CASE PRESENTATION

1. Case presentation on
Bronchial Asthma
R.Anusha,
PharmD Intern,
170514882007.
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2. • Patient Name: Mrs.VS
• Gender: Female
• Age:82 years
• IP No:319682
• DOA:5/10/19
• DOD:9/10/19
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3. SUBJECTIVE
• Chief complaints: Patient presented to emergency
room with Fever(1020 F) since 3 days, SOB at rest.
• Present illness history: Complaints of breathlessness
since 2 days and history of fever with cough 2 days
ago.
• Past medical history: K/C/O HTN, S/P AV, S/P
CABG (2009).
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4. • Medication reconciliation:
T.CERUVIN 75mg PO OD
T.ATOCOR 40 mg PO H/S
T.TELMA 40 mg PO OD
T.PAN-D 40 mg PO OD
T.NEUROBIAN FORTE 1 Tab PO OD
• Outside lab reports: Platelet count: 1.75 lakh, TLC:8200
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5. OBJECTIVE
PHYSICAL APPERANCE
• Height:150cms
• Weight:60kgs
• BMI:26.67kg/m2
VITALS
• Pulse rate:80 beats/min
• Blood pressure:130/80 mm
Hg
• Respiratory rate:20
breaths/min
• Temperature: Afebrile
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6. Respiratory system: BAE+ Expiratory wheeze, Polyphonic
rhonci, Basal crepts.
Diagnostic tests:
Platelets:1.40 Lakh
WBC:3900
Na:132mEq/L
CRP:52 mg/L
Dengue NS 1 antigen: -Ve
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7. • FINAL DIAGNOSIS: Bronchial Asthma
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8. DRUG CHART
Drug Generic Dose ROA Freq. Indication
Inj.MAGNEX
FORTE
Cefaperazone
sulbactum
1.5 gm IV BD
started on 5/10/19
Infection
Neb.DUOLIN Ipratropium
bromide,
Salbutamol
1 resp P/N Q6H
stopped on 7/10/19
Wheezing
IVF.NS 0.9% NaCl 50ml/hr IV Onflow
stopped on 6/10/19
Hydration
Inj.PAN Pantoprazole 40 mg IV OD
started on 5/10/19
APD
T.CALPOL Paracetamol 500 mg PO OD
stopped on 6/10/19
Fever
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9. • Generic
• Dose
• ROA
• Freq.
• Indication
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Drug Generic Dose ROA Freq. Indication
T.ATOCOR Atorvastatin 20 mg PO HS CAD
T.ROMILAST Montelukast 10 mg PO BD started
on 6/10/19
Wheezing
T.DERIPHYLLINE
RETARD
Etophylline 115
mg
Theophylline 35
mg
150
mg
PO OD
started on
6/10/19
Branchospasm
Inj.DEXA Dexamethasone 4 mg IV OD(on
7/10/19)
BD(on
8/10/19)
Steriod for
bronchospasm

10. SOS/STAT MEDICATIONS
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Brand Generic Dose ROA Freq. Indication
Neb.DUOLIN Ipratropium
bromide,Salbutamol
1 resp P/N STAT Wheezing
Neb.BUDECORT Budesonide 1 resp P/N STAT Wheezing
Syp.ASCORIL Bromhexine,
Guaifenesine,
Menthol,
Terbutaline
10 ml PO STAT Cough
Inj.DERIPHYLLIN Etophylline
Theophylline
150mg IV SOS SOB

11. GOALS OF THE TREATMENT
• Achieve and maintain control of asthma symptoms.
• Maintain pulmonary function as close to normal as possible.
• Prevent asthma exacerbations.
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12. ASSESSMENT
DAY-1(5/10/19)
• Patient presented to emergency room with complaints of
breathlessness since 2 days and history of fever 2 days ago.
• Patient was shifted to room and required lab reports revealed
low platelet counts.
PLAN:
• Impression? LRTI
• IV Fluids
• Antiplatelets according to platelet count
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13. First patient was treated immediately for symptomatic relief.
• Neb. DUOLIN
(Salbutamol and Ipratropium bromide) was
indicated for the treatment of reversible bronchospasm by
relaxing the smooth muscles of the bronchi.
• Neb. BUDECORT
(Budesonide) is an inhaled corticosteroid
was given to control and prevent symptoms (wheezing and
shortness of breath) by inhibiting multiple types of mediators
involved in asthamatic response.
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14. • Inj.DERIPHYLLIN
Deriphyllin is a combination medicine used to prevent
and treat wheezing, shortness of breath, chest tightness
associated asthma.
• Syp.ASCORIL
was used to relieve cough.
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15. Then patient was treated with
• Inj.MAGNEX FORTE
(Cefaperazone sulbactum) was given to prevent infections.
• IVF.NS
(0.9% NaCl)50ml/hr for fluid management.
• Inj.PAN
(Pantoprazole)was given for stress ulcer prophylaxis.
• T.CALPOL
(Paracetamol) was given to treat the fever.
• T.ATOCOR
(Atorvastatin) was given as per medication
renconciliation
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16. DAY-2(6/10/19)
• No fresh complaints
• Vitals stable
• Afebrile
• C/o cough and wheezing
PLAN:
• Monitor vitals
• Add T.ROMILAST and T.DERIPHYLLIN RETARD
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17. • T.ROMILAST
(Montelukast) was given to prevent the wheezing
and shortness of breath caused by asthma and decrease the
number of asthma attacks.
• T.DERIPHYLLIN RETARD
Deriphyllin is a combination medicine used to prevent
and treat wheezing, shortness of breath, chest tightness
associated with asthma.
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18. DAY-3(7/10/19)
• C/o LRTI
• K/c/o CAD(CABG),AVR
• Cough with expectoration
• Vitals stable
• Afebrile
PLAN:
• Continue same treatment and Inj.DEXA was added.
• Monitor vitals
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19. • Inj.DEXA
(Dexamethasone) - the systemic steroid was given
once daily for preventing asthma exacerbations
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20. DAY 4(8/10/19)
• Patient was conscious and coherent
• Vitals stable
• Dexamethasone was increased from once daily to twice daily.
• Symptoms were controlled.
PLAN:
• Continue same treatment
• Monitor vitals
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21. DAY 5 (9/10/19)
• Patient was feeling better
• Symptoms were improved
• Vitals stable
PLAN:
• Plan for discharge
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22. MONITORING PARAMETERS
• To monitor pulmonary function.
• To monitor for improvement in signs and symptoms of
asthma.
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23. PATIENT COUNSELLING
• Asthma is a chronic lung disease that causes inflammation
and narrowing of the airways.
• These changes can cause episodes of wheezing, chest
tightness, shortness of breath, and/or coughing.
• To take medicines as prescribed by doctor.
• Patient should be assessed every 1-6 months for asthma
control.
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24. DISCHARGE MEDICATION:
T.ROMILAST 10 mg 1 tab PO BD after breakfast and after
dinner till next review(Cough)
T.DERIPHYILLINE RETARD 150 mg 1 tab PO OD after
dinner till next review
T.ZOCEF(Cefuroxime) 250 mg 1 tab PO BD after breakfast
and after dinner for 5 days(Antibiotic)
T.PAN 40 1 tab PO OD BBF for 10 days(Acidity)
T.ATOCOR 40 mg 1 tab PO OD after dinner to
continue(Statin)
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25. AEROCORT(Levosalbutamol/Beclometasone) inhaler 50/50
mcg 2 puffs orally TID 8AM-1PM-8PM till
review(Branchospasm)
Review after 3 days with CBP, Serum electrolytes, LFT,
Serum creatinine after 3 days.
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