Tuesday, October 4, 2011

Management Interview 8 minutes (Asthma review)

Name: Peter Smith
Age: 32
Sex: Male Handyman


Peter has seen you a few times before but not has returned for follow up until now.   It has been 13 months since his last visit.  He recently presented to the Ipswich ED with acute asthma and now is seeing you for review as per the hospital request.  He has also failed to attend his last 2 visits with you without an obvious reason documented.

He smokes 30/day and has been separated from his wife for 12months.  He drinks up to 6 stubbies nearly every night.  He has 1 son who lives with his ex wife in Tasmania.

Medication Ventolin prn, Seretide 500/50 1 puff bd but is taking as PRN.

Please manage as appropriate.

Things to think about.....
??problem list
??what needs to be managed
??what investigations
??how to manage


  1. problem list –
    1. Asthma: symptoms control, prevention, monitoring, medication compliance
    2. alcohol problem
    3. Depression/anxiety
    4. Smoking and other drug abuse
    5. Exercise, immunisation
    what needs to be managed-
    1. Asthma : assess type, severity, monitoring, medication compliance, management plan, action plan, smoking cessation, treat infective exacerbation
    2. Alcohol problem and related healthy issues:
    (same to case 5) - adverse effect of alcohol including physical effects and psychological and social issues, such as liver damage, GI symptoms, CVS problem, brain damage, insomnia, depression/anxiety, relationship problem, sexual dysfunction, safety of driving
    3. Other drug abuse?
    4. Depression/anxiety: suicidal ideation/self harm, counselling, antidepressants
    5. Relationship issue

    6. Health promotion

    what investigations-
    FBC, ELFT, TFT, CXR, spirometry, USS abdo

    how to manage –
    1. Supportive and non-judgemental approach
    2. Teach PFE monitoring, education about asthma management, asthma care plan, asthma action plan, involve practice nurse
    3. Assessment depression/anxiety, mental health care plan and refer to Psychologist if need, antidepressant if indicated, support net work
    4. Management of alcohol drinking problem, Psychologist counselling, refer to ATODS, AA meeting, trial of abstinence to assess whether physical dependence,
    5. Need several consultations to deal with the multiple issues
    6. Need regular followup

  2. Great work...I think you covered this case very well. The essence of this case is a depressed patient who is non compliant with their asthma self management.

    Knowing this and assuming that his asthma is now stable, how would you prioritize his management at this point?

    Dr Vin Tran
    MBBS FRACGP University of Qld