Dan - Case Home

19 y/o Caucasian Male with Mild Persistent Asthma and Nocturnal Symptoms

Dan N. is a 19-year-old Caucasian male who presents for a routine office visit to his family physician, Dr. Nicolette Boca. He complains of episodic wheezing and chest tightening several days a month, with nocturnal exacerbations every week or sometimes every 2 weeks for many years. He has difficulty arising and performing at work on the days following such episodes.

Dan was never diagnosed with asthma or significant allergies, but he has been using a short-acting ß₂-agonist for intermittent wheezing since he was 13 years old. He does not recall any instances when he has experienced symptom exacerbations or wheezing due to cold weather, but he has had difficulty breathing during exercise.
No significant irritants have been identified.

Dan’s lung function tests seem to yield confounding results; however, his physician has diagnosed him with mild persistent asthma based on his symptoms and his frequent use of his ß₂-agonist. She contacts Dr. Gary Rachelefsky, an asthma and allergy specialist, to discuss his case and the available therapeutic options.

In this case, we will learn the role of the distal airways in asthma and examine the therapeutic options that are available for patients like Dan. We will apply treatment guidelines in the clinical setting, with particular emphasis on managing the patient’s symptoms, avoiding any potential exacerbations of symptoms that interfere with his daily life, and possibly avoiding disease progression.

Let’s take a look at Dan’s history and a little more detail about his case and see how we might develop an appropriate treatment plan for him.

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In this case, Gary Rachelefsky, MD, and fictitious family physician, Nicolette Boca, MD, portray a specialist and a primary care physician, respectively, each providing valuable insight into the management of this type of patient with asthma.