1. Perpetual succour hospital department of family & community medicine Family case presentation: “ I got pink puffer kids” LIZA D. MARIPOSQUE, M.D. 1 ST Year FAMED Resident March 2009

2. INTRODUCTION

14. DISCUSSION

18. Asthma Classifications by Severity Behrman, Kliegman, Jenson, et.al. Nelson Textbook of Pediatrics, 17 th Edn. p767 FEV 1 or PEF ≥80 of predicted; PEF Variability 20-30% 3-4 months ≥ 3 per week Mild Persistent FEV 1 or PEF >60 & ≤80% of predicted; PEF Variability >30% >1 time per week Daily symptoms, daily use of short acting ß-agonist Moderate Persistent FEV 1 or PEF ≤60 of predicted; PEF Variability >30% frequent Continual symptoms, limited physical activity, frequent exacerbations Severe Persistent FEV 1 or PEF ≥80 of predicted; PEF Variability <20% < 3 months <3 per week Mild Intermittent LUNG FUNCTION NIGHTS W/ SYMPTOMS DAYS W/ SYMPTOMS ASTHMA SEVERITY

19. Pathogenesis Asthma Triggers Airway Obstruction Airway Inflammation, Hyperresponsiveness, & Remodelling Status Asthmaticus Early phase:15-30mins Late Phase:4-12hr after allergen exposure DEATH

29. Stepwise Approach for Managing Asthma in terms of Severity Behrman, Kliegman, Jenson, et.al. Nelson Textbook of Pediatrics, 17th Edn. p767 Step 1 + group education & monitoring Anti-inflammatory: low-medium dose inhaled glucocorticoids, & either LABA, Leukotriene Short acting ß-agonist - prn Step 3: Moderate persistent Step 1 + group education & monitoring Anti-inflammatory: low dose inhaled glucocorticoids, cromolyn, leukotriene modifier, nocromil. Alternative: sustained release theophylline Short acting ß-agonist - prn Step 2: Mild Persistent Step 1 + group education & monitoring + referral Anti-inflammatory: high-dose inhaled glucocorticoids + LABA, either leukotriene modifier, sustained release theophylline. Oral glucocorticoid Short acting ß-agonist - prn Step 4: Severe Persistent No daily medication needed LONG-TERM CONTROL MEDICATION Use of MDI & spacer, environmental control measures Short acting ß-agonist - prn Step 1: Mild Intermittent EDUCATION QUICK RELIEF MEDICATION ASTHMA SEVERITY

30. FEV 1 = forced expiratory volume in 1 second; PEF = peak expiratory flow. * Any exacerbation should prompt review of maintenance treatment to ensure that it is adequate. † By definition, an exacerbation in any week makes that an uncontrolled asthma week. ‡ Lung function is not a reliable test for children 5 years and younger. One in any week† One or more/year* None Exacerbations <80% predicted or personal best (if known) Normal Lung function (PEF or FEV1)‡ More than twice/week None (twice or less/week) Need for reliever/rescue treatment Any None Nocturnal symptoms/awakening Any None Limitations of activities Three or more features of partly controlled asthma present in any week More than twice/week None (twice or less/week) Daytime symptoms Uncontrolled Partly controlled (Any measure present in any week) Controlled (All of the following) Characteristic Levels of asthma control according to the Global Initiative for Asthma (GINA ).

32. Family dynamics

35. Marissa, Winnie Rose, Winnie Jr., Winjel House of Betty, the sister SITUATIONAL ANALYSIS

36. Lapuz-Caparida’s Hause Bedroom

37. Dining area

38. Deep well

42. Family genogram lapuz-caparida family january 13, 2009 Entiquino, 49 @ x † Francisca 36, ͏͏ Ѿ @ Carmen 39 Betty 30 Rosela 27 Renante 25 Marissa 24, Roger 23 Jenny 22 Remarck 16 Queeny 10 Winnie Sr. 27, Winmar, 7 @ Winnie Jr. 5 @ Winjel, 2 Winrose, 10 mos. 1988 I ii III @ Rostica 59, Alejandro 60 Generoso 42 Dita 36 Rita 45 Ronnie 29 Amay 28 Benvienido 25 LEGENDS: @ - Asthmatic Index Patient † or X deceased recurrent urticarial rashes 5 months pregnant ͏͏ Ѿ Abella-Lapuz Jimenes-Caparida male female

43. FAMILY CIRCLE MARISSA WINMAR WINROSE WINNIE SR. WINJEL WINNIE JR. BETTY

44. FAMILY APGAR i INFORMANT: MARISSA CAPARIDA & betty 9 Total √ I am satisfied with the way my family and I share time together. R √ I am satisfied with the way my family expresses affection and responds to my emotions. A √ I am satisfied that my family accepts and supports my wishes to take on new activities and direction. G √ I am satisfied with the way my family talks over things with me and shares problems with me. P √ I am satisfied that I can turn to my family for help when something is troubling me. A Hardly ever Some of the time Almost always

45. screem Limitations in finances for medical check-up & medicine. Can borrow money from the eldest sister in case of emergency. Medical check-up with the family physician M edical Learns at home Primary education E ducational Inadequate monthly income. The father works as a construction worker E conomic Attends mass occasionally during fiesta, Christmas. Prays at home. R eligious Using herbal medicine & linements Herbal medicine C ultural Nobody can help the wife in attending the 4 children Interacts with neighbors and relatives. No known enemies. S ocial Pathology/Weakness Resource/ Strength

50. THANK YOU!