A 5 year-old boy comes to the emergency department for asthma. He has recently had a sore throat and rhinorrhea that started 3 days ago. His mom has been giving him albuterol every 4 hours as prescribed but brought him in today because he continues to wheeze. He’s never been intubated or admitted to the ICU. In the past month, he has been to the ED twice and responded very well to treatment. He has frequent symptoms and during the winter there are times when he uses his rescue medications almost every day. He is otherwise well and is up to date on his vaccinations.
PSH: Circumcision
Allergies: Seasonal
Social: Lives with mom, dad and 2 sisters. Dad is a smoker and they have no pets in the house.
Physical Examination:
VS: HR 130, BP: 86/42, RR: 36, SpO2: 100%
GEN: Well appearing, speaking full sentences, ambulates without respiratory distress
HEENT: Tympanic membranes erythematous and bulging bilaterally, able to make out anatomical landmarks, adequate light reflex; boggy turbinates; erythematous posterior oropharynx, enlarged tonsils, no exudates
PULM: Diffuse expiratory wheezes, mild intercostal retractions, nasal flaring
CV: Regular rhythm, tachycardia, no murmurs
ABD: +BS, soft NT/ND
Skin: no rash
How would you classify this child’s asthma?
Are there any scores that can help decide if the patient needs to be admitted or can go home?
Would you prescribe an inhaled corticosteroid?
What other adjunctive therapies and instructions would you consider?
Steven Greenstein
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