From the Guidelines
For discharge planning, two high-priority questions would be: "What support systems do you have at home?" and "How is your home environment set up?" These questions are crucial because Chris's partner has Parkinson's Disease, which may limit their ability to assist Chris during recovery, as noted in the guidelines for asthma management 1. Understanding available family support, friends, or community services would help determine if additional home care is needed. The home environment question is important to assess for potential barriers like stairs, which could be challenging for someone with respiratory difficulties, and to identify modifications needed for safe discharge.
When observing Chris's breathing pattern, you might notice increased work of breathing with accessory muscle use. This would include visible contraction of the sternocleidomastoid, scalenes, and upper trapezius muscles during inspiration as they attempt to expand the thoracic cavity. In severe respiratory distress, you might also observe intercostal retractions and use of the abdominal muscles during expiration. Chris may demonstrate a rapid, shallow breathing pattern with decreased tidal volume due to airflow limitation from asthma. The breathing might be asymmetrical with prolonged expiration, as air trapping occurs in the narrowed airways. This pattern reflects the body's attempt to compensate for increased airway resistance and reduced gas exchange efficiency typical in asthma exacerbations, which is consistent with the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma 1.
Key considerations for Chris's discharge plan should include continuation of treatment with inhaled SABA, completion of the course of oral systemic corticosteroid, and consideration of initiation of an inhaled corticosteroid (ICS) as recommended by the guidelines 1. Patient education on medications, including inhaler technique, review or initiation of an action plan, and recommendation for close medical follow-up are also essential. Before discharge, scheduling a follow-up appointment with the primary care provider and/or asthma specialist within 1-4 weeks is crucial for monitoring Chris's condition and adjusting the treatment plan as necessary 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
High-Priority Distinctive Questions for Discharge Planning
- What support systems are in place at home to assist with medication management and potential exacerbations of asthma, considering Chris's partner has recently been diagnosed with Parkinson's Disease?
- How will Chris access follow-up medical care and physiotherapy appointments after discharge, given their living situation and potential mobility limitations 2, 3?
Breathing Pattern and Muscles of Respiration
- Chris may exhibit a breathing pattern characterized by wheezing, dyspnea, and cough, indicative of airway obstruction and inflammation associated with asthma 2, 4.
- The muscles of respiration involved in Chris's breathing pattern may include:
- Diaphragm: primary muscle used for inhalation, which may be weakened or less effective due to airway obstruction and inflammation.
- Accessory muscles: such as sternocleidomastoid and scalene muscles, which may be used to assist with inhalation in cases of respiratory distress.
- Intercostal muscles: which may be used to help expand the chest cavity and improve lung volume 5.