Case challenge: ASTHMA

Module: health threats
Chapter: air pollution

Some questions to think about before scrolling:

What are some questions you can ask to help identify asthma triggers?

What are some strategies to stay safe in times of poor air quality?

The PATIENT

It is late August, and you are on your rural family practice rotation with Dr. Burns in Nelson, British Columbia.

Polly Uton is a 25-year-old female, who comes into the clinic with complaints of wheezing and breathlessness over the past 2 weeks. She has a childhood history of asthma, and up until recently was able to manage any asthma exacerbations using salbutamol twice a week, and during exercise. However, in the recent weeks she has needed to use her puffer 4-5x a week and is unable to exercise without it.

She is otherwise healthy, and not on any other medication. An infectious review of symptoms is unremarkable, revealing no fever, sputum production, urticaria or pleuritic chest pain.

Identifying and controlling asthma triggers is an important part of successful asthma management.

What are some questions you can ask to help identify asthma triggers?

 
unsplash-image-ZFtFuBaOvJ0.jpg

Allergen exposures.

  • Think about mold or pollen

  • Ask about pets/ new animal exposures

  • Ask if these symptoms appear at certain times of year

unsplash-image-Vgef_lqtEI4.jpg

Think about irritant triggers such as:

  • Smoking/ vaping

  • Wood burning stoves

  • New perfumes or cleaning agents

  • Air pollution/ wildfire smoke

unsplash-image-LSj8MOwnm4I.jpg

Occupational exposures:

  • Ask if symptoms are worse at work or school vs on the weekends

  • Inquire if coworkers have similar symptoms

  • Ask about fume/ dust exposures at work, or any work on farmland

unsplash-image-b9CaYHNfmho.jpg

Medications.

  • Ask about new medications. Think about eye drops, beta blockers, and ACE inhibitors

  • Ask if there has been increased use of Aspirin or NSAIDS, and if asthma has worsened in association with this [1,2]

The NEXT STEPS

Currently there is an Air Quality Advisory issued in Nelson, due to wildfire smoke. You bring this up with Polly, and she states that she was unaware of any advisory. She has just moved to Nelson from Nova Scotia over the summer and has never experienced wildfire smoke before. The timing of her symptoms matches up with the smoke advisory, and the two of you deduce that her exposure to this poor air quality is likely significantly responsible for her current presentation.

You touch base with Dr. Burns, who says he will be in shortly to consider medication options with her, but in the meantime, wants you to discuss adaptation strategies to help control her asthma triggers.

What are some strategies to stay safe in times of poor air quality?

DSC00653 2.JPG

Click here to access new 2020 Provincial Wildfire Resources

 

  • Monitor outdoor air quality, and plan outdoor activities accordingly. (via the Air Quality Health Index from Health Canada, or the  Plume app)

  • Choose less strenuous activities during times of poor air quality

  • Stay cool, and hydrated

  • Reduce or stop activities if breathing becomes uncomfortable

  • If travelling in a car, keep the windows up and change settings to re-circulate the air & ensure that your cabin air filter doesn’t need to be replaced

  • Be aware that indoors still may have elevated pollution levels, so self-monitor symptoms, and consider a HEPA filter if able to

  • Reduce indoor air pollution - from fireplace and wood stove use, smoking, or burning incense 

  • Make sure you carry your rescue medications on you at all times

  • If you are experiencing extreme difficulty in breathing, chest pain, or severe cough, contact your physician or call 911 immediately [3,4]

The Outcome

Polly is grateful for information and takes note of the BC air quality advisory website so she is able to stay up to date with air quality. Dr. Burns updates you a few weeks later that she is doing much better with her new medication regime, and with her steps taken to minimize her smoke exposure.

References

[1] Uptodate - Asthma Triggers. (n.d.). Retrieved May 04, 2021, from https://www.uptodate.com/contents/image?imageKey=PULM%2F80507&topicKey=PULM%2F547&search=asthma&rank=1~150&source=see_link

[2] Common asthma triggers. (2020, August 21). Retrieved May 04, 2021, from https://www.cdc.gov/asthma/triggers.html

[3] Laumbach, R., Meng, Q., & Kipen, H. (2015). What can individuals do to reduce personal health risks from air pollution? Journal of Thoracic Disease, 96(107). doi:10.3978/j.issn.2072-1439.2014.12.21

[4] Public Health Agency of Canada. (2018, June 8). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/environmental-public-health climate-change/climate-change-public-health-factsheets-air.html