Patient: 19 year old with acute asthma attack. Is already taking Proventil HFA MDI 2 puffs prn, Flovent 44mcg one puff BID, albuterol nebulization 2.5mg in 3mls NS prn and Ortho Novum /7/7/7 daily. Should any of medications be added, changed or discontinued?Thank you!
Symptoms: Hx of moderate asthma, current SOB, wheezing, poor exercise tolerance, head cold for 4 day, exposed to cat (allergic to cats), wakes up 2x a week with SOB and wheezing, chest tightness in morning, suprasternal muscle retractions, tachy, elevated b/p
Doctor: Hello, Welcome To Ask The Doctor.We are here to help you our best.I need a few more information to help better:1. Is he taking these medicines on regular basis? Or started now?2. Did he get the acute episode of asthma exacerbation while on these medicines?3. The description given by you for his symptoms is on regular basis or just developed now?In short, i need to know, whether he has been on these medicines when he developed the attack, or the medicines were started following the acute attack.Please revert with the asked details, so that we can discuss the treatment part.
Comments / Follow Ups
Patient: Yes, he was on these medications when the exacerbation occurred
Doctor: Ok, So he has got acute exacerbation of Bronchial Asthma. See, in such case, a person needs to be given antibiotics like Augmentin or Azithromycin.
Since he is already on high doses on inhaled drugs so in acute case, if he is wheezing, he might require oral steroids for a short course. I would recommend Prednisolone for a short course in such case.
Bronchodilator syrups containing Bromohexine also helps.
In fact, oral drugs like Deriphylline or Doxofylline needs to be added up.
Once the acute attack settles, steroids are tapered and stopped following which he can continue his regular medicines.
I suppose, with such wheezing, he should be evaluated by your regular Physician.
Share my opinion with him and if he agrees, he would start him on the discussed treatment.
I hope it helps you.
Wish him a speedy recovery.