From the Guidelines
The patient should begin her prednisone taper as prescribed by her pulmonologist and use albuterol via nebulizer every 4-6 hours around-the-clock for the next 72 hours. This treatment approach addresses her worsening asthma symptoms (wheezing, shortness of breath, and cough) following her recent bronchitis diagnosis. The prednisone taper will gradually reduce inflammation in her airways while preventing withdrawal symptoms from the high-dose steroids she's been taking. Using albuterol regularly rather than just morning and night will provide consistent bronchodilation throughout the day and night, helping to keep her airways open. This is particularly important given her history of asthma, recent respiratory infection, and possible decreased lung capacity from previous COVID infections. According to the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1, considering a short course of oral systemic corticosteroids is recommended to establish reversibility and the extent of possible benefit from asthma treatment, especially in older adults. The treatment aims to break the cycle of inflammation and bronchoconstriction that is causing her symptoms. If her symptoms don't improve within 72 hours on this regimen, she should seek further medical evaluation as she may need additional interventions or a different treatment approach.
Some key considerations in her treatment include:
- Adjusting medications as necessary to address coexisting medical conditions, such as her asthma and possible decreased lung capacity from previous COVID infections 1.
- Reviewing the patient’s technique and adherence in using medications, and making necessary adjustments, which is crucial given her history of asthma and recent respiratory infection 1.
- Using albuterol via nebulizer, which is a recommended treatment for patients with COPD or asthma, especially during exacerbations 1.
- The importance of supplemental oxygen therapy if needed, although in this case, the patient does not have pneumonia and her current oxygen saturation is not mentioned 1.
Given the patient's history and current symptoms, the most appropriate course of action is to follow the prescribed treatment plan and monitor her symptoms closely. If her condition worsens or does not improve, further evaluation and adjustment of her treatment plan may be necessary.
From the Research
Patient's Condition
The patient is a 69-year-old female former smoker with a past medical history of asthma. She was recently diagnosed with bronchitis and started on 40 mg of prednisone, which she has now completed. She reports worsening wheezing, shortness of breath, and cough.
Treatment and Management
- The patient has been using her nebulizer morning and night but not throughout the day 2, 3.
- She was advised to start tapering prednisone and use albuterol every 4-6 hours as needed for 72 hours.
- The use of inhaled corticosteroids, such as budesonide and ciclesonide, has been shown to probably reduce the combined endpoint of admission to hospital or death and increase the resolution of all initial symptoms at day 14 in people with confirmed COVID-19 and mild symptoms 4.
- Systemic corticosteroids, such as prednisone, may be beneficial in the management of COVID-19-exacerbated asthma, as they can suppress type 2 inflammation and restore impaired antiviral immunity 5.
Considerations
- The patient's history of COVID-19, which she states has decreased her lung capacity, and her current symptoms of worsening wheezing, shortness of breath, and cough, suggest that she may be at risk for severe illness from COVID-19 6, 4.
- The use of nebulized therapy, such as albuterol, may be effective in managing the patient's symptoms, but it is essential to follow proper guidelines to minimize the risk of transmission of SARS-CoV-2 2, 3.
- The patient's father was recently admitted to the hospital with parainfluenza, which may increase her risk of exposure to respiratory viruses and exacerbate her asthma symptoms.