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Chapter 45: Asthma

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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.

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

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a. Fluticasone

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b. Loratadine

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c. Montelukast

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d. Albuterol

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

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

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

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

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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?

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a. Rhinorrhea

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b. Cough

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c. Reflux

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d. Enuresis

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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.

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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.

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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.

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

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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?

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a. Inhaler technique assessment for slow deep inhale

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b. Albuterol use in the last month

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c. Adherence to morning and evening peak flows

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d. Inhaler technique assessment ...

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