HOMEPAGE Resources for SBM

1998 Fall Year1 Case1

Case History
Learning Objectives
Web References
Literature References


CASE HISTORY

The patient is 10-years-old. He lives with his aunt, who has been his foster mother since age four and his uncle. He feels good today.

When the patient moved in with his aunt at age four, she noted he would have episodes of sneezing and rubbing his eyes. This would be worse in the Fall and occasionally in the Spring. He would also have some wheezing and snoring at night in addition to some shortness of breath on exertion. He would cough up some mucous in the mornings. However most of the time he did well. He was seen at a local hospital for his medical care and eventually saw a pediatric allergist. He had allergy skin testing which showed allergies to cats, dogs, grass, and dust mites. He was started on some inhaled medications but the biggest change in his symptoms occurred when the house was cleaned to eliminate dust mite problems. His mattress, mattress pad and pillows were changed. The rug in the bedroom was cleaned with a special powder. Drapes were washed. This resulted in a marked improvement in the symptoms as far as his aunt was concerned. He also seemed more calm. She felt in the past that he would act agitated at times. He also used to have itching. Occasionally he still itches around some grasses. He sneezes if exposed to dust. He never had hearing or ear problems. He has never had allergy shots. Although he had some wheezing and shortness of breath in the past he rarely has any symptoms now. This was most noticeable at school when he exercised and especially when he had to do a mile run. the Patient is heavy and some of the symptoms were felt by the Aunt to be related to that. He has never missed time from school because of his illness. His growth has been normal. Although he has tested positive for allergies to cats and dogs, he is frequently around dogs and occasionally around cats with no change in his symptoms. His current medications include:

Even though his symptoms improved with his medication and dust mite precautions, his aunt still noted that he would wheeze at night and occasionally become short of breath. He often had to sleep propped up. He went for an ear, nose and throat examination and was felt to have markedly enlarged tonsils. He underwent an adenotonsillectomy in August 1997. Since he recovered from the surgery, he has been sleeping better and has not been snoring or wheezing at night. He also thinks he breaths better during the day.

At the present time, the Patient is very active and loves all sports. He does not get short of breath when playing sports and keeps up with his other friends. He takes his medications regularly and they do not bother him. He says they make him feel better. He was taught how to use the sprays when he first began treatment with them. He does not have any wheezing or shortness of breath but does get occasional itching with grasses. He will enter the 4th grade this fall.

He has had no food sensitivities. He has no problems with eating food and does not get upset stomach or heartburn. He does not remember the last time he had a respiratory or throat infection. He has not had any skin rashes.

A stepbrother and his mother have allergies and asthma. His aunt is unaware of any complications during the Patientís motherís pregnancy but there was drug use involved. The mother also smoked while the Patient lived with her. Neither his aunt nor her husband smoke and she does not allow smoking in her house. There is forced air heating in the house. the patientís health insurance is covered through Medicaid. In the past he has had blood and urine tests which have been normal. He had a chest x-ray that was normal. He had pulmonary function tests in the past but she was not told of the results. He does not do any measurements of pulmonary function at home.


LEARNING OBJECTIVES

Allergies
Asthma
Asthma medications
Allergy tests
Breathing tests


WEB REFERENCES

American Academy of Allergy, Asthma & Immunology
DESCRIPTION: Lots of patient information. Professional information open only to members.
URL: http://www.aaaai.org/

Asthma - National Heart, Lung, and Blood Institute
DESCRIPTION: Information for both patients and professionals.
ASCII and PDF formats.
URL: HTTP://www.nhlbi.nih.gov/nhlbi/othcomp/opec/naepp/naeppage.htm

Asthma - the Mining Co.
DESCRIPTION: Lots of information for both patients and professionals
URL: http://asthma.miningco.com/mbody.htm?PID=2750&COB=home


LITERATURE REFERENCES

Douglas W. P. Hay, Ph.D.
Pharmacology of Leukotriene Receptor Antagonists
Chest 111: 35S (1997 supplement)

N. Franklin Andkinson, Jr., M.D., et. al.
A Controlled Trial of Immunotherapy for Asthma in Allergic Children
NEJM 336: 324 (1997)

Robert F. Lemanske, Jr., M.D. and William Busse, M.D.
Asthma
JAMA 278: 1855 (1997)

Jay A. Nadel and William W. Busse
Asthma
Am. J. Respir. Crit. Care Med 157: 5130 (1998)

Stephen T. Holgate
The Cellular and Mediator Basis of Asthma in Relation To Natural History
Lancet 350(Suppl II): 5 (1997)