Given the symptoms that Marissa is presenting with, differential diagnoses include: asthma, allergic reaction, infection (bronchitis, bronchiolitis, pneumonia, upper respiratory infection, etc.), and acid reflux.
Given the symptoms that Marissa is presenting with, differential diagnoses include: asthma, allergic reaction, infection (bronchitis, bronchiolitis, pneumonia, upper respiratory infection, etc.), and acid reflux. However, because she her symptoms reflect more of a chronic condition, is not presenting with a fever, and has already been diagnosed with asthma, her most likely primary diagnosis would be asthma. According to Schultz and Martin (2013), “Asthma is characterized by reversible small airway narrowing that is caused by a combination of bronchoconstriction, airway wall inflammation, and mucus secretion that usually presents with recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing” (p.14). To rule out the differential diagnoses, a chest x-ray should be performed as well as allergy testing and subsequently asking the parents whether the patient was exposed to a known allergen. Performing spirometry can determine the severity of asthma and its progression as well as rule out differential diagnoses. Restrictive lung disease should be considered with low forced vital capacity, while when there is flattening of the early part of the expiratory loop or when the inspiratory loop is flattened or notched, large airway obstruction should be considered (Schultz & Martin, 2013).
Due to the nature of asthma pathophysiology, a pharmacological approach must be implemented that includes anti-inflammatory medication as well as bronchodilators. Schultz and Martin (2013) recommends a combination of inhaled and oral glucocorticoids in the management of acute and persistent asthma in children over the age of 5 years. Corticosteroids provide an anti-inflammatory effect which improves asthma symptoms and lung function, while reducing asthma exacerbations and hospitalizations. Evidence-based research does not support the use of one glucocorticoid over another in the treatment of asthma. Marissa should continue taking her albuterol inhaler while her symptoms persist as needed every 4 hours. Albuterol is a Beta 2 adrenergic agonist which causes smooth muscle relaxation and bronchodilation. Albuterol is considered a rescue inhaler, so long acting Beta agonists, such as Advair, should be considered in the long term treatment of her asthma. Furthermore, cyctenyl leukotriene antagonists, such as montelukast, has been proven effective in the treatment of pediatric asthma (Schultz & Martin, 2013). This class of medications reduce inflammation and bronchoconstriction that can be caused by leukotrienes.
Edmunds, M. W. & Mayhew, M. S. (2013). Pharmacology for the primary care provider (4th ed.). St. Louis, MO: Elsevier.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Schultz, A., Martin, A. C. (2013). Outpatient management of asthma in children. Clinical Insights: Pediatrics, 7 (1), 13-24