What are the patient's current diagnoses?

Current Diagnoses

Based on the clinical presentation provided, this patient has acute asthma exacerbation triggered by influenza-like illness (ILI) with concurrent acute bacterial sinusitis.

Primary Diagnoses

Acute Asthma Exacerbation

• The patient presents with wheezing, dyspnea, and respiratory distress requiring hospitalization, which meets criteria for severe acute exacerbation of bronchial asthma 1
• Viral respiratory infections, particularly influenza, are the predominant triggers that drive acute exacerbations of bronchial asthma, accounting for nearly 80% of exacerbation episodes 2, 3
• The presence of fever >38°C, tachycardia >100 beats/min, tachypnea ≥24 breaths/min, and oxygen saturation concerns indicate clinical instability and severe illness 4
• Patients with asthma who develop ILI are at higher risk for complications, with approximately one-third experiencing severe outcomes requiring ICU admission 5

Influenza-Like Illness (ILI)

• Fever >38°C is the hallmark vital sign and diagnostic criterion for influenza-like illness requiring antiviral treatment 4
• The patient meets criteria for ILI based on fever, respiratory symptoms, and systemic manifestations 4, 6
• Early empiric antiviral therapy with oseltamivir should be initiated immediately in winter months for all severe asthma exacerbations where viral infection is suspected 2, 5
• Delay in seeking medical care is associated with severe exacerbations (odds ratio 2.93), making early treatment critical 6

Acute Bacterial Sinusitis

• The patient presents with sinus pressure, headache, and purulent nasal discharge persisting beyond 10-14 days, meeting criteria for acute bacterial sinusitis 1, 7, 8
• Sinusitis that fails to improve after 21-28 days of initial antibiotic treatment may be caused by pathogens not adequately covered by prior antibiotics, presence of nasal polyps, or noncompliance 7
• The combination of facial-dental pain, postnasal drainage, nasal congestion, and purulent secretions are hallmark symptoms of bacterial sinusitis 8

Secondary/Comorbid Diagnoses

Allergic Rhinitis

• Consultation with an allergist-immunologist is appropriate when patients have comorbid conditions such as asthma and chronic sinusitis 1
• Underlying allergic rhinitis should be evaluated as a risk factor contributing to recurrent sinusitis 1
• The presence of nasal congestion, rhinorrhea, and postnasal drainage suggests concurrent allergic or non-allergic rhinitis 1

Possible Chronic Persistent Asthma

• Classification of asthma severity requires assessment of impairment (symptoms, nighttime awakenings, SABA use, activity limitation) and risk (exacerbation frequency) 1
• Patients requiring hospitalization for asthma exacerbation likely have at least moderate persistent asthma 1
• Patients who had two or more exacerbations requiring oral systemic corticosteroids in the past year should be considered to have persistent asthma 1

Critical Management Implications

Immediate Treatment Requirements

• Oxygen 40-60% should be administered immediately for all patients with severe asthma exacerbation 1
• Nebulized salbutamol 5 mg or terbutaline 10 mg via oxygen-driven nebulizer should be given stat 1
• Prednisolone 30-60 mg orally or intravenous hydrocortisone 200 mg should be administered 1
• Empiric antibiotics with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated for all severe exacerbations where infection is suspected 2

Antibiotic Coverage for Sinusitis

• High-dose amoxicillin-clavulanate (90 mg/kg amoxicillin and 6.4 mg/kg clavulanate, not to exceed 2 g every 12 hours) is recommended for treatment failure after initial therapy 1, 7
• Treatment should continue for 10-14 days or until symptomatically improved to near normal 1, 7
• Nasal corticosteroids should be added to reduce mucosal inflammation 7

Monitoring and Follow-up

• Temperature, respiratory rate, pulse, blood pressure, mental status, and oxygen saturation should be monitored at least twice daily in hospitalized patients 4
• Patients meeting two or more clinical instability criteria should remain hospitalized 4
• Do not dismiss patients with normal vital signs if they have bilateral chest findings, as primary viral pneumonia can progress rapidly 4

Common Pitfalls to Avoid

• Do not delay antiviral therapy - early treatment within 48 hours of symptom onset is associated with better outcomes and reduced severe complications 5
• Do not underestimate the severity - patients with asthma and ILI may not report typical ILI symptoms but can still progress to severe exacerbation 6
• Do not overlook co-infection - both viral and bacterial agents can play a role, and co-infection may worsen prognosis 2
• Do not discontinue treatment prematurely - sinusitis requires full 10-14 day course even if symptoms improve earlier 1, 7