Posted: January 10th, 2023

Respiratory Disorders Essays

JR is experiencing a severe asthma attack based on the severity of his symptoms. Also, he reports daily shortness of breath, wheezing, disturbed sleep two times a week, and increased variability in spirometry readings. I can conclude that he has uncontrolled asthma. Several external triggers contribute to his worsening condition, including pet dander, second-hand smoke, and occupational exposure. Additionally, methods to reduce exposure to allergens while tailoring modifications to the patient’s lifestyle and budget improve compliance (Reddel et al., 2015). For example, quitting his job may not be possible; however, instructing JR to wear a protective mask to limit work-related allergen exposure is a practical solution. JR should have been on step 4 before his E.R. admission. The Global Initiative for Asthma (GINA) recommendations for step 4 include; formoterol DPI a long-acting beta-2 agonist (LABA), 12 mcg capsule inhaled every 12 hours daily, tiotropium a long-acting muscarinic antagonist (LAMA), two inhalations of 1.25mcg  daily, and Albuterol MDI a short-acting beta-agonist (SABA), as needed (2109). While in the emergency room, JR requires supplemental oxygen and oral corticosteroids 2mg/kg daily. Systemic corticosteroids are proven to speed the resolution of symptoms and reduce reoccurrence when continued for 3-4 days after an acute attack (Alangari, 2014). Also, JR should be tested for a possible specific phenotype that predisposes him to attacks and schedule an appointment with an asthma specialist. Patient education should include inhaler skills to ensure proper administration of doses, a written asthma treatment plan, and regular spirometry monitoring. Unfortunately, there are no specific criteria for assessing control; however, three months of good control may include reducing exacerbations, symptom management, and peak flows with decreased variability. In conclusion, step down includes tapering oral corticosteroids first. Next, re-evaluate asthma medications every 3-6 months and reduce add-on treatments individually based on observed benefits and risk factors (GINA, 2019).



Alangari A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic medicine, 9(4), 187–192.

Global strategy for asthma management and prevention 2019 (update) [internet].

Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., Haahtela, T., Hurd, S. S., Inoue, H., de Jongste, J. C., Lemanske, R. F., Jr, Levy, M. L., O’Byrne, P. M., Paggiaro, P., Pedersen, S. E., Pizzichini, E., Soto-Quiroz, M., Szefler, S. J., Wong, G. W., & FitzGerald, J. M. (2015). A summary of the new GINA strategy: a roadmap to asthma control. The European respiratory journal, 46(3), 622–639.

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Last post Nov 1, 2020 11:01 PM by Dianne Cohen

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