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Worsening Asthma in a Young Inmate

Reviewed By Allergy, Immunology & Inflammation Assembly

Submitted by

Carleen M. Risaliti, MD

Clinical Instructor and Pulmonary/Critical Care Fellow

Department of Internal Medicine

The Ohio State University Wexner Medical Center

Columbus, Ohio

Jonathan P. Parsons, MD

Professor of Internal Medicine

Department of Internal Medicine

The Ohio State University Wexner Medical Center

Columbus, Ohio

Submit your comments to the author(s).

History

The patient is a 35 year-old year old male inmate at a regional correctional facility with a history of asthma who is admitted to the hospital for persistent shortness of breath. The patient had been admitted to the hospital for dyspnea a week prior and symptoms initially improved but then became acutely worse again upon discharge back to prison. Aside from his history of asthma, the patient has no other past medical history or surgical history.

With respect to his asthma, the patient was diagnosed at the age of two. He was hospitalized several times as a young child but then was relatively asymptomatic until he was incarcerated two years ago. Since his incarceration, he has been hospitalized seven times. He has also been intubated twice within the past two years due to his asthma and has been in the ICU at least three times. The patient’s current medications include mometasone/formoterol 200mcg/5mcg 2 puffs BID, montelukast 10mg P.O. and albuterol as needed. The patient also has received several oral steroid bursts over the course of the past several months and has not been completely off of oral steroids for three months. He is a never smoker.</p

Physical Exam

On physical exam, the patient was afebrile with a HR of 92, BP 115/57 and O2 saturation of 98% on 2L. Pulmonary exam revealed diffuse inspiratory and expiratory wheezes. There was no clubbing of his digits. No nasal polyps. The patient had significant kyphoscoliosis but the remainder of the exam was unremarkable.

Lab

Pulmonary function tests completed several months prior revealed FEV1 of 3.3L (76%), FVC 5.36L (101%), FEV1/VC 60%. Post-bronchodilator FEV1 increased to 3.70 (+12%) and FVC increased to 5.54 (+1%).

Question 1

What alternative or comorbid conditions should be considered in a patient presenting with a history of severe asthma?


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