Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, poorly controlled asthma symptoms characterized by persistent cough, chest tightness, and wheezing. Sputum analysis reveals neutrophilic predominance (>60-70% neutrophils) with absence of eosinophilic markers. Symptoms are often refractory to standard inhaled corticosteroid (ICS) monotherapy. No history of atopy or elevated FeNO levels.
Clinical Examination Findings
General appearance: Patient in no acute distress, speaking in full sentences. Respiratory: Auscultation reveals bilateral expiratory wheezing, more pronounced in lower lung fields. No signs of consolidation or pleural effusion. Cardiovascular: Regular rate and rhythm, no murmurs or peripheral edema. Oropharynx: No evidence of post-nasal drip or significant inflammation.
Treatment Protocol
Plan: Initiate step-up therapy due to neutrophilic phenotype. Consider addition of long-acting muscarinic antagonists (LAMA) or macrolide therapy (e.g., Azithromycin) for anti-inflammatory effects. Optimize ICS-LABA combination. Review inhaler technique and adherence. Monitor for potential triggers and consider smoking cessation if applicable.