The answer to Fridays CHEST Challenge question is B! Were you correct? A 48-year-old woman with history of asthma is referred because of increased cough and wheezing over the past 3 weeks following an upper respiratory infection. She was previously asymptomatic on a regimen of inhaled fluticasone 220 μg twice daily and on rare occasions she used inhaled albuterol (salbutamol). However, since her respiratory infection she has been waking up coughing during the night every night and has been using her albuterol daily, despite taking her other medications regularly. Her physical examination reveals scattered wheezing but is otherwise normal. Spirometry shows an FEV1 that is 71% predicted, and the chest radiograph is normal. You verify that her technique of using the metered-dose inhaler is flawless. What do you recommend? A. Increase the dose of fluticasone to 440 μg twice daily. B. Add an inhaled long-acting beta-agonist. C. Add a leukotriene antagonist. D. Add ipratropium bromide. RATIONALE: This patient has uncontrolled asthma while taking a moderately high dose of inhaled corticosteroids. Another controller medication is indicated, and adding a long-acting beta-agonist is the best option to improve asthma control (choice B is correct). The 2004 revised Global Initiative for Asthma guidelines recommend that asthma management should be based on clinical control, rather than by classification of disease severity. Control is defined by daytime symptoms or need for rescue treatment twice or less per week, the absence of limitations of activity, nocturnal symptoms and awakening, and normal peak flow or FEV1. Partial control is defined as the presence of any of these symptoms, or a peak flow or FEV1
Posted on: Mon, 16 Jun 2014 13:00:01 +0000
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