PHC CASE

:Done by

Scenario
Khalid is a 4 years old boy presented to PHC complaining of
persistent Cough & Shortness of Breath for two days :
Cough: Wasn't productive, Worsened at night (Disturbing
Sleep).
today day of presentation to PHC the patient started
complaining of sever Dyspnea on top of previous cough.
No previous symptoms of either Dyspnea or Cough.
Important Negatives:
No Chest Pain
No Palpitation

No Vomiting
No fever

History
Past Medical & Surgical Hx:

.No previous medical or surgical history

No Bronchial asthma
:Medications

.None
Allergies:

.No known allergies

Family Hx:

His older brother is diagnosed with

.Bronchial asthma

DDx

Influenza

Post Nasal Drip

Bronchial Asthma.

pneumonia .

Acute bronchiolitis

Sinusitis

Seasonal allergic rhinitis

Examination

Patient looks well, in respiratory distress, not pale,

cyanosed, or jaundiced.

Vitals:

HR=140 BPM

70-120 High

RR=30

Temperature=37.1 Co

BP:107/56

90-110 / 55-75 normal

O2 Sat=92%

96-98

14-22

High

Low

Examination

Respiratory examinations :

Inspection >> Normal abdominothoracic movement

Palpation >> Normal tactile fremitus , position of trachea

Auscultation >> presence of wheeze , no fine or coarse

crackles and.

Percussion >> Normal resonant sound , No dullness

DDx

Influenza

Post Nasal Drip

Bronchial Asthma.

pneumonia .

Acute bronchiolitis

Sinusitis

Seasonal allergic rhinitis

:The most likely diagnosis

Bronchial Asthma

Bronchial Asthma

A chronic inflammatory disorder of

the airway.

Infiltration of mast cells, eosinophils

and lymphocytes in response to
allergens.

Triggers of Asthma:

1. Allergens
2. Irritants: Infections, Chemicals
Diet/Medications , Emotional stress
Exercise and Cold temperature .

Epidemiology

The prevalence of asthma increased

steadily over the past couple of years,
studies suggest that 300 million people
world-wide have bronchial asthma.

In Saudi Arabia 20% of school students

have asthma. Around 1 out 5 have asthma
.

It is one of the most common chronic

diseases in Saudi Arabia, affecting more
than 2 million Saudis. (SINA)

Pathophysiology

The pathophysiology of asthma is

complex and involves the following
components:

Airway inflammation

airflow obstruction

Bronchial hyperresponsiveness

Airway inflammation

Airway inflammation in asthma may represent a

loss of normal balance between Th lymphocytes.

Th1 cells produce interleukin (IL)-2 and IFN-,

which are critical in cellular defense
mechanisms in response to infection.

Th2, in contrast, generates a family of cytokines

(IL-4, IL-5, IL-6, IL-9, and IL-13) that can
mediate allergic inflammation.

Airway inflammation

Airway obstruction

Airway obstruction causes increased

resistance to airflow and decreased
expiratory flow rates. These changes
lead to a decreased ability to expel
air and may result in hyperinflation.

Airway obstruction

Diagnosis of Asthma

It is usually based on:

Pattern of symptoms

Response to therapy over time

Spirometry.

VC, FVC, FEV, FEV1, FEF

Clinical Features

Intermittent symptoms: SOB,

wheezing, Chest

tightness and cough

Symptoms are variable in severity

Wheezing is the most common

finding in physical examination.

Spirometry

Normally FEV1 = 600 mL in males & 500 mL

in females .

Patients with asthma cannot reach the

normal FEV1 because of the bronchial
narrowing .

FEV1 normally is 80% of the forced vital

capacity.

It is expressed as: FEV1/FVC=0.8

In asthma, FEV1 is reduced more than FVC,

so FEV1/FVC is decreased

Management

Management
Treatment course at PHC :
Patient was given Oxygen
+
Ventolin Steam in PHC

Management
:Treatment course at home
Pulmicort

nebulizer 500 mcg

BID for 5 days, then OD for 5
days.

Ventoline

nebulizer 5 mg BID
for 2 days then PRN.

Thank you