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asthma with LRTIi
- 1. Case presentation Presented by: Deepali P. Liman Pharm.D intern
- 2. Subjective ï‚— 80 years female patient came with the complaints of cough with expectoration, breathlessness since 2 days ï‚— K/C/O of bronchial asthma since 15 years and on medication for the same. ï‚— 2 days before Patient went to local hospital with same complaints and they prescribed following medicines 1. Aerocort (Beclomethasone Dipropionate/Levosalbutamol) MDI sos 2. Syp.alkol (terbutaline, guianefenecin, bromhexine) 2tsp. TDS
- 3. Objective Lab reports Normal range 1st day 2nd day TLC 4000- 10000/cumm 12400 lymphocytes 20-40 % 18 Blood glucose level (R) 70-140 mg/dl 166 102 PP-I 70-140 mg/dl 149 On the day of admission BP :130/90 mmHg Pulse :96/min HR: 82/min Febrile (103º F) RS: wheeze B/L + CNS : CO
- 4. Specialized diagnostic tests ï‚— Culture sensitivity report :4-5 epithelial cells, few pus cells, many GPC in pairs seen and GNB ï‚— ECG: ST flattening II, III, avf,V4-V6 ï‚— X ray PA view :B/L haziness +Lower Middle Zone and Lower Left Zone opacity
- 5. 2nd day 3rd day 4th day 5th day 6th day Fever Afebrile Afebrile Febrile Afebrile Breathlessness decreased Breathlessness decreased No Breathlessnes s No Breathlessness Breathlessness decreased Cough + Cough + Cough decreased Cough persisting Cough decreased BP: 124/80 mmHg 130/70 mmHg 140/80 mmHg 180/100 (am) 140/90 (pm) 130/90 mmHg Pulse :88/min 90/min 80/min 84/min 84/min Wheeze + Wheeze + Wheeze + Wheeze + Wheeze decreased Day wise analysis
- 6. Assessment Subjective evidence Cough with expectoration Breathlessness k/c/o of bronchial asthma Objective evidence TLC increased, fever Culture sensitivity tests ï‚— Acute exacerbation with bronchial asthma with LRTI
- 7. Plan Goals of therapy ï‚— Assess and monitor objective measures ï‚— Prevent chronic and troublesome symptoms ï‚— Provide therapy for control BP ï‚— Prevent recurrent exacerbations of bronchial asthma ï‚— Provide optimal pharmacotherapy with minimal adverse effects ï‚— Provide proper patient counseling
- 8. Treatment Brand name Generic name Dose Dosing schedule Start date Stop date Indication Inj. C-tri Ceftriaxone 2 gm 1-0-0 14/8 19/8 Hospital acquired pneumonia Inj. Rablet Rabeprazole 20 mg 1-0-0 14/8 16/8 Acidity Inj. Emset Ondansetron 4 mg 1-0-1 14/8 17/8 Vomiting Inj. Effcorlin Hydrocortisone sodium succinate 100 mg 1-0-1 14/8 19/8 Asthma Neb. Duolin Salbutamol, ipratropium bromide 2puffs 1-1-1 14/8 19/8 Bronchodilator Neb. Budecort Budesonide 2puffs 1-1-1 14/8 19/8 Bronchodilator T.Vazir Azithromycin 500 mg 1-0-0 14/8 16/8 LRTI Inj. Finamac Paracetamol 1 gm sos 14/8 19/8 To decrease fever Syp. Ascoril SF Terbutaline,bromhexine, guainefenesin 1-1-1 15/8 19/8 To decrease cough T. Azee Azithromycin 500 mg 1-0-0 16/8 19/8 LRTI T. Amlo Amlodipine 5 mg 1-0-0 18/8 19/8 To control BP T. Synasma Doxophyllin 400 mg 1-0-1 17/8 19/8 Bronchodilator
- 9. Discharge medications Brand name Generic name Time course Indications T. Zifi CV 200 Cefixime + clavulanic acid 1-0-1 for 7days To treat LRTI T. Pred 20 Prednisolone 1-0-1 for 7days Asthma T. Moxiflox forte 500mg Moxifloxacin 1-0-1 for 7days Infection ,Acute exacerbation Foracort with revolizer Budesonide and formetrol SOS Asthma attack T. Amlo 5 Amlodipine 1-0-0 for 15 days To control BP T zolfresh 5 Zolpidem 0-0-1 for 5 days Anxiety Syp ascoril SF 2tsp Terbutaline, bromhexine, guainefenesin 1-1-1 for 5 days To reduce cough Syp. Cremaffin 3tsp Magnesium hydroxide 0-0-1 for 5 days Constipation
- 10. Patient counseling  Educate patient about asthma and asthma medications  Instruct patient about the proper techniques for inhaling medications  Description of the rationale, correct use and side effects of preventive medications  Caretaker should try to maintain hygienic condition at home  Ask if the patient knows his/her triggers (air pollution, dust, mold pollen, tobacco smoke, temperature changes, exercise, flu, cold, anxiety, stress, emotions, perfume, spray and deodorants) if not, recommended a daily diary where the patients records events just prior to the asthma attack  Inform the patients who smoke to quit and avoid secondhand smoke.  Patient should don’t talk whenever having food  Patient should have lots of fluids because, fluids gets thin the cough.  Patient should do gargle after inhalation technique