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Chapter 46. Asthma

AJ is a 5-year-old who has been experiencing daytime rhinorrhea, night-time 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?

a. Rhinorrhea

b. Cough

c. Reflux

d. Enuresis

Answer b is correct. Although wheezing is considered one of the classic symptoms of asthma, night-time cough has been shown to be a common symptom requiring further work up for asthma.

Answer a is incorrect. Rhinorrhea is upper airway symptoms and may contribute to poor asthma control, however, does not warrant a work up for asthma.

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

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

You are providing follow-up education for a 3-year-old child with asthma who in the past month is scheduling their AccuNeb 1.25 mg tid for symptoms. Parents indicate that he wakes up at least once a night due to cough. What is the best treatment option given the patient’s current asthma control? Select all that apply.

a. Continue current treatment.

b. Step up one step.

c. Step down one step.

d. Oral steroid burst.

Answer b is correct. Patient is using short-acting β-agonist (SABA) several times per day with night awakening greater than 1 time per week which is indicative of very poorly controlled asthma requiring step-up treatment.

Answer d is correct. An oral steroid burst will quickly suppress excessive lung inflammation due to very poorly controlled asthma.

Answer a is incorrect. Symptom presents and medication used not consistent with well control.

Answer c is incorrect. Symptom presents and medication used not consistent with well control.

AM is currently on fluticasone 220 mcg metered-dose inhaler (MDI) two puffs BID, Albuterol MDI two puffs q4 to 6-hour prn cough. The patient has been noticing white lesions on his tongue and inner cheeks. Which inhaler technique can a pharmacist recommend to prevent current symptoms? Select all that apply.

a. Rinse and spit with water after use.

b. Inhale medication quickly.

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