Occupational Asthma: Case Discussion

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Table of Contents

Primary Diagnosis
Treatment Plan
Patient Management Plan
Education and Follow-Up Plan
References

Primary Diagnosis

The primary diagnosis is occupational asthma; the causative agents of the indicated type of the disease are located directly at the person’s workplace. Michelle notes that a worsening of the symptoms develops on weekdays, and when she gets home, they decrease. According to Vandenplas et al. (2017), occupational asthma symptoms are similar to those of non-professional bronchial asthma. It is characterized by wheezing, coughing, chest compression, and shortness of breath.

Asthma attacks appear under the influence of industrial allergens. Therefore, to make a diagnosis, it is necessary to establish the type of allergen present in the work environment at the time of the onset of an asthmatic attack (Vandenplas et al., 2017). The patient has seasonal allergies, which determines the predisposition to the development of the illness. In terms of Michelle’s case, she works in a bakery, so occupational allergens significantly increase the frequency and severity of a pre-existing disease.

Symptoms, often more serious during work and in the evening, improve on weekends, and return to work, however, they may deteriorate towards the end of the workweek. The patient may notice that particular activity or certain substances present in the work environment cause multiple symptoms.

Treatment Plan

Treatment of occupational asthma consists of medical and preventive measures in the workplace. The process begins with an accurate diagnosis and identification of the factors causing the disease. As long as occupational asthma is provoked by exposure to sensitizing substances, lowering the contact with such substances does not always lead to the complete disappearance of symptoms. Severe asthmatic attacks or progressive deterioration can be caused by vulnerability to low concentrations of the essence; therefore, it is recommended to permanently stop this exposure (Bernstein, 2016).

For a patient, a timely planned rehabilitation leave or retraining can become an integral part of treatment. Bernstein (2016) claims that if it is impossible to stop the direction entirely, it is necessary to reduce its level, accompanied by careful medical supervision and control. Medication therapy for bronchial asthma includes the basics required to continuously control the disease, including oral and inhaled glucocorticosteroids, and symptomatic, designed to attack drugs that relieve spasm of bronchial smooth muscles – β2.

Considering that asthma being a chronic disease, the duration of therapy is determined by its course, and treatment can be continued throughout life. Singulair can be used in combination therapy with other prophylactic drugs. It prevents bronchoconstriction in response to trigger effects, improves the broncho-dilating effect of salbutamol on lung function, and reduces asthma (Trivedi et al., 2017). The inhalation form is the most effective and safest as the medicine is delivered where it is needed.

The action develops quickly; the highest concentrations are created in the respiratory tract. Many medications can only be used in inhalation because, when taken orally, they are not absorbed (Trivedi et al., 2017). In the form of breath, other drugs act locally, which increases their effectiveness and safety.

Michelle’s request for an antibiotic cannot be approved. Antibiotics for asthmatics are prescribed only when the presence of an infectious process is beyond doubt. Confirmation of the assumption of infection is always done using laboratory and instrumental research methods, such as X-ray or sputum, blood, and microflora cultures in a hospital (Trivedi et al., 2017). Prescribing antibiotics for patients with bronchial asthma requires special care. Immunity weakened by an ongoing inflammatory process can react sharply to such treatment; a significant deterioration in the patient’s condition is possible.

Patient Management Plan

The possible risk of a severe form of the disease threatens three groups of patients, including children, pregnant women, and people with chronic lung illnesses. In addition to viral pneumonia caused directly by the H1N1 virus, the course of the disease can be complicated by bacterial pneumonia, which causes a rapidly progressive deterioration in the patient’s condition (Schwarze et al., 2018).

Bacterial pneumonia is most generally affected by Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistant strains (Schwarze et al., 2018). Therefore, medicals are advised to prescribe early antibiotic therapy for the treatment of community-acquired pneumonia.

However, the condition develops on the second or third day from the onset of the disease and is characterized by evolving symptoms of acute respiratory failure. With regard to Michelle’s case, the number of respiratory rate does not exceed 30 or more per minute; oxygen saturation is slightly below 95% – 94%; cough is productive. There is no evidence that there are primary pneumonia symptoms, leading to respiratory distress syndrome and pulmonary edema development with a possibly fatal outcome.

After laboratory confirmation of the disease, the final diagnosis is possible, including a virological method of seeding nasopharyngeal mucus, sputum on certain media. Clinical signs suggesting the development of influenza complications are shortness of breath with little physical activity or at rest, difficulty breathing, cyanosis of the skin, bloody or colored sputum (Schwarze et al., 2018). Moreover, it is characterized by chest pain, high body temperature for more than three days, poorly controlled by standard doses of antipyretic drugs, painful cough, and low blood pressure(Schwarze et al., 2018).

