NR565 Week 6 Discussion Client Scenario about Asthma Diagnosis

Client Scenario about Asthma Diagnosis

Client Situation

Saagar Agarwal is a 60-year-old patient who comes to the clinic complaining of difficulty in breathing, a long-term cough, and an increase in phlegm. He has been smoking for years and was diagnosed with the disease 3 years ago with a diagnosis of COP. His health problem(s) have worsened in the last few weeks, mostly after getting a cold. He has trouble ascending stairs and wakes up at night often from coughing. Right now, Saagar uses an MDI to take albuterol at any time she needs it. He tells us about the fact that he uses it several times a day, pointing to a lack of control over the disease.

Clinical Practice Guideline Assessment

While Saagar’s treatment is being managed, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines should be used. GOLD states that the care of people with COP depends on the severity of symptoms and the likelihood of exacerbations. Because Saagar’s symptoms have worsened and are present every day, he most likely falls in the GOLD Group D, which covers those with a lot of symptoms and at least one exacerbation. The GOLD guidelines advise that those people in Group D should start dual therapy of a LABA and LAMA. If the symptoms don’t clear up, then an inhaled corticosteroid (ICS) can be considered, especially if the patient’s eosinophil levels are high. GOLD guidelines suggest that patients with COPD stop smoking, be vaccinated, and take part in pulmonary rehabilitation, which are not approaches that require medications. The purpose is to reduce symptoms, prevent more severe episodes, and improve quality of life.

Professional Assessment and Pharmacological Plan

Although Saagar is using SABA, like albuterol, it is not enough to treat a case with moderate-to-severe disease. Since he uses the rescue inhaler so much and he has so many functional problems, it appears that his disease is out of control. As a nurse practitioner, I would initiate treatment with a LABA/LAMA combination such as formoterol/tiotropium to ensure that a patient’s airways remain open, their symptoms improve, and the risk of exacerbations is reduced (Miravitalles et al., 2022).

Should Saagar continue to have frequent exacerbations despite having 2 bronchodilators, triple therapy with LABA/LAMA/ICS may be necessary. Still, the first step is evidence-based: introducing dual therapy. I will also check how he utilizes the inhaler and suggest a smoking cessation program since this helps to stop the disease from progressing. As well as the medicine, I would advise Saagar to make better diet choices, understand the need to vaccinate against flu and pneumococcal, and join pulmonary rehab to help him breathe better and have more stamina.

Additional Considerations and Follow-Up

Several other details need to be researched to ensure that Saagar receives the best care. The first step would be to know his eosinophil count, because that may help determine whether he needs inhaled corticosteroids. I would also check the amount of oxygen in his blood both at rest and while he is active to see if he needs oxygen support. In addition, health professionals should look for other conditions such as heart failure, sleep apnea, and depression as they are common in people with COPD and may make their condition worse (dos Santos et al., 2022). It is necessary to check how he is taking his medicines, whether he has access to his inhalers, and whether he has insurance. At that point, I would check how bad the symptoms were (with the help of the COPD Assessment Test), if any problems were being caused by the drugs he took, and how he was using his inhaler. If the symptoms last, a pulmonologist may be recommended for further treatment.

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