GROUP 6

CASE STUDY 2
 Angelo C. Madama, a 16-year-old high
school student from Tuguegarao City,
who works part-time as a street food
vendor at night, presents with severe
shortness of breath, wheezing, and
chest tightness that have
progressively worsened over the past
few hours. The patient was initially
Clinical diagnosed with asthma in childhood,
and the current episode is
characterized by an acute and
case persistent asthma attack that has not
responded to the usual home
treatments. The patient’s symptoms
have escalated to the point where
normal breathing is almost impossible,
and he has become increasingly
fatigued, prompting the visit to the
emergency department.
 His mother reports that the patient
had been using his prescribed
bronchodilator inhaler at home, but
the symptoms have not improved.
Over the past few hours, the
wheezing has become louder, and the
Clinical patient has been unable to perform
his usual activities, including
attending school and working as a
case street food vendor. The wheezing and
cough have been accompanied by a
feeling of tightness in the chest and
occasional dizziness, making it
difficult for him to even sit still.
 The patient’s has a long-standing history of
asthma, which has been managed
intermittently with inhalers and oral
medications. He has had several previous
asthma exacerbations, usually triggered by
cold weather, dust, or exposure to smoke,
especially due to his occupation as a part-time
vendor near busy streets. These episodes were

Clinical typically less severe and responded well to

medication. He has no history of major medical
:
illnesses or hospitalizations unrelated to
asthma.

case Family history shows that both of the patient’s

parents have a history of asthma. His father
has also been diagnosed with chronic
obstructive pulmonary disease, which is likely
due to years of smoking. There are no other
significant chronic conditions in the immediate
family. The patient’s maternal side has no
known history of respiratory illnesses other
than asthma.
 Immunization records are up to date, and the
patient has received all vaccines in according to
the national vaccination schedule. The patient
lives in a densely populated urban area, where
exposure to air pollution, vehicle smoke, and
environmental allergens are frequent. He works
as a part-time street food vendor in the evening,
which involves being exposed to smoke from
grills, dust, and pollutants from passing vehicles.

Clinical The patient is a non-smoker, but he does spend

long hours near areas where others are smoking.
The patient has had a persistent cough for the
past few days, which is now accompanied by

case wheezing and difficulty in catching his breath. He

also reports feeling fatigued and having a
diminished appetite due to the ongoing
symptoms. There are no gastrointestinal or
neurological complaints, but the patient has been
experiencing some mild dizziness, especially
when attempting to stand or walk. He denies any
fever, chest pain, or hemoptysis, though he does
note that the coughing is worse at night.
 On physical examination, the patient is
alert but visibly anxious and in respiratory
distress. His vital signs are as follows:
temperature 37.5°C, heart rate 110 beats
per minute, respiratory rate 28 breaths per
minute, and oxygen saturation of 90% on
room air. The patient’s chest is hyper-
resonant upon percussion, and there is
Clinical noticeable wheezing during both
inspiration and expiration. Breath sounds
are diminished in both lung fields, with

case prolonged expiration and intercostal

retractions observed. The patient’s skin
appears pale, and his lips show signs of
mild cyanosis, especially upon exertion.
The rest of the physical examination is
unremarkable, with no signs of edema or
other systemic involvement
GENERAL INFORMATION

Name: Angelo C. Madama

Age: 16 years old
Sex: Male
Address: Tuguegarao City
CHIEF COMPLAINT

The patient presents

with severe shortness
of breath, wheezing,
and chest tightness
that have progressively
worsened over the past
few hours.
HISTORY OF PRESENT ILLNESS

Persistent cough for the past few days

Wheezing and shortness of breath
(dyspnea)
Fatigue and decreased appetite
Mild dizziness, especially on standing or
walking
No gastrointestinal or neurological
symptoms
No fever, chest pain, or hemoptysis
Cough worsens at night
PAST MEDICAL HISTORY

Long-standing history of asthma

Managed intermittently with inhalers
and oral medications
History of asthma exacerbations,
usually triggered by:
Cold weather
Dust
Smoke exposure (notably from
working as a part-time vendor near
busy streets)
PAST MEDICAL HISTORY

Previous episodes were mild and

responded well to treatment
No major medical illnesses or
hospitalizations unrelated to asthma
FAMILY HISTORY

Both parents have a history of

asthma
Father diagnosed with chronic
obstructive pulmonary disease
(COPD), likely related to long-term
smoking
No other significant chronic
conditions reported in the
immediate family
.
MATERNAL HISTORY

Not specified
BIRTH HISTORY

Not specified
IMMUNIZATION

Immunization records
are up to date, and the
patient has received all
vaccines in according
to the national
vaccination schedule.
PERSONAL & SOCIAL HISTORY

Lives in a densely populated urban

area
Frequent exposure to air pollution,
vehicle smoke, and environmental
allergens
Works as a part-time street food
vendor in the evening
Exposed to grill smoke, dust, and
traffic pollutants
Non-smoker, but regularly exposed
to secondhand smoke
REVIEW OF SYSTEMS

Respiratory: Persistent cough,

wheezing, shortness of breath, chest
tightness, worse at night
General: Fatigue, poor appetite, mild
dizziness
Cardiovascular, Gastrointestinal,
Neurological, Dermatologic: No
significant findings
ENT: No nasal congestion, sore
throat, or ear symptoms
Fever, chills, or systemic symptoms:
Denied
PHYSICAL EXAMINATION

