corticosteroids are thrush and dysphonia

Answer b is incorrect. Second-generation antihistamine does not cause thrush or dysphonia.

Answer c is incorrect. Leukotriene modifiers do not cause thrush or dysphonia.

Answer d is incorrect. Short-acting β-agonists do not cause thrush or dysphonia.

AJ is a 5 year old who has been experiencing daytime rhinorrhea, nighttime cough that woke him two times this past week, enuresis two times in the past months, and has a history of reflux. Which symptom is most likely to warrant a workup for asthma?

a. Rhinorrhea

b. Cough

c. Reflux

d. Enuresis

Answer b is correct. Although wheezing is considered one of the classic symptoms of asthma, nighttime cough has been shown to be a common symptom requiring further workup for asthma.

Answer a is incorrect. Rhinorrhea is an upper airway symptom and may contribute to poor asthma control; however, it does not warrant a workup for asthma.

Answer c is incorrect. Reflux may play a role in asthma that does not respond to treatment; however, it is not a symptom that leads to the workup for asthma.

Answer d is incorrect. There has been no correlation between asthma and enuresis.

CM is started on fluticasone/salmeterol DPI 100/50 μg one puff bid. She returns for a follow-up visit with minimal improvement of symptoms and a FEV1 of 70% indicating not well-controlled asthma. After assessing environmental control and medication adherence, what additional factor should be addressed prior to stepping up her asthma therapy?

a. Inhaler technique assessment for slow deep inhale

b. Albuterol use in the last month

c. Adherence to morning and evening peak flows

d. Inhaler technique assessment ...

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