Occupational Asthma or Bakers Asthma Diagnosis
Occupational Asthma or Baker’s Asthma Diagnosis
Occupational Asthma or Baker’s Asthma Diagnosis
Permalink: https://collepals.com/occupational-ast…asthma-diagnosis/
Based upon the presenting symptoms and assessment findings given, the most likely diagnosis related to this case study would be occupational asthma or baker’s asthma. This is an active airway disease, which affects four to twenty five percent of bakers worldwide (Brittner, Peters, Frenzel, Muskin, Brettschneider, 2015). Michelle complains of shortness of breath while at work, however she has relief and no longer experiences shortness of breath once leaving work and, on the weekends, while at home. Physical exam findings showed thin, exudate to bilateral nares, boggy, pale mucosa, and wheezing noted upon inspiration and expiration. Due to wheezing and shortness of breath while at work could be due to an allergen related to an inhalation of a type of flour used at the bakery. With Michelle having exudate to both nares this would be related to an allergic rhinitis. Allergic rhinitis is an inflammation of the nasal mucosa, which is an IgE-mediated allergy causing sneezing, a stuffy nose, or a runny nose (Tanno, et al., 2016). Occupational Asthma or Baker’s Asthma Diagnosis
In 2016, Michelle, had a pulmonary function test performed. There was an increase of 15% seen in her pulmonary function test post bronchodilator. The existence of airflow obstruction and a good bronchodilator response is consistent with the diagnosis of asthma. Key indicators associated with asthma include the following: recurrent difficulty in breathing or shortness of breath, recurrent wheezing or tightness in one’s chest, and a cough (worsening at night). The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry (Mccracken, Veeranki, Ameredes, & Calhoun, 2017). Michelle is experiencing symptoms daily, and along with this her FEV1 is >60% but less than 80%. Based upon her severity she would be considered a moderate persistent asthmatic.
As a healthcare provider, to treat Michelle’s asthma, I would initially order a CBC, CMP, chest x-ray, and I would refer her to an allergist to have skin testing performed. A CBC would help to rule out infection, where as a CMP would check basic electrolytes, kidney function, and her blood glucose. A chest x-ray would help to exclude other possible disease and give use the opportunity to compare it with her chest x-ray from 2016. For asthmatics with a moderate persistent severity, it is recommended to use a low-dose inhaled corticosteroid and a long-acting inhaled beta two-agonist (Uphold & Graham, 2013). In acute asthma attacks, short beta two agonists provide individuals with rapid relief, however a daily maintenance of asthma would require an inhaled corticosteroid. ProAir, is a SABA, which is used as a rescue or relief inhaler for asthmatics (Hon, Leung, & Leung, 2014). A SABA is indicative and used for bronchospasms. A combination inhaler (corticosteroid + long-acting best-two agonist) such as Symbicort helps to improve asthma control and is effective in controlling persistent asthma. Singulair is a cysteinyl leukotriene receptor antagonist used for the maintenance treatment of asthma (prevention of bronchostriction) and to relieve symptoms of seasonal allergies such as rhinitis (Hon, Leung, & Leung, 2014). In knowing this, I would place Michelle on the Singulair and discontinue her Zyrtec. At the end of this discussion, I will list out the medications for Michelle.
Follow up care for maintenance control for asthma is imperative. Due to asthma being “newly diagnosed” for Michelle I would have her follow up in one month to make sure the medications are working appropriately. After the initial follow up, I would then have her follow up every three months afterwards unless symptoms worsen. A referral to an allergist would be given to obtain skin testing. This will help to identify which specific wheat allergies she may be experiencing. I would also refer Michelle to pulmonology to have another pulmonary function test performed to have a comparison to the one which was obtained in 2016, and to make sure her levels are maintaining and not decreasing. Education is key in all diseases no matter how easy or how complicated they are. Important education notes would first be to address her newly prescribed medications. It is important she knows when to use her inhalers, how often to use them, and the side affects which may be associated with them. In office, she should demonstrate how to use the inhalers. She should be given reading material associated with asthma, its disease process, and asthma triggers should be discussed along with how to avoid them. One last thing which should be discussed is how to recognize symptoms of poor asthma control.
I think many would agree that antibiotics are way over used in all types of practice. It is unfortunate, because the majority of patients demand for antibiotics when they do not necessarily need them. In Michelle’s case, it is important to describe to her that this is an allergic response she is having due to her work environment. With that being said, it is important to discuss the differences between an allergic response, viral, and bacterial infections. I would also explain to her that the chest x-ray will show if there is any pneumonia in place and if at that time there is, an antibiotic will be prescribed. However, her presenting symptoms do not suggest these findings. The majority of asthma attacks are due to viral illnesses, however in Michelle’s case she is experiencing an allergic response where an antibiotic is not indicated. The treatment of asthma should be focused around alleviating one’s symptoms, and preventing the disease form progressing further. Occupational Asthma or Baker’s Asthma Diagnosis
- Singular 10mg-Take one tablet by mouth daily
- ProAir HFA 90mcg (Albuterol)- Inhale 1-2 puffs every four hours PRN for shortness of breath
- Symbicort 106/4.5mcg-Take 2 puffs by mouth twice daily
References:
Bittner, C., Peters, U., Frenzel, K., Müsken, H., & Brettschneider, R. (2015). New wheat allergens related to bakers asthma. Journal of Allergy and Clinical Immunology, 136(5). doi:10.1016/j.jaci.2015.05.010.
Hon, K. E., Leung, T. F., & Leung, A. K. (2014). Clinical effectiveness and safety of montelukast in asthma. What are the conclusions from clinical trials and meta-analyses? Drug Design, Development and Therapy, 839. doi:10.2147/dddt.s39100.
Mccracken, J. L., Veeranki, S. P., Ameredes, B. T., & Calhoun, W. J. (2017). Diagnosis and Management of Asthma in Adults. Jama, 318(3), 279. doi:10.1001/jama.2017.8372.
Tanno, L. K., Calderon, M. A., Smith, H. E., Sanchez-Borges, M., Sheikh, A., & Demoly, P. (2016). Dissemination of definitions and concepts of allergic and hypersensitivity conditions. World Allergy Organization Journal, 9(1). doi:10.1186/s40413-016-0115-2.
Uphold, C. R., & Graham, M. V. (2013). Clinical guidelines in family practice (5th ed.). Gainesville, Florida.: Barmarrae Books. Occupational Asthma or Baker’s Asthma Diagnosis
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.