Summary
This case study examines a 15-year-old female, who suffers from dyspnoea and non-productive nocturnal cough. The patient denies pains in her chest and other symptoms. Three differential diagnoses identified for the given patient are as follows: asthma, COPD, and pneumonia. Taking into account that COPD is more attributable to adults and older adults, who smoke continuously, this disease may be considered non-characteristic to her. The diagnosis of pneumonia should be based on the symptoms of productive cough, fever, chest pain, and so on. Therefore, the presumptive final diagnosis for the identified patient is asthma, expressions of which similar to those reported by the patient.
Paying attention to both objective and subjective data regarding the patient, one may assume a comprehensive plan of treatment, including a therapeutic option, drug treatment, dieting, and patient education. Among potential drugs the prescription of which is to be determined after additional tests, there are glucocorticosteroids, leukotriene, monoclonal antibodies, and receptor antagonists. The use of inhalators may also be considered for acute asthma attacks. Since the patient suffers from seasonal allergies and her mother is also prone to allergy, one should note that allergens may be one of the causes of asthma. Therefore, it is essential to specify allergens affecting the patient and eliminate them. As for dieting, it is better if nutrition would be hypoallergenic and healthy because asthma deteriorates as a result of immunity disorders. Last but not least, the patient should receive relevant education about how to use inhalers, avoid allergens, and follow prescriptions. In combination, the above treatment plan would allow improving the patient’s health outcomes by addressing shortness of breath and cough and prevent further disease development.
Case Analysis
What is the Chief Complaint?
The given patient states that she suffers from shortness of breath and a prolonged cough. Initially, she experienced the above symptoms only during exercising, but now they are consistent. The chief complaint concerns dyspnoea.
Based on the Subjective and Objective Information Provided What are Your 3 Top Differential Diagnosis Listing the Presumptive Final Diagnosis First?
Considering the described patient examination, one may distinguish between such differential diagnoses as asthma, Chronic Obstructive Pulmonary Disease (COPD), and pneumonia. Asthma is expressed in shortness of breath and cough. It is also conditioned by allergies in the family history and a high-pitched whistling on expiration in all lobes in her breast. Shortness of breath or even suffocation may arise as against the background of complete well-being and rest at night as well as during physical exercises (Niimi et al., 2013). Non-productive nocturnal cough is typical for an asthmatic attack, while it occurs synchronously with dyspnoea and is characterized by a supersaturation.
COPD is associated with the progressive restriction of airflow in the airways developing during a continuous period, the cause of which is inflammation of the lung tissue in response to irritation with pathogenic gases and particles (Murphy & Panos, 2013). However, COPD is more characteristic for older adults who smoke. In its turn, pneumonia is an acute infection of lungs of an inflammatory nature, the clinic manifestation of which is characterized by fever, weakness, chest pain, shortness of breath, cough with phlegm, etc. (van Vugt et al., 2013). Since the patient has a non-productive nocturnal cough and denies chest pain and acute conditions, pneumonia seems to be an inappropriate diagnosis.
What Treatment Plan Would You Consider Utilizing Current Evidence-Based Practice Guidelines?
First of all, it is essential to determine the severity of the disease by applying such tests as peak flow, imaging tests, and allergy testing (Korevaar et al., 2015). The treatment plan should involve the following elements:
- Drug treatment, which includes a basic therapy aimed at anti-inflammatory treatment as well as asymptomatic therapy targeting the elimination of asthma-related symptoms. The above treatment would affect the process of the disease and allow controlling it. The following are referred to as basic therapy preparations: glucocorticosteroids (including inhalators), monoclonal antibodies, leukotriene, and receptor antagonists (Bel et al., 2014). Inhalators should be used to minimize acute attacks with all consequences coming from the attack.
- Exclusion from the life of the patient those factors that cause the development of the disease (allergens, etc.) is critical (Mellins, Evans, Clark, Zimmerman, & Wiesemann, 2015). It may be animals, dust, some foods, etc.
- Diet. There should be some foods and beverages to be eliminated from the patient’s ration to improve her health. Proper nutrition refers to one of the basic elements in the struggle against asthma. Since this disease is of an immune-allergic nature, the diet assumes a corresponding correction of nutrition to be hypoallergenic.
- Patient education. The treatment of asthma consists of a series of exacerbations and remissions, while it is possible to achieve stable and long-term remission with proper attention to the disease. For instance, the patient should receive detailed instructions regarding the use of inhalers (Price et al., 2013). The prognosis depends to a large extent on how carefully the patient would treat her health and follow the prescriptions. The minimized contact with allergens and timely consultation with a doctor are key points in patient education. The latter is especially important for people who are at risk or who have a genetic predisposition as the given patient.
References
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Korevaar, D. A., Westerhof, G. A., Wang, J., Cohen, J. F., Spijker, R., Sterk, P. J.,… Bossuyt, P. M. (2015). Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: A systematic review and meta-analysis. The Lancet Respiratory Medicine, 3(4), 290-300.
Mellins, R. B., Evans, D., Clark, N., Zimmerman, B., & Wiesemann, S. (2015). Developing and communicating a long-term treatment plan for asthma. American Family Physician, 91(1), 1-13.
Murphy, D. E., & Panos, R. J. (2013). Diagnosis of COPD and clinical course in patients with unrecognized airflow limitation. International Journal of Chronic Obstructive Pulmonary Disease, 8(1), 199-208.
Niimi, A., Ohbayashi, H., Sagara, H., Yamauchi, K., Akiyama, K., Takahashi, K.,… Kimura, G. (2013). Cough variant and cough-predominant asthma are major causes of persistent cough: A multicenter study in Japan. Journal of Asthma, 50(9), 932-937.
Price, D., Bosnic-Anticevich, S., Briggs, A., Chrystyn, H., Rand, C., Scheuch, G., & Bousquet, J. (2013). Inhaler competence in asthma: Common errors, barriers to use and recommended solutions. Respiratory Medicine, 107(1), 37-46.
van Vugt, S. F., Verheij, T. J., de Jong, P. A., Butler, C. C., Hood, K., Coenen, S.,… Broekhuizen, B. D. (2013). Diagnosing pneumonia in patients with acute cough: Clinical judgment compared to chest radiography. European Respiratory Journal, 42(4), 1076-1082.