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Chapter 46. Asthma
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JB is started on fluticasone 220 mcg MDI 2 puffs bid, albuterol MDI 2 puff q4-6 hour prn cough, montelukast 10 mg 1 tablet at bedtime and lortadine 10 mg daily. 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 patients current side effects?
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Answer a is correct. The most common side effects of low to medium dose-ICSs are thrush and dysphonia.
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Answer b is incorrect. Second generation antihistamine do 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-agonist 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 work up for asthma?
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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 work up for asthma.
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Answer a is incorrect. Rhinorrhea is upper airway symptom and may contribute to poor asthma control; however, it does not warrant a work up 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 work up 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 mcg 1 puff bid. She returns for a follow-up visit with minimal improvement of symptoms and an 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 ...