What is the appropriate management plan for a patient with a severe sore throat, cough, shortness of breath, and a history of asthma, who also has seasonal allergies and has been exposed to COVID-19?

Management of Respiratory Symptoms in a Patient with Asthma and Possible COVID-19 Exposure

For this patient with severe sore throat, cough, shortness of breath, and history of asthma with COVID-19 exposure, a combination approach using bronchodilators, antihistamines, and supportive care is recommended.

Initial Assessment and Risk Stratification

• This 47-year-old female presents with symptoms that could represent COVID-19 infection, asthma exacerbation, or seasonal allergies with post-nasal drip 1, 2
• The presence of sore throat (8/10 severity), cough, shortness of breath, and known COVID-19 exposure increases the likelihood of COVID-19 infection 1, 3
• The patient's history of asthma places her at higher risk for respiratory complications if she has COVID-19, though allergic asthma may have lower risk of severe COVID-19 than non-allergic asthma 4
• The absence of fever is notable but does not rule out COVID-19 1

Management of Cough

• Brompheniramine-DM liquid (2-10 MG/10ML) 10 mL orally every 6 hours as needed is appropriate for managing cough symptoms 5
• Brompheniramine with dextromethorphan addresses both the allergic component and cough suppression 5
• For patients with distressing cough, consider positioning - avoid lying on back as this makes coughing ineffective 1
• Vick's vapor rub application to chest at night can help with cough and congestion through aromatherapy effects 1

Management of Allergic Component

• Cetirizine 10 mg daily is appropriate for managing the allergic rhinitis component, which may be contributing to post-nasal drip and cough 4
• Continued antihistamine therapy is important as allergic symptoms can mimic or exacerbate COVID-19 symptoms 2, 3
• Patients with allergic rhinitis using intranasal corticosteroids have shown lower rates of hospitalization due to COVID-19 4

Asthma Management

• Proper use of the patient's inhaler as directed is critical for managing shortness of breath 1, 6
• Poor asthma control is linked to severe COVID-19 outcomes, making optimal asthma management essential 4, 7
• If shortness of breath worsens, consider increasing frequency of inhaler use according to an asthma action plan 6

COVID-19 Considerations

• Monitor for worsening symptoms, particularly increasing shortness of breath, which may indicate COVID-19 progression 1
• Advise the patient to maintain adequate hydration (no more than 2 liters per day) 1
• If fever develops, paracetamol is preferred over NSAIDs for symptom relief in the context of possible COVID-19 1
• Breathing techniques may help manage breathlessness: pursed-lip breathing, sitting upright, and leaning forward with arms bracing a chair 1, 6

Follow-up and Monitoring

• Establish clear instructions on when to seek emergency care: worsening shortness of breath, persistent chest pain, confusion, or bluish lips 1, 3
• Consider COVID-19 testing based on exposure history and symptom progression 1
• Schedule follow-up in 7-10 days to reassess symptoms and treatment efficacy 1
• Be aware that post-COVID cough can persist for weeks to months in some patients 8, 7

Special Considerations

• If symptoms worsen significantly with increased respiratory distress, prompt medical evaluation is needed to assess for severe COVID-19 or asthma exacerbation 1, 7
• Patients with asthma and COVID-19 may have more severe presentations than those without asthma 7
• Continue prescribed asthma medications as stopping them could lead to worsening respiratory status 4