Terence Hing, a 15-year-old teenager, was diagnosed as having mild persistent asthma at age 10. He has presented to the school nurse following a lunchtime soccer game with dyspnea, cough, and an expiratory wheeze. He states he's had a cold and his chest feels "a bit tighter than usual".
On examination, his observations include:
- BP is 120/84 mmHg
- Pulse = 120
- Respiratory rate = 28
- Temperature = 37.5°C
- O2 Sats = 94 (SPO2)
Auscultation of his lungs reveals widespread expiratory wheeze. Other symptoms include dyspnea, he is speaking in short sentences, and is using accessory muscles when breathing. Last spirometry result was unknown.
Terence describes a history of frequent asthma symptoms and 3 hospitalizations in the past 5 years but no Intensive Care Unit (ICU) admissions. Terence's parents smoke mostly outside the house. Terence denies smoking but states some of his mates smoke around him "now and then". He has hay fever and has eczema. He lives with his parents and is the oldest of three children. One sibling (who is 10 years old) also has asthma as does his mother who reportedly had frequent hospitalizations when she was younger. Terence describes his family as supportive and lets him manage his own asthma.
Medications include:
- Salbutamol 100 micrograms (Airomir, Asmol, Ventolin) MDI PRN 4-6hrs
- Ipratropium Bromide 21 micrograms (Atrovent) 2 puffs TDS
Terence reports that he often forgets to bring his puffers to school.
