JG is a 37-year-old male presenting with wheezing and shortness of breath. During his visit today, he reports having to use his albuterol 3 days per week over the past month.

JG is a 37-year-old male presenting with wheezing and shortness of breath. During his visit today, he reports having to use his albuterol 3 days per week over the past month.

SCENARIO 1

JG is a 37-year-old male presenting with wheezing and shortness of breath. During his visit today, he reports having to use his albuterol 3 days per week over the past month. He reports being awakened by a cough six nights during the last month. His current medications include: salmeterol 50 mcg inhaler BID, albuterol MDI two puffs q4-6 hr PRN shortness of breath, prednisone 20mg qam, loratadine 10 mg daily, diphenhydramine 50 mg qhs prn. How would you step up asthma therapy for this patient (include complete medication order)? What medication changes would you make? What drug classification is salmeterol? Can it be used as monotherapy? What patient teaching and monitoring would you provide regarding the updated drug therapy plan?

SCENARIO 1

JG is a 47-year-old female with moderate persistent asthma who is on a daily use albuterol and more than twice a week. She is currently on management with salmeterol, a LABA. The medication program is inadequate as monotherapy and contrary to the current GINA guideline, 2023 (Di Cicco et al., 2021). The need for better asthma control and increasing use of systemic prednisone underlined.

GET HUMAN-WRITTEN ASSIGNMENTS HERE

Discontinue regular use of salmeterol alone as a monotherapy and start fluticasone-salmeterol (Advair Diskus) 250/50 mcg inhaler; one inhalation twice daily for asthma control. Albuterol will be continued as a rescue inhaler for exacerbation. They include Advair Diskus 250/50 mcg with 60 inhalations in which one inhalation is taken twice daily with three refills, and Albuterol HFA MDI 90 mcg 200 puffs, two puffs every 4-6hr with two refills (Lommatzsch et al., 2020).

The education revolves around the correct usage of the ICS-LABA combination to prevent the airways from inflammation and to avoid exacerbations. The patient’s inhaler usage technique will be assessed. Then, the patient will be educated on appropriate asthma triggers to avoid, as well as be encouraged to follow a peak flow monitoring schedule. Fluency is checked in four weeks with a questionnaire covering symptoms, nighttime interferences, and the amount of albuterol used; spirometry is also performed. LABAs like salmeterol must not be administered alone because of the elevated mortality dangers when provided singly as a treating remedy (Daley et al., 2022). However, the risk has brought to safe and healthy management by the use of LABAs in combination with ICS.

References

Daley-Yates, P., Aggarwal, B., Lulic, Z., Fulmali, S., Cruz, A. A., & Singh, D. (2022). Pharmacology versus convenience: a benefit/risk analysis of regular maintenance versus infrequent or as-needed inhaled corticosteroid use in mild asthma. 
Advances in Therapy
, 1-21.

Di Cicco, M. E., Leone, M., Scavone, M., Del Giudice, M. M., Licari, A., Duse, M., … & Tosca, M. (2021). Intermittent and mild persistent asthma: how therapy has changed. 
Acta Bio Medica: Atenei Parmensis
, 
92
(Suppl 7).

Lommatzsch, M., Buhl, R., & Korn, S. (2020). The treatment of mild and moderate asthma in adults. 
Deutsches Ärzteblatt International
, 
117
(25), 434.