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Abstract: A 48-year-old male patient presented to the clinic with episodic wheezing with cough and sputum for 3 years, which had been aggravated for half a month. The patient was evaluated by his condition and required hospitalization. After hospitalization, the patient was diagnosed with an acute attack of bronchial asthma, which is a respiratory disease, by examination and also by combining the patient’s symptoms, signs and treatment history. The patient was given medication, and the patient was free of wheezing and coughing and sputum. After the patient was discharged from the hospital with regular inhalation of asthma calming medication, no acute attack occurred within six months.
Basic information】Male, 48 years old
Disease Type】Acute attack of bronchial asthma
Hospital】Heilongjiang Provincial Hospital
Time of consultation】October 2019
Treatment plan] Oxygen + medication (cefmetazole sodium for injection + doxorubicin for injection + methylprednisolone sodium succinate for injection + salbutamol inhalation aerosol + ipratropium bromide solution for inhalation + budesonide suspension for inhalation + budesonide formoterol powder for inhalation)
Treatment Period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】Cured cough, sputum and wheezing, lung ventilation function improved significantly
I. Initial consultation
A 48-year-old male patient presented with episodic wheezing with cough and sputum for 3 years, which had been aggravated for half a month. The patient often developed wheezing, activity limitation, coughing up small amounts of white sputum after exposure to dust, and often had a nocturnal cough, which was relieved by intermittent inhalation of salbutamol sulfate inhalation aerosol treatment at regular intervals, but the symptoms recurred. The patient had a history of sinusitis for many years, dry rales could be heard on lung auscultation, no abnormalities were found on lung CT, sinus CT showed bilateral maxillary and septal sinusitis and deviated nasal septum, and blood gas analysis results were pH: 7.400, PO2: 75 mmHg, CO2: 40.4 mmHg, suggesting hypoxemia. And the blood routine suggested elevated eosinophils and elevated total IgE. Allergen test results showed dust allergy, elevated exhaled gas nitric oxide (FeNO), expiratory degree mean NO concentration value of 55 ppb, pulmonary ventilation function showed moderate mixed pulmonary ventilation dysfunction, small airway dysfunction, FEV1 increased by 34% compared to pre-drug, absolute value increased by 700 ml, and positive bronchodilator test. The preliminary diagnosis was acute attack of bronchial asthma.
II. Treatment history
After the patient was admitted to the hospital, according to the condition and examination and laboratory tests, the patient’s asthma condition was judged to be acute attack of bronchial asthma (moderate), so oxygen was administered, anti-infective drugs such as cefmetazole sodium for injection, as well as doxorubicin for injection, methylprednisolone sodium succinate for injection, and also nebulized inhalation with salbutamol inhalation aerosol, ipratropium bromide solution for inhalation, budesonide suspension for inhalation . After 7 days of treatment, the patient was discharged without wheezing and coughing and sputum, no dry rales were heard on auscultation, and the blood gas analysis was normal on recheck. When the patient was given the discharge treatment plan, he was reluctant to inhale drugs for a long time, especially those containing hormones. He patiently explained to the patient that asthma is a chronic airway inflammation disease, and glucocorticoids are the most effective drugs to control asthma, and the inhaled dose is small, so long-term inhalation will not have obvious side effects. The discharge treatment plan started with a 3-tier treatment plan. That is, budesonide formoterol powder inhalation.
III. Treatment effect
The patient was hospitalized for 7 days, and the symptoms of wheezing and nocturnal cough and sputum gradually disappeared after activity, and she felt no complaints of discomfort. The lungs were clear on auscultation, and no dry rales were heard. After discharge, the patient was given sequential treatment, i.e. budesonide formoterol powder inhalation. The patient was instructed to discharge with chest tightness <2 times within 1 week, without activity limitation and nocturnal awakening, without the use of relieving drugs such as salbutamol inhalation aerosol. 2 months later, the pulmonary ventilation function FVC, FEV1 reached the normal range, and PEF and small airway function were significantly higher.
IV. Notes
We are glad that the patient’s symptoms such as cough and sputum were relieved after treatment, but we should still pay attention to any cough and sputum after discharge, especially cough, wheezing and chest tightness at night, and seek medical consultation promptly if the above uncomfortable symptoms appear. In life, patients should pay attention to avoid contact with allergens, prevent colds, enhance physical fitness, and perform aerobic exercise appropriately when there is no acute attack. Review lung function every 3 months or so, adjust the drug dose according to the condition and lung ventilation function test results, and use the lowest dose of the drug for at least 1 year before considering stopping it. Asthma cannot be cured, but long-term standardized treatment can enable most patients to achieve good or complete clinical control, and regular inhalation of asthma medication is usually required.
V. Personal insight
Patients with bronchial asthma usually have symptoms such as coughing, coughing and episodic wheezing. Generally, after the acute attack of the disease is well controlled, patients will take it lightly and no longer pay attention to and maintain the medication, which will lead to the condition not being fully controlled and recurrent attacks will occur. Therefore, the doctor should give long-term treatment plan according to the patient’s condition, such as this case, the patient still undergoes budesonide formoterol powder inhalation treatment after discharge. At the same time, the need for long-term treatment should be clearly explained to the patient, and the patient should be taught simple first aid and regular review at the outpatient clinic.