Reviewed By Allergy, Immunology & Inflammation Assembly
Submitted by
Carleen M. Risaliti, MD
Clinical Instructor and Pulmonary/Critical Care Fellow
Department of Internal Medicine
The Ohio State University Wexner Medical Center
Columbus, Ohio
Jonathan P. Parsons, MD
Professor of Internal Medicine
Department of Internal Medicine
The Ohio State University Wexner Medical Center
Columbus, Ohio
Submit your comments to the author(s).
History
The patient is a 35 year-old year old male inmate at a regional correctional facility with a history of asthma who is admitted to the hospital for persistent shortness of breath. The patient had been admitted to the hospital for dyspnea a week prior and symptoms initially improved but then became acutely worse again upon discharge back to prison. Aside from his history of asthma, the patient has no other past medical history or surgical history.
With respect to his asthma, the patient was diagnosed at the age of two. He was hospitalized several times as a young child but then was relatively asymptomatic until he was incarcerated two years ago. Since his incarceration, he has been hospitalized seven times. He has also been intubated twice within the past two years due to his asthma and has been in the ICU at least three times. The patient’s current medications include mometasone/formoterol 200mcg/5mcg 2 puffs BID, montelukast 10mg P.O. and albuterol as needed. The patient also has received several oral steroid bursts over the course of the past several months and has not been completely off of oral steroids for three months. He is a never smoker.</p
Physical Exam
Lab
References
- Jain VV, Allison DR, Andrews S, Mejia J, Mills PK, Peterson MW. Misdiagnosis among frequent exacerbators of clinically diagnosed asthma and COPD in absence of confirmation of airflow obstruction. Lung 2015;193(4):505-512.
- Heffler E, Pizzimenti S, Guida G, Bucca C, Rolla G. Prevalence of over-/misdiagnosis of asthma in patients referred to an allergy clinic. J Asthma 2015:1-4.
- Chung KF, Wenzel SE, Brozek JL et al. International ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma. 2013:1-112.
- Malo JL, Tarlo SM, Sastre J et al. An official American Thoracic Society workshop report: presentations and discussion of the fifth Jack Pepys workshop on asthma in the workplace. American Thoracic Society Documents 2015;12(7):S99-S110.
- Friedman-Jimenez G, Harrison D, Luo H. Occupational asthma and work-exacerbated asthma. Semin Respir Crit Care Med 2015;36:388-407.
- Smith AM, Bernstein DI. Management of work-related asthma. J Allergy Clin Immunol 2009;123:551-557.
- Diaz, RA, Charles Z, George E, Adler AI. NICE guidance on omalizumab for severe asthma. Lancet Respir Med 2013;1(3):189-90.
- Normansell R, Walker S, Milan SJ, Walters EH, Nair P. Omalizumab for asthma in adults and children (Review). Cochrane Database Syst Rev 2014;1:1-159.
- Sutherland ER, King TS, Icitovic N et al. A trial of clarithromycin for the treatment of suboptimally controlled asthma. J Allergy Clin Immunol 2010;126:747-753.
- Brusselle GG, VanderStichele C, Jordens P et al. Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial. Thorax 2013;68:322-329.
- Polosa R, Bellinvia S, Caruso M et al. Weekly low-dose methotrexate for reduction of Global Initiative for Asthma Step 5 treatment in severe refractory asthma: study protocol for a randomized controlled trial. Trials 2014;15:492-499.