HISTORY OF PRESENT ILLNESS:
A 27 year-old Hispanic female, born and raised in McAllen, Texas, was referred to a pulmonologist because of severe asthma.
Her asthma symptoms began during childhood and were controlled with Marex, an over-the-counter combination of a bronchodilator and antihistamine used to treat asthma. She never had to be hospitalized, but required frequent visits to the ER for asthma exacerbations. During adolescence her symptoms became quiescent and she was able to practice sports while in high school.
Five years prior to this visit her asthma relapsed, with symptoms including chest pressure, cough, shortness of breath and wheezing. She is unable to identify any triggers for her asthma exacerbations. However, her symptoms are worse at the end of the week. Before the asthma exacerbations she frequently develops itching and increased secretions in her eyes and nose.
Her asthma symptoms have become progressively worse. She now has symptoms every day and night, and over the past year she has received several courses of oral prednisone to control asthma exacerbations. She is afraid of cortisone side effects, and would rather not use that medication. She was also prescribed inhaled beclomethasone (Beclovent), albuterol (Ventolin), and theophylline (Slobid). She has not used Beclovent since December 1993, and prior to that she used it very irregularly. She believes Beclovent is a steroid, does not work, and is too expensive.
During the past six months she has had seven ER visits for asthma exacerbations, and has missed 21 days at work. She uses two to three canisters of Ventolin per month. She describes no medicine allergies and has never been allergy tested.
She works (since her marriage) as a cleaning clerk in a textile factory, does not smoke, but is exposed to environmental tobacco smoke because her husband and in-laws, with whom she lives, smoke. There are a cat and two dogs where she lives. One of the dogs is a Chihuahua recently acquired because of the belief that this type of dog can ameliorate asthma symptoms.
She has two healthy children, ages 2 and 3. During both pregnancies her asthma did well. She has a sister with asthma and hay fever. Both parents are alive and her mother suffers from diabetes. The patient completed 11 years of school in McAllen.
As part of her evaluation, she showed poor technique in the use of MDIs, and lack of knowledge about environmental control and asthma triggers. She feels she could lose her job if she continues missing work due to her asthma. She does not want to use steroids, she prefers to have the interview in English, and she expresses a desire to be trained in asthma management.
Here is a multimedia textbook on Diffuse Lung Diseases from the University of Iowa Virtual Hospital.
Here is some information on imaging techniques regarding asthma from the Virtual Hospital.