R. J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing. A. What is the underlying mechanism of R. J.’s asthma? What are the three airway responses that occur during an asthma episode?
B. In addition to bronchodilator therapy with intermittent albuterol, what other pharmacotherapy is important in the management of asthma?
C. What is the significance of a PEFR at 60% predicted? If spirometry were performed at this time, what would be the likely findings?
D. How should R. J.’s current problem be managed? What parameters should be assessed to monitor response to therapy?
E. In addition to reviewing appropriate drug therapy, what other preventive and treatment measures should be included in R. J.’s discharge teaching?