CP 1

MAY is a 38-year old Malay guy who presented to the emergency department with chief complaints of difficulty in breathing, cough, wheezing, and runny nose for the past five days prior to his admission to the hospital. MAY is a truck driver and admitted that he smokes like a chimney while chewing his favourite Wrigley’s Peppermint Gum almost everyday to avoid being sleepy while he is on the road. On admission, symptoms of MAY was treated with IV Hydrocortisone 100mg QID. Other relevant details are as follows:

PHMx:
•Bronchial asthma x 4yrs
•HTN x 2yrs

PMedHx:
•MDI Salbutamol 2 puffs PRN
•MDI Ipratoprium bromide-Salbutamol (Combivent) 2 puffs QID
•MDI Salmeterol 2 puffs BD
•T. Metoprolol 200mg BD

ROS
•General appearance: Fairly hydrated, noted finger clubbing, mildly tachypneic
•CVS: DRNM
•Lungs: Coarse crepitations
•CXR: Hyperinflated lungs, cor pulmonale
•P/A: Soft, nontender

Vital Signs (on admission)
•Temp: Afebrile
•BP: 145/83
•HR: 97
•RR: 30
•SaO2: 96% on 3L N/P

Lab Investigations:
•FBC- ↑easinophil
•LFT- ↑ALT, ↑AST
•RP-SCR-138µmol/L, K+↓
•ABG-pH: 7.8, ↑pCO2, ↑HCO3

Questions:
1.What are the common symptoms of asthma presented by MAY?
2.Interpret ABG results.
3.What lab investigations support the diagnosis of asthma in this case?
4.What questions would you ask MAY regarding his condition and the medications he’s currently taking?
5.What is (are) the risk factors of acute asthmatic attack in MAY?
6.List major DRPs you found in this patient.