You are the NP working in the urgent care center. You have a 14 year old patient accompanied by his parents. The patients states a chief complaint of coughing for 2 weeks. The patient has a history of asthma which has been well controlled this past year. The patient is not currently on any daily medications. He is noted to also have morning sneezing and nasal congestion. It is reported that an increased number of students are sick with colds at school. He has no known allergies to foods or medications. He has history of eczema. How would you approach the medical management of this patient and why?
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As the NP working in the urgent care center, I would approach the medical management of this 14-year-old patient with a chief complaint of coughing for 2 weeks by first conducting a thorough physical examination, including assessing for signs of asthma exacerbation and upper respiratory infection. I would also ask about any recent exposures to sick individuals or changes in the patient’s environment.
Based on the patient’s history of well-controlled asthma and the presence of symptoms consistent with a viral upper respiratory infection, such as morning sneezing and nasal congestion, I would likely diagnose the patient with a viral-induced asthma exacerbation. In this case, management would involve treating the underlying viral infection with supportive care, such as rest, hydration, and over-the-counter symptomatic relief for symptoms such as cough and congestion. I would also recommend the patient to continue using his rescue inhaler as needed and to follow up with his primary care provider to monitor his asthma control.
In addition, I would also discuss with the patient and his parents about the importance of good asthma control measures, such as maintaining good inhaled corticosteroid therapy, avoiding triggers, and having a written asthma action plan in place.
References:
Global Initiative for Asthma. Global strategy for asthma management and prevention. 2019. Available at: https://ginasthma.org/wp-content/uploads/2019/03/GINA-2019-main-report-20190328.pdf
National Institute for Health and Care Excellence. Asthma: diagnosis and management. Updated 2020. Available at: https://www.nice.org.uk/guidance/ng80/resources/asthma-diagnosis-and-management-pdf-35106824241496
American Academy of Pediatrics. Management of asthma. 2020. Available at: https://pediatrics.aappublications.org/content/146/5/e20193728
