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Jack Jones Case Summary

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Jack Jones is currently managed on an Albuterol nebulizer 0.083% every 4-6 hours as needed. For the last month, Jack has been coughing throughout the evenings and almost every day. His mother has been treating him with his nebulizer three times daily with some improvement of symptoms. Before discussing a new treatment plan, I took the time to discuss with the mother that Albuterol is a short acting beta -2 agonist (SABA) and vasodilator that is most effective for reversing acute airway obstruction caused by bronchoconstriction. Thus, this should only be used for quick relief of asthma symptoms and not for every day use. Her son is experiencing nearly daily coughs that are persistent in the evenings that it is likely he now has moderate to severe asthma instead of mild asthma. Due to worsening asthmatic symptoms, it is best to add on another medication. We do not want to stop the Albuterol nebulizer, because all asthmatic patients must have a quick relief medication on hand.

As discussed earlier, Jack has moderate to severe asthma that it is recommended to start an inhaled corticosteroid with a leukotriene modifier. An inhaled corticosteroid works to suppress inflammatory cell activation and function to decrease airway inflammation, prevent microvascular leakage to decrease airway edema, decrease mucus production, …show more content…
However, if patient develops any adverse reactions particularly with Montelukast –depression or showing signs of suicidal ideation we will discontinue Montelukast and switch him to a long acting beta 2 agonist, which will have the same benefit of alleviating Jack’s symptoms. If it is also inadequate and unable to improve symptoms, we can discontinue the long acting beta 2 agonist and consider a Theophylline. Theophylline’s are not always favorable because of their narrow therapeutic

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