Discussion: Common Conditions In The Adolescent Client

Discussion: Common Conditions In The Adolescent Client

Discussion: Common Conditions In The Adolescent Client

A fifteen-year-old female presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately, she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema, and her father has high blood pressure. She is the only child. She denies smoking and illegal drug use. On examination, she is in no acute distress and her vital signs are T 98.6, BP 120/80, pulse 80, and respirations 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs.

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1. What is the chief complaint?
2. Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?
3. What treatment plan would you consider utilizing current evidence-based practice guidelines?

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Discussion Post: On Common Conditions in the Adolescent Client

What is the chief complaint?

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The patient’s chief complaint is shortness of breath and coughing at night.

Based on the subjective and objective information provided, what are your 3 top differential diagnoses listing the presumptive final diagnosis first?

Asthma:  Asthma has complex pathophysiology involving airway inflammation, periodic airflow obstruction, and bronchial hyperresponsiveness. The clinical manifestations of asthma include wheezing, coughing, shortness of breath (SOB), and chest tightness or pain (Quirt et al., 2018). The cough is usually non-productive and non-paroxysmal. Physical exam findings include wheezing, which occurs only during end-expiratory in mild asthma and can be present during inspiration in more severe asthmatic episodes. Some patients only have the symptoms at night and have a normal pulmonary function in the daytime. In patients with allergies, the same allergens that trigger the allergic symptoms also cause asthma symptoms (Quirt et al., 2018). Asthma is a differential diagnosis based on pertinent positive findings of SOB, nocturnal non-productive cough, reduced air movement, and wheezing on expiration. The patient’s history of seasonal allergies increases the likelihood of asthma.

Exercise-induced asthma: This condition is characterized by respiratory difficulty triggered by aerobic exercise and lasts several minutes. Symptoms occur during or after exercise and include chest tightness or pain, cough, shortness of breath, wheezing, underperformance or poor physical performance, fatigue, delayed recovery time, and GI discomfort (Koya et al., 2020). However, a patient’s physical exam findings are often unremarkable in the clinical setting. Exercise-induced asthma is a differential diagnosis based on the patient’s history of shortness of breath and a non-productive cough during extreme exercise. However, it is an unlikely primary diagnosis since the patient has been experiencing the symptoms continuously.

COPD: COPD is a complex respiratory condition with a combination of emphysema, chronic bronchitis, and reactive airway disease. Symptoms include a productive cough that worsens in the morning, shortness of breath, and wheezing. Respiratory exam findings include hyperinflation (barrel chest), wheezing (often heard on forced and unforced expiration), diffusely reduced breath sounds, hyperresonance on percussion, prolonged expiration, and coarse crackles (Choi & Rhee, 2020). COPD is a differential diagnosis based on the patient’s findings of SOB, cough, decreased air movement, and wheezing. However, the patient has a normal anterior and posterior chest and resonant lungs, which rule out COPD as the primary diagnosis.

What treatment plan would you consider utilizing current evidence-based practice guidelines?

The patient’s treatment plan will include a quick-relief (to relieve acute asthma exacerbations) and long-term control medication.

1. ProAir HFA Aerosol metered-dose inhaler 90-180 mcg (1-2 puffs). The drug will be used in acute asthmatic symptoms (Papi et al., 2020).
2. Beclomethasone aerosol 40-80 mcg inhaled PO q12hr. The drug will reduce airway hyperresponsiveness and promote long-term control of asthma symptoms. Beclomethasone is an inhaled corticosteroid. Inhaled corticosteroids are considered the primary drug of choice to control chronic asthma (Papi et al., 2020).

References

Choi, J. Y., & Rhee, C. K. (2020). Diagnosis and Treatment of Early Chronic Obstructive Lung Disease (COPD). Journal of clinical medicine, 9(11), 3426. https://doi.org/10.3390/jcm9113426

Koya, T., Ueno, H., Hasegawa, T., Arakawa, M., & Kikuchi, T. (2020). Management of Exercise-Induced Bronchoconstriction in Athletes. The journal of allergy and clinical immunology. In practice, 8(7), 2183–2192. https://doi.org/10.1016/j.jaip.2020.03.011

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: reshaping the concept of asthma management. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 16, 75. https://doi.org/10.1186/s13223-020-00472-8

Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018). Asthma. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 50. https://doi.org/10.1186/s13223-018-0279-0

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