The Case
A 22-year-old woman diagnosed with “mild persistent” asthma is suffering from recently increased symptoms of asthma. She is pregnant, and her lab work confirms it. As a medication, she uses two types of metered-dose inhalers: albuterol and fluticasone. Her use of these inhalers has increased over the last three months. Additionally, she mentions that during exercise she experiences shortness of breath and occasionally it happens without exercise. During the last six months, she has been hospitalized twice and had to visit the emergency department three times because of her asthma.
Suggestions of a Poorly Controlled Asthma
The examination of the presented case showcased multiple signs of poorly controlled asthma. The most indicative sign of uncontrolled asthma is increased coughing, especially at night. This leads the patient to use her albuterol metered-dose inhaler with increased frequency to combat the symptoms of asthma. The suggestion of Exercise-Induced Bronchospasm, as well as, shortness of breath without exercise is also signs that her asthma is not well controlled (National Heart, Lung, and Blood Institute, 2017). Also, frequent hospitalizations and decreased effectiveness of her fluticasone MDI, and mild persistent asthma diagnosis during the patient’s childhood are indirect clues (Zanforlin, Corsico, DI Marco, Patella, & Scichilone, 2016).
Leading Factors
The leading factor for this lack of control over asthma can be attributed to pregnancy. Her lab work shows the presence of a positive human chorionic gonadotropin which is a common occurrence during pregnancy. Pregnancy leads to a complex restructure of hormones inside the body of a woman. This could lead to hormonal imbalance. Subsequently, hormonal misbalance lessens the effect of her fluticasone MDI, leaving her asthma without required control (Baldacara & Silva, 2017).
Classification of Symptoms According to the National Institute of Health Guidelines
The patient has used an albuterol MDI more than three days a week for the last two months to deal with symptoms of asthma (Maselli, Adams, Peters, & Levine, 2012). This would suggest that her asthma is at least not well controlled but she also mentioned that last week she used it once at least every day putting her asthma into the very poorly controlled category according to the very poorly controlled category of asthma. She was awoken by her cough three times last month. This can categorize her level of asthma control as at least not well controlled. The presence of exercise-induced bronchospasm prevents the use of her lungs at full capacity, as well as preventing her from doing her normal activities, which also puts her into the very poorly controlled category (National Heart, Lung, and Blood Institute, 2017).
Treatment
According to the National Institute of Health guidelines for the treatment of asthma in pregnant women, I would suggest the following methods (National Heart, Lung, and Blood Institute, 2017). I would suggest monthly visits to the physician to monitor and control the treatment of her asthma. It is especially important for her as a pregnant woman because the negative effects of asthma could be highly dangerous to the health of a woman and her unborn child (Blackburn, Allington, Procacci, & Rivey, 2014). Albuterol is considered the preferred SABA during pregnancy by the NIS. Therefore, she should continue using it as a short-term control medication. Her use of fluticasone MDI should be stopped because it has shown itself to be ineffective even infrequent use (Cossette et al., 2014). As a long-term control medication budesonide should be used as it does not hurt the development of the child (Goldie & Brightling, 2013).
References
Baldacara, R., & Silva, I. (2017). Association between asthma and female sex hormones. Sao Paulo Medical Journal, 135(7), 46-59. Web.
Blackburn, H., Allington, D., Procacci, K., & Rivey, M. (2014). Asthma in pregnancy. World Journal Of Pharmacology, 3(4), 56. Web.
Cossette, B., Beauchesne, M., Forget, A., Lemière, C., Larivée, P., Rey, É., & Blais, L. (2014). Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy. Annals Of Allergy, Asthma & Immunology, 112(5), 459-464. Web.
Goldie, M., & Brightling, C. (2013). Asthma in pregnancy. The Obstetrician & Gynaecologist, 15(4), 241-245. Web.
Maselli, D., Adams, S., Peters, J., & Levine, S. (2012). Management of asthma during pregnancy. Therapeutic Advances In Respiratory Disease, 7(2), 87-100. Web.
National Heart, Lung, and Blood Institute,. (2017). Guidelines for the Diagnosis and Management of Asthma (EPR-3) – NHLBI, NIH. Nhlbi.nih.gov. Web.
Zanforlin, A., Corsico, A. G., DI Marco, F., Patella, V., & Scichilone, N. (2016). Asthma in pregnancy: one more piece of the puzzle. Minerva medica, 107(1), 1-4.