Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of severe eosinophilic asthma. Reports persistent symptoms despite high-dose ICS/LABA therapy, including nocturnal awakenings, exertional dyspnea, and recurrent wheezing. Denies recent systemic corticosteroid bursts, but notes frequent rescue inhaler use (>3x/week). No history of smoking. Symptoms are poorly controlled with current regimen, impacting daily activities.
Clinical Examination Findings
General: Patient is in no acute distress, speaking in full sentences. Respiratory: Tachypnea absent. Auscultation reveals bilateral expiratory wheezing, most prominent in the lower lung fields. No crackles or rhonchi. Accessory muscle use is minimal. Cardiovascular: Regular rate and rhythm, no murmurs. Skin: No signs of atopic dermatitis or urticaria.
Treatment Protocol
Plan: Continue high-dose ICS/LABA. Initiate biologic therapy (anti-IL-5/IL-5R or anti-IgE) as per eosinophil count and IgE levels. Optimize inhaler technique. Schedule follow-up pulmonary function testing (PFTs) and FeNO monitoring. Maintain asthma action plan with clear instructions for rescue medication and escalation to oral corticosteroids if symptoms worsen.