Asthma
SW is a 16-year-old adolescent who periodically visits PILLS ‘R’ US Pharmacy for her medications. Today she comes to see the pharmacist after visiting her doctor, who has treated her asthma throughout her childhood. She has been experiencing an increasing burden of asthma symptoms, and she is unable to spend as much time outdoors, now that spring is here. SW wants to make sure that she is on the best therapy to control her asthma.
The pharmacist decides to look at SW’s medical profile before he assesses her therapy. She currently uses an albuterol inhaler, 2 puffs every 4 to 6 hours as needed for shortness of breath or wheezing; and a Pulmicort (budesonide inhalation powder) inhaler, 1 puff twice daily.
The pharmacist decides to find out more about the nature of her symptoms. He asks her about the average frequency of her symptoms during the last few weeks. SW says that she has symptoms every day and has nightly symptoms 2 to 3 times per week. SW also tells the pharmacist that she has been using her peak flow meter and obtained readings at 60% to 80% of her personal best. She is concerned because the readings have been varying greatly recently—sometimes a >30% difference. She has been using her albuterol inhaler very frequently, several times a day on most days.
On realizing that the patient’s asthma is not adequately controlled, the pharmacist decides to place a phone call to the doctor to recommend that they review the patient’s therapy together. The doctor takes a look at the current regimen and initially questions the pharmacist’s judgment. After being referred to the National Asthma Education and Prevention Program (NAEPP) guidelines, the physician asks for the pharmacist’s recommendation for changing SW’s drug therapy.
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