For the entire febrile period and 5-7 days of average temperature, bed rest is prescribed to prevent complications (Schwarze et al., 2018). Antiviral drugs, for instance, oseltamivir, can be used to treat people who are at risk of severe complications from the diseases (Wang et al., 2020). The pause between taking antipyretics should be at least 4-5 hours.

It is necessary to drink plenty of water, for example, still mineral water, tea to reduce the phenomena of intoxication. Acetylsalicylic acid and metamizole sodium should not be taken for influenza (Wang et al., 2020). In case nausea and vomiting, a patient needs to drink often in several sips. Antibiotics are indicated only in case of complications, and only a doctor decides to prescribe these medications (Wang et al., 2020).

Treatment of an asthmatic with antibiotics should be provided in a hospital. It will allow the physician to avoid unforeseen effects of antibacterial drugs on the patient’s body and intervene in time if circumstances require it (Wang et al., 2020). Bed rest is required; food should contain enough vitamins, and alcohol intake is categorically contraindicated.

Home Return

Even though the illness does not seem critical, Michelle is not recommended to return home as in severe disease cases. The deterioration of the patient’s condition usually occurs 3-5 days after the onset of symptoms. The state is deteriorating rapidly – many patients develop respiratory failure within 24 hours, requiring immediate admission to intensive care (Schwarze et al., 2018).

The sick person is contagious to others not only from the moment the symptoms of influenza appear but also during the incubation period, which is usually 1-2 days, up to 7 days from the moment of the onset of the disease (Schwarze et al., 2018). Prescribed drugs provide an optimal effect when defined in the early days of illness.

Oseltamivir

This drug represses the neuraminidase action of influenza A and B viruses, ensuring the release of virions from the cell, rather than their penetration into healthy cells. It inhibits the spread of viruses in the body. Prescription: 75 mg capsule – 2 times per day for five days – no later than 48 hours after the first symptoms appear (Wang et al., 2020).

Σ-aminocaproic acid (Σ-ACA)

It is an inhibitor of fibrinolysis and has antiviral and antiallergic activity. Prescription: orally with simultaneous rinsing of the nasal passages with a 5% solution (Wang et al., 2020).

Education and Follow-Up Plan

For you, Michelle, I recommend staying at the hospital for two additional days. If the illness did not develop and cause adverse outcomes, you would come home. Nevertheless, it is necessary to inform the attending physician about all other medications used and whether side effects have occurred during the treatment.

If you do not feel well, follow the doctor’s recommendations for first aid at home. When increasing the dose of medication, monitor the maximum allowed amounts and the maximum permitted administration frequency. If you feel worse, always contact your doctor to find out tactics for further treatment. You can contact doctors’ round-the-clock information service at the short telephone number specified in the action plan. If you feel unwell or have trouble breathing, call an ambulance, or go to the hospital emergency department.

References

Bernstein, J. A. (2016). Occupational asthma. In M. Mahmoudi (Ed.), Allergy and asthma (pp. 253-270). Springer.

Rolfes, M. A., Flannery, B., Chung, J. R., O’Halloran, A., Garg, S., Belongia, E. A., & Alden, N. B. (2019). Effects of influenza vaccination in the United States during the 2017–2018 influenza season. Clinical Infectious Diseases, 69(11), 1845-1853. Web.

Schwarze, J., Openshaw, P., Jha, A., Del Giacco, S. R., Firinu, D., Tsilochristou, O., & Custovic, A. (2018). Influenza burden, prevention, and treatment in asthma‐A scoping review by the EAACI Influenza in asthma task force. Allergy, 73(6), 1151-1181. Web.

Trivedi, V., Apala, D. R., & Iyer, V. N. (2017). Occupational asthma: Diagnostic challenges and management dilemmas. Current Opinion in Pulmonary Medicine, 23(2), 177-183. Web.

Vandenplas, O., Suojalehto, H., & Cullinan, P. (2017). Diagnosing occupational asthma. Clinical & Experimental Allergy, 47(1), 6-18. Web.

Wang, Y., Fan, G., Salam, A., Horby, P., Hayden, F. G., Chen, C.,& Wang, C. (2020). Comparative effectiveness of combined favipiravir and oseltamivir therapy versus oseltamivir monotherapy in critically ill patients with influenza virus infection. The Journal of Infectious Diseases, 221(10), 1688-1698. Web.

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