You’re seeing a 25-year-old female patient with a history of asthma for a new patient evaluation. She is a lifelong nonsmoker, and gives a history of 1-2 tablespoons of sputum production daily. On review of systems she has a history of intermittent crampy abdominal pain that hasn’t been formally evaluated yet.
Results of in-office spirometry show a FEV1/FVC of 70% and FEV1 60% predicted. She feels her asthma is poorly controlled, as she has daily wheezing, and she wakes up most nights with cough and sputum.
You prescribe her medications for her asthma according to the severity of spirometry and frequency of symptoms. (What do you prescribe?)
Three months later she returns to your clinic and she has been using short acting bronchodilators daily and has been to urgent care once since she last saw you.
How would you now classify her asthma? By what major/minor criteria?
Name three diseases on your differential diagnosis that can be associated with her asthma.
Which of these choices is the best next test to perform?
Chest radiography
HRCT of the chest
Culture of sputum
What additional tests should be performed to evaluate the diseases on your differential diagnosis list?
See this for a brief synopsis: ATS core curriculum pulm
Also see: Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med 2014;370:1820–1828, Concise Review AJRCCM, MANAGEMENT OF DIFFICULT TO TREAT ASTHMA
Stay tuned for part 2.