Evidence-based practice! Curto and colleagues (2019) investigated the prevalence of asthma in the elderly (>65 years) to determine if there were specific clinical and functional characteristics of this population. The researchers conducted a retrospective comparative descriptive study of demographic, clinical, and functional variables for 1,713 patients with asthma. Three groups were examined: those less than 65 years old, those aged 65 to 74 years, and those aged 75 years or older. They found that the patients with asthma were predominantly female, less likely to smoke, had greater obesity, poorer lung function, and lower values of nitric oxide in exhaled air. The most frequently seen comorbidity was gastroesophageal reflux. The researchers concluded that asthma in adults ages 65 and older is more severe and associated with greater comorbidity, which would indicate the need for a more integrated and multidimensional approach to asthma treatment for these patients (Curto et al., 2019). Case study 1 A 38-year-old individual comes to your clinic with complaints of experiencing increased shortness of breath and wheezing for the last 4 months while at work. The patient has not previously been diagnosed with asthma. The patient started a new job 4 months ago in the bakery of a local grocery store. Symptoms are only present at work and are always better when at home. You suspect work-related asthma. Case Study Questions 1. What type of questions would you ask to further assess the patient’s history and any potential relationship between symptoms and work environment? 2. The patient states they need this job, yet the shortness of breath and wheezing while at work are hindering job performance. What advice would you give on how to address this dilemma? 3. What asthma education should be provided to this patient? Case Study Answers 1. Because the symptom pattern suggests that the increased symptoms are related to the work environment, it is Case study 2 A 78-year-old woman with asthma visits the geriatric care clinic. The patient is being treated with a propranolol, a beta blocker medication, for hypertension and she takes ibuprofen, an NSAID, for joint pain. Asthma medications include albuterol inhaler, a beta-2 agonist, as needed. The patient denies using a valved holding chamber (a type of spacer that includes a one- way valve at the mouthpiece, which holds the medicine, allowing more time to take a slow, deep breath) for the medication administration. During the history, the patient appears confused, stating she has trouble remembering when to take medications. The patient tells you no one has ever provided a written management plan and no spacer. She reports a nocturnal cough almost every night but states, “That’s to be expected at my age.” Physical exam reveals difficulty breathing and audible wheezes. Case Study Questions 1. What are the asthma management goals for this patient? 2. What nonasthma medications place her at risk for worsening asthma? Conclusion Asthma management is critical to achieving good asthma outcomes. Adherence to the EPR3 (NHLBI, 2007) and GINA (2021) guidelines can assure appropriate management. Routine follow-up with healthcare professionals is essential so that asthma action plans can be adjusted and medications can be stepped up or down as needed. Comorbid conditions and
important to ask if allergy testing for environmental allergens has been done, and if so, what were the results. If allergy testing has not been done, a referral to an allergist is warranted. 2. The patient needs to approach the company’s management and update them on the health concerns being related to substances in the bakery. Hopefully, the company would proactively reassign the patient to work in a different department in the grocery store or, at the very least, allow the use of a respirator on the job to protect from exposure. 3. The patient needs an asthma action plan developed in partnership with the healthcare professional. The patient needs to be aware of the medications needed to control asthma symptoms, what they are for, when to take them, and as importantly, how to take them. The patient needs to be able to identify early warning signs that asthma is worsening so asthma management steps as indicated on the plan can be initiated. 3. How do this patient’s mental status and perception affect her self-management? Case Study Answers 1. The goals for this patient include minimizing adverse drug reactions with nonasthma medications, preventing nocturnal symptoms, educating her regarding the proper use of asthma medication and the use of a spacer, and recognizing and treating asthma symptoms early. 2. Propranolol and ibuprofen place the patient at risk for worsening asthma. Propranolol is a beta blocker and causes bronchospasm. The healthcare provider should consider another class of antihypertensive medication that would effectively control the patient’s blood pressure. The ibuprofen could worsen asthma. Different medications should be considered. 3. The patient has a complex medical regimen that is difficult to follow. Her memory loss and perception that asthma symptoms are inevitable because of her age (in reality, caused by poor disease management) complicate her management of, and adherence to, treatment.
conditions contributing to asthma symptomatology need to be addressed. Special consideration needs to be addressed for the older person with asthma.
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Book Code: ANCCUS2423
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