A 25- year- old, healthy woman presents to your office with a complaint of inter

Question

A 25- year- old, healthy woman presents to your office with a complaint of intermittent dyspnea and chest tightness. Her symptoms have been intermittently recurring for the last 3 years. Over the last 2-3 months they have occurred more frequently and lasted longer. Her symptoms tend to be worse during spring months. She denies any exercise- induced or nocturnal symptoms. Her father has a history of asthma. She works as a computer programmer and software developer. She has a roommate who moved in 3 months ago with a dog. She is an occasional smoker and drinks socially. She denies any recreational drug use. On exam she is mildly dyspneic, has end- expiratory wheezing and her respiratory rate is 20.

1. The clinical scenario is most consistent with which diagnosis?

2.    What data in the clinical scenario supports your diagnosis?

3.     What may be triggering this patient's exacerbation of the disorder identified in question 1?  

a. What two medication drug classes may trigger an exacerbation of dyspnea in a person with the disorder identified in question 1?

b. Describe the early events responsible for the pathogenesis of the disorder identified in question 1. How does this result in chronic airway inflammation and airway hyperresponsiveness?

c. Describe the pathologic mechanism that is responsible for this patient’s wheezing.

d. What might you expect the results of her pulmonary function tests to be? Why?

5.    For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored?  

Explanation / Answer

1.BRONCHIAL ASTHMA

2.Her father has a history of asthma,end- expiratory wheezing ,occasional smoker ,Her symptoms tend to be worse during spring months.

3.Symptoms tend to be worse during spring months.

A)Beta blockers,NSAIDS

B)Smoking,contact with dog ,bronchoconstriction causes airway obstruction and hyperresponsiveness

C)Broncho constriction and airway obstruction

D)Abnormal PFT results with the two most common pulmonary function tests :spirometry and methacholine challenge tests.Asthmatic patient will get dyspnic with inhalation of methacholine aerosol and feel difficulty in doing spirometry as their aiway getb constricted

5.Status asthmaticus

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