A 10-year-old fifth grader. At the age of 4, he was diagnosed with asthma. He presents to the primary care office with his mother after yesterday’s visit to the emergency room for an asthma exacerbation. He reports worsening respiratory symptoms including coughing, shortness of breath, and chest tightness. These symptoms have worsened since the start of basketball season 2 weeks ago, but they became significantly worse over the weekend, after the adoption of a new kitten. In the emergency room, he was treated with albuterol via nebulizer and was discharged on a course of oral prednisone.
State the two pertinent history questions you, as the provider, should ask to help determine his treatment plan. Also state the questions and comments you would pose to the mother to identify the family’s understanding of patient asthma diagnosis, treatment and care. Explain how you would incorporate an assessment of patient’s social determinants of health needs into the treatment plan.
Solution
Pertinent History Questions to Ask the Patient
- “How often have you been using your rescue inhaler (albuterol) since basketball season started?”
- This question helps assess the frequency of asthma symptoms and the level of asthma control. Frequent use of a rescue inhaler indicates poor asthma control and may necessitate adjustments in the treatment plan.
- “Have you noticed any specific triggers that make your symptoms worse, such as physical activity, being around the kitten, or exposure to cold air?”
- Understanding the specific triggers that worsen the patient’s asthma can guide the provider in offering targeted advice on trigger avoidance and in making adjustments to the patient’s medication regimen.
Questions and Comments for the Mother
- “Can you tell me what you understand about your child’s asthma, including what triggers his symptoms and how to manage them?”
- This open-ended question assesses the mother’s knowledge of her child’s condition, triggers, and the correct use of medications.
- “How comfortable are you with the current asthma action plan, and do you feel confident in recognizing when his asthma is not well controlled?”
- This question helps gauge the mother’s confidence in managing her child’s asthma and identifying when he needs medical attention.
- “It’s important that your son avoids triggers that can worsen his asthma. Are you aware of how the new kitten or other environmental factors might be affecting his symptoms?”
- This comment emphasizes the importance of trigger avoidance and educates the mother on the potential impact of the new kitten on her child’s asthma.