General Survey:The patient is alert but

visibly anxious and in respiratory
distress.
Vital Signs:
Temperature: 37.5°
Heart rate: 110 beats per minute
Respiratory Rate: 28 breaths per
minute,
Oxygen saturation: 90% on room air
Chest:
hyper-resonant on percussion
noticeable wheezing during both
inspiration and expiration.
Breath sounds are diminished in
both lung fields, with prolonged
expiration and intercostal retractions
observed.
PHYSICAL EXAMINATION

Skin:
Pale
Lips show signs of mild
cyanosis, especially upon
exertion.
The rest of the physical examination
is unremarkable, with no signs of
edema or other systemic
involvement
SALIENTFEATURES

16-year-old male with known asthma,

presenting with acute exacerbation
Exposure to smoke, dust, cold air due to part-
time work as street vendor
Severe wheezing, respiratory distress,
fatigue, and mild cyanosis on examination
Vital signs: Tachycardia, tachypnea, O₂
saturation at 90% on room air
Diminished breath sounds, hyper-resonant
chest, prolonged expiration, intercostal
retractions
Family history of asthma
Environmental risk factors: Urban pollution,
secondhand smoke, occupational exposure
DIFFERENTIAL DIAGNOSIS

1. Severe Acute Asthma Exacerbation

– most likely
2. Acute Bronchospasm due to
environmental irritants
3. Viral Respiratory Tract Infection
with reactive airway response
4. Allergic Bronchitis
5. Early onset COPD (unlikely given
age and non-smoking status)
FINAL DIAGNOSIS

ASTHMA
EXACERBATION
 INTRODUCTION

Asthma is a common chronic disorder of the

airways with a complex interaction of airflow
obstruction, bronchial hyperresponsiveness, and an
underlying inflammation. Asthma exacerbation is
defined as a sudden worsening of asthma symptoms
caused by an airway obstruction, inflammation, and
increased mucus production.
 ETIOLOGY
RESPIRATORY IRRITANTS
INFECTIONS
Exposure to irritants such as
Respiratory infections like
smoke, air pollution, and
colds, flu, and pneumonia can
strong odors can trigger
worsen asthma symptoms. ALLERGENS asthma symptoms.
Exposure to allergens such
as dust mites, pollen, and pet
dander can trigger asthma
EXERCISE symptoms. MEDICATIONS

Strenuous physical activity Certain medications such as

can cause asthma symptoms aspirin and beta-blockers can
in some people worsen asthma symptoms.
 Asthma affects 300 million

EPIDEMIOLOGY people worldwide and causes

250,000 deaths annually
(WHO).
5–10% of asthma patients
experience flare-ups each year.
In developed countries,
prevalence has plateaued at
around 10% of adults and 15%
of children.
In developing countries, asthma
prevalence is rising, linked to
urbanization.
Asthma can occur at any age,
with a peak onset at age 3.
Males are more prone to
childhood exacerbations;
females more so in adulthood.
 Pathophysiology
Allergens Activate Dendritic Cells Release Cytokines

Stimulate TH2 Cells Histamine and Leukotrienes

Inflammation Mucus Buildup

Bronchoconstriction

Narrowing bronchioles
Air Trapped
Obstruction
Dynamic Hyperinflation

Difficulty with breathing

CLINICAL MANIFESTATIONS
Wheezing (high-pitched whistling sound when breathing out)
Coughing (which may be dry or produce mucus)
Shortness of breath (which can range from mild to severe)
Rapid breathing or chest tightness
Difficulty talking or using accessory muscles to breathe
Fatigue, sweating, and feeling anxious or agitated
Difficulty performing daily activities, such as walking or exercising
 DIAGNOSTICS
1. Lung function tests
detect how well you inhale (breathe in) and exhale (breathe out) air
from your lungs.
Common lung function tests used to assess your airways include:
Spirometry - a type of lung function test that measures how much
you breathe in and out and how fast you breathe out.
FeNO test (exhaled nitric oxide) - the nitric oxide gas in your
breath is measured by this test.
Bronchial provocation or “trigger” tests - tests that measure if
your lungs are sensitive to certain irritants or triggers.
2. Complete Blood Count
it can estimate the degree of airway inflammation in asthma patients,
allowing medical professionals to better understand their patients
and give them the best therapy possible.
 MANAGEMENT AND PREVENTION
TREATMENT FOR ASTHMA

-> Bronchodilators - Give a rapid relief of

symptoms mainly through relaxation of airway
smooth muscle.

-> Anti-inflammatory - Inhibits the underlying

inflammatory process
MANAGEMENT AND PREVENTION
PREVENTION OF ASTHMA

1. Avoid exposure in different allergens

2. Smoking
3. Personal Hygiene
4. Monitor asthma triggers
 PROGNOSIS
Most infants who wheeze with upper respiratory
infections become symptom-free by age six.
Children with persistent symptoms often develop
airway reactivity later.
Asthma starting before age three has a poor prognosis
unless limited to viral infections
Mild childhood asthma with symptom-free periods
often resolves over time.
Severe childhood asthma, hay fever, and female sex
increase the risk of asthma persisting into adulthood.
 COMPLICATIONS
GENERAL PULMONARY
COMPLICATION COMPLICATION
Severe asthma attacks that require Respiratory Failure
emergency treatment or hospital Pneumonia
care.
Status Asthmaticus
Permanent decline in lung
function. Respiratory muscle fatigue
Poor sleep and fatigue. Death
Symptoms that interfere with play,
sports or other activities.
Anxiety and panic attacks
Thank you for
Listening