Hi, I have a case study that I am working on and could use s…

Hi, I have a case study that I am working on and could use some assistance.1. What should the goals of therapy be in this case?2. What nondrug therapies might be useful?3. What feasible pharmacotherapeutic alternatives are available for treating this pt’s chronic asthma?Chief Complaint“I think the dust is getting to me!”HPILilly Madison is a 17-year-old Caucasian girl who presents to her primary care provider for follow-up and evaluation regarding her asthma. During her visit, she reports having had to use her albuterol MDI approximately 3-4 days per week over the past 2 months, but over the past week she admits to using albuterol once daily. She reports being awakened by a cough at night once a week during the past month. She states she especially becomes short of breath when she visits her father’s workshop (“Madison Custom Cabinetry”) and when she exercises (although she admits that her shortness of breath is not always brought on by exercise and sometimes occurs when she is not actively exercising). In addition to her albuterol MDI, which she uses PRN, and she also has a fluticasone MDI, which she uses “most days of the week.” She indicates that her morning peak flows have been running around 300 L/min (personal best = 400 L/min) over the past several weeks.PMHAsthma (previously documented as “mild persistent”) diagnosed at age 7; no prior history of intubations; hospitalized once in the past year for asthma exacerbation; one visit to the ED in the past 6 months; treated with oral systemic corticosteroids during last hospitalization and at ED visit.Migraine headache disorder (without aura; diagnosed at age 15); currently taking prophylactic medication; has had only one migraine attack in the last year.FHMother 49 years old with HTN, migraine HA disorder, and asthma; (nonsmoker); father 50 years old (smoker) with HTN and type 2 DM; brother, age 21, healthy (smoker); twin sister, age 17, healthy (nonsmoker)SHNo alcohol or tobacco use. Single, not sexually active. Lives at home with parents (father is a cabinet maker), twin sister, and two cats. Brother is currently away at college.MedsFlovent HFA 44 mcg, two puffs BIDProventil HFA two puffs Q 4-6 H PRN shortness of breath, cough, wheezingPropranolol 80 mg PO BIDMaxalt-MLT 5 mg PO PRN acute migraineAllPCN (rash)ROSDenies fever, chills, headache, eye discharge or redness, rhinorrhea, sneezing, sputum production, chest pain, palpitations, dizziness, or confusionPhysical ExaminationGenWell-developed, well-nourished white female appearing stated age in NADVSBP 110/68, HR 78, RR 16, T 37?C; Wt 58 kg, Ht 5??5??HEENTPERRLA; mild oral thrush present on tongue and buccal mucosaNeck/Lymph NodesSupple; no lymphadenopathy or thyromegalyLungs/ThoraxNo intercostal retractions or accessory muscle use with respirations; good air movement; mild expiratory wheezes bilaterallyCVRRR; no MRGAbdSoft, NTND; (+) BSExtNormal ROM; peripheral pulses 3+; no CCENeuroA&O × 3. Cranial nerves II-XII grossly intact. No focal weakness or loss of sensation.Labs| Download (.pdf) | PrintNa 136 mEq/L Hgb 14 g/dL WBC 6.0 × 103/mm3K 3.6 mEq/L Hct 42% ??PMNs 56%Cl 99 mEq/L RBC 5.0 × 106/mm3 ??Bands 1%CO2 27 mEq/L Plts 192 × 103/mm3 ??Eosinophils 3%BUN 18 mg/dL ??Basophils 2%SCr 0.6 mg/dL ??Lymphocytes 33%Glu 98 mg/dL ??Monocytes 5%Ca 9.3 mg/dLAssessmentA 17-year-old girl with uncontrolled chronic asthma and mild oral thrush
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