Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of Type 1 Brittle Asthma, characterized by wide, unpredictable diurnal peak expiratory flow (PEF) variability (>40% for >50% of the time over a 2-week period) despite optimal inhaled corticosteroid (ICS) therapy. Reports recurrent, sudden-onset, severe life-threatening exacerbations requiring emergency intervention. Denies identifiable triggers for recent episodes. Current symptoms include persistent dyspnea, nocturnal awakening, and chest tightness.
Clinical Examination Findings
General: Patient appears in mild respiratory distress, tachypneic, using accessory muscles. HEENT: No nasal polyps or allergic rhinitis signs. Respiratory: Bilateral diffuse expiratory wheezing, prolonged expiratory phase, decreased air entry at bases. Cardiovascular: Tachycardic, regular rhythm, no murmurs. Extremities: No peripheral edema or cyanosis. Skin: No signs of atopic dermatitis.
Treatment Protocol
Plan: 1. Continue high-dose ICS/LABA combination therapy. 2. Maintain strict adherence to daily PEF monitoring. 3. Rescue medication: SABA as needed for acute symptoms. 4. Consider add-on therapy (e.g., LAMA, Leukotriene receptor antagonists, or biologics if indicated). 5. Review asthma action plan and ensure availability of emergency injectable corticosteroids. 6. Follow-up in respiratory clinic for assessment of control and potential step-up therapy.