BB is a year old female who presents with her family today in clinic with complaints of increased wheezing. She states that this is similar to a breathing problem she had as a child when she h

BB is a year old female who presents with her family today in clinic with complaints of increased wheezing. She
states that this is similar to a breathing problem she had as a child when she had to wear a mask on her face and
breathe in mist. She states that her breathing has become bothersome and she can’t run around the house with her
brother to play pranks on their family members anymore.
PMH: intermittent asthma (diagnosed at age 5) Vaccine history: none this year
SH: lives with mom, dad, and brother in an old Victorian home; recently their “cousin” It came to live with them and
brought his cats along; WA denies any substance use
Medications:
 Mircette 1 tablet po daily

1. What questions would you want to ask WA to assess her asthma control? (Use GINA Guidelines)

2. Assuming that her answers to your above question classifies her asthma as not well controlled, what
change(s) would you like to make to her medication regimen? (include drug name, dose, route, frequency)

3. How would you counsel WA about her asthma medications?

4. What advice would you give WA and her family about potential asthma triggers?

5. It is currently October, what vaccine should WA receive?

WA returns for a follow-up appointment 3 months later stating that she has not had any improvement in her symptoms,
despite staying away from her cousin’s cats.
Medications:
 Symbicort 80/4.5 mcg 2 puffs PRN for wheezing
 Mircette 1 tablet po daily

6. What is your first step?

7. Assuming you get no additional, helpful information from #1, what medication change would you like to
make today? (include drug name, dose, route, frequency)

It has now been 3 years since you’ve seen WA. She presents to the clinic for a routine check-up. She was referred to a
pulmonologist since your last visit, and her asthma medications were adjusted and she was stable; therefore, WA was
discharged from their clinic 3 months ago. Since that time, WA has been experiencing more shortness of breath, and is
concerned that she is losing control of her asthma despite absolute adherence to her medications.
Medications:
 Mircette 1 tablet po daily
 Symbicort 80/4.5 mg 2 puffs BID and PRN for wheezing
WA fills out the following questionnaire while waiting to be seen today:

8. What medication change would you like to make today? (include drug name, dose, route, frequency)