CASE STUDY 1

Patient J is a boy, 5 years of age, residing in Southwest Michigan. One March evening, Patient J was home with a conscientious babysitter. He had experienced several coughing episodes during the previous days and began to cough while playing hide-and-seek with the babysitter. She noticed that the coughing was continuing and that the more he coughed, the more he cried. She was not able to calm the patient and telephoned his parents at a nearby restaurant. Within 20 minutes, the parents returned home and found Patient J upset, crying, and coughing. They could hear audible wheezing on exhalation and could see the young boy's chest retract on inspiration. A physician was called immediately, and the parents were instructed to meet the pediatrician at his office located next to the area's hospital; they arrived within 30 minutes. The pediatrician administered a nebulizer treatment with albuterol in a 0.083% solution for inhalation, which seemed to resolve the cough, wheeze, and labored breathing after 15 to 20 minutes.

The patient's history was reviewed. According to his parents and office records, Patient J's first few years of life were essentially medically uneventful with the exception of occasional benign rashes, several that were specifically found to be related to a wood sensitivity. By 4 years of age, Patient J had experienced a number of cold viruses and allergies, with severe bouts of nasal and chest congestion. He had no history of medical emergencies related to labored breathing or otherwise.

As a precaution, the physician was prepared to recommend hospital admission to provide intensive respiratory tent therapy in the event that the symptoms did not improve. However, the symptoms seemed to resolve completely, and Patient J was sent home with his parents and placed on a 10-day period of antibiotic therapy and an albuterol aerosol inhaler, one or two inhalations every four to six hours as needed. It was also recommended that a nebulizer be kept at home, for faster results in case of sudden onset of moderate-to-severe coughing, chest congestion, wheezing, and/or tightness in the chest.

Patient J was subsequently diagnosed with an extrinsic, mild-intermittent asthma, triggered by several sensitivities, specifically to wood, dust, pollen, and cold weather. Recommendations for control of the patient's asthma symptoms were made to the patient and his family in an effort to manage the condition. He was encouraged to sleep with his head propped up with pillows about 30 degrees. Outdoor play and activities at home or at school were evaluated for appropriate participation based on severe weather, particularly when accompanied by wind. On very cold days or days with high mold or pollen counts, Patient J was instructed to wear a mask. Spring and fall proved to be difficult times for outdoor activities. His lungs became sensitive to the smoke from burning leaves and the mold-infested fallen leaves in autumn.

At home, Patient J's room was evaluated for sources of asthma triggers. Stuffed animals, carpeting, and heavy draperies were kept to a minimum. He had no feather-filled pillows, and his bedding was washed weekly in hot water. He slept with a room air purifier. When his asthma flared up, the patient was given his prescribed medications and warm liquids. A soothing bath or shower allowed him to be in an area of humidified, misty air, which often relaxed and dilated the bronchial airways.

One decade later, Patient J's asthma remains in control. At 15 years of age, he continues to take his medication and stays aware of his asthma triggers. The frequency and severity of asthma episodes have gradually lessened over time. He and his family, however, are aware that the condition is capable of changing or worsening at any time and may return with increased frequency and severity in later years. For now, Patient J is living a normal, healthy, active adolescent life.