UNIVERSITY OF SANTO TOMAS

FACULTY OF PHARMACY
DEPARTMENT OF PHARMACY
PHA 6132 LECTURE: CASE ANALYSIS ASTHMA

NAME: ________________________________ Section: _______

Intended Learning Outcomes:

• Students will be able to justify the pharmacotherapy of patient with asthma and to
recommend non-pharmacological and pharmacological approaches to control asthma,

Direction: Read and analyze the case presented. Answer all questions related to the case.

CASE

MRK, a 44-year-old woman, presents to her GP with mild shortness of breath and a non-productive
cough, worse at night and sometimes with allergic rhinitis symptoms episodic cough, wheeze,
shortness of breath, and chest tightness. She is currently working in the bakery, and these symptoms
become worse within 1-2 hours of starting work each day and worsen throughout the workweek. She
especially finds red bran to worsen her symptoms almost immediately on exposure. She notices an
improvement within 1-2 hours outside of being at her workplace.

Her past medical history is significant for seasonal allergic rhinitis in the summer months since
childhood. She is a lifelong non-smoker and non-alcoholic drinker. Her family history is significant for
asthma in her mother and brother.

Upon consultation, she can talk in sentences, but her respiratory rate is increased. Her peak flow is 420
L/min, which is 80% of the predicted result. The physician prescribes Beclometasone 200 mcg one puff
morning and night and Salbutamol 100 mcg to use two puffs as required. Her physician demonstra tes
the use of the metered-dose inhaler (MDI) and explains the difference between a reliever
(bronchodilator) and a preventer (steroid) inhaler.

After two (2) weeks of therapy, Her symptoms deteriorated slightly with a cold several weeks previously
and have not improved. She also complains of itchy eyes, sneezing, and persistent blockage of her nose.
She now needs Salbutamol 4 -6 times per day to help her breathing. On examination: she is speaking in
full sentences, respiratory rate is 20 breaths/min, pulse rate is 90 beats/min, her peak expiratory fl ow
rate (PEFR) is 320 L/min (best 400 L/min) she has a mild expiratory wheeze to hear on auscultation of her
chest. Her physician ordered to continue her medication

She returns for review after two weeks. She reports that she has noticed some improvement, but she still
has a non-productive cough, occasional wheeze, and shortness of breath. She is still using her short-
acting bronchodilator 2–3 times per day and her steroid inhaler twice a day. Her PEFR is 350 L/min, and
her chest is now clear to auscultation. She comments that her blocked nose adds to her difficulty with
breathing at night. Other factors/advice by the physician are satisfactory, and her symptoms are still not
controlled than her treatment

Prepared by:
Asst. Prof. Michelle Bartolome, MSc
 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF PHARMACY
PHA 6132 LECTURE: CASE ANALYSIS ASTHMA

Questions:

Part 1: During the consultation (15 points)

1. At what step # of stepwise approach treatment are the medications prescribed? Explain (5pts )

2. Do you agree with the prescribed drug and dose? Explain.

3. Identify the controller and reliever drug. Describe their mechanism of action in the treatment of
asthma. (5pts)

PART 2: After two weeks of therapy,

4. What do you think are the factors considered by the physician to continue her medication? (5
pts)

Prepared by:
Asst. Prof. Michelle Bartolome, MSc
 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF PHARMACY
PHA 6132 LECTURE: CASE ANALYSIS ASTHMA

Part 3: After 4th weeks of therapy

5. Is her asthma well controlled, poorly controlled or uncontrolled? (5 pts)

6. What are the features of well-controlled asthma? (5 pts)

7. Should her asthma treatment be changed at this stage? What would be your recommendation?
(5pts)

8. What other medication would you recommend to the physician aside from asthma drugs? (5pts)

9. What are essential information about the inhaler/use of the inhaler should the patient
know?(5pts)

10. As a future pharmacist, what non-pharmacological approach ould you recommend to asthma
patient? (5 points)

Prepared by:
Asst. Prof. Michelle Bartolome, MSc