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A 10-year-old child with asthma has been on Fluticasone metered-dose inhaler for six months with no improvement seen in the pulmonary function tests.
Which of the following strategies would help the child have better control over the symptoms?
Suggested Answer: D
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Asthma Management:
When a patient does not respond to a single controller medication like Fluticasone (a corticosteroid), a step-up in therapy is often required.
Treatment Strategies:
Chest Physiotherapy and Increased Oral Fluid: Helpful but not primary interventions for improving pulmonary function in asthma.
Intravenous Hydrocortisone: Typically for acute severe exacerbations, not chronic management.
Adding Salmeterol (Long-acting Beta Agonist): Combined with an inhaled corticosteroid (ICS), it can improve asthma control by reducing symptoms and preventing exacerbations.
Global Initiative for Asthma (GINA) guidelines
National Heart, Lung, and Blood Institute (NHLBI)
32 comments · newest first
CA
Carisa
10 months ago
Wait, why hasn’t the Fluticasone worked after six months?
AR
Ardella
11 months ago
Chest physiotherapy is good, but not a main treatment.
AL
Alyce
11 months ago
IV hydrocortisone seems extreme for this case.
DO
Doretha
11 months ago
Totally agree, adding Salmeterol could really help!
RE
Reena
11 months ago
Fluticasone alone might not be enough for some kids.
JE
Jeniffer
12 months ago
I feel like switching to intravenous hydrocortisone might be too drastic for a child with mild asthma. It seems like a last resort option.
AN
Annamaria
12 months ago
Increasing fluid intake sounds reasonable, but I doubt it would have a significant impact on asthma symptoms compared to medication adjustments.
LI
Linette
12 months ago
I'm not entirely sure, but I think chest physiotherapy isn't typically the first line for asthma management. It seems more relevant for conditions like cystic fibrosis.
MA
Madonna
1 year ago
I remember reading that adding a long-acting beta-agonist like Salmeterol can help improve asthma control when inhaled corticosteroids alone aren't enough.
JO
Josephine
1 year ago
I feel pretty confident about this one. Since the child hasn't responded to the Fluticasone, the best strategy would be to add a long-acting bronchodilator like Salmeterol to the treatment plan. That should help improve symptom control.
ME
Melynda
1 year ago
I'm a little confused by this question. Changing to IV hydrocortisone seems like a pretty drastic step if the current inhaler isn't working. I'll have to review the asthma treatment guidelines to figure out the best next step.
VE
Veronica
1 year ago
Okay, I've got this. The key here is that the current treatment isn't working, so we need to change the medication regimen. Adding a long-acting bronchodilator like Salmeterol is probably the best option to improve symptom control.
RO
Rosio
1 year ago
This seems like a pretty straightforward asthma management question. I'm going to carefully review the details and think through the options.
UL
Ula
1 year ago
Hmm, I'm a bit unsure about this one. The child has been on Fluticasone for 6 months with no improvement, so I'm not sure if just increasing fluids or doing chest PT would be enough. I'll have to think it through.
HE
Heike
1 year ago
This seems like a straightforward question about incident response procedures. I'll focus on identifying the document that would most likely contain the notification process details.
CO
Cordell
1 year ago
Hmm, I'm a bit confused by the wording here. I'll need to carefully read through the options and try to visualize how fast reroute might impact the path-mtu.
LA
Laquita
2 years ago
Hmm, I wonder if we could just teach the kid to breathe fire instead? That would really open up those airways, don't you think?
KA
Kasandra
2 years ago
Increasing fluid intake to loosen secretions? That's a good idea, but I don't think it's enough on its own. Definitely need to add the Salmeterol for better asthma control.
MU
Murray
2 years ago
Increasing fluid intake is important, but adding Salmeterol would definitely help with symptom management.
ZI
Zita
2 years ago
I agree, adding Salmeterol to the treatment regimen would be beneficial for better asthma control.
SH
Shoshana
2 years ago
I believe adding Salmeterol is a safer choice as it is a long-acting beta agonist that can help with symptom control.
FE
Felix
2 years ago
Chest physiotherapy every 4-6 hours? That sounds like a lot of work for a 10-year-old. I'd go with the Salmeterol option too, it's a more straightforward solution.
JO
Jolanda
2 years ago
I'm not so sure about that. Changing to intravenous hydrocortisone seems like a drastic step if the child hasn't responded to the inhaler. Maybe try increasing the Fluticasone dose first before resorting to injections.
BL
Blair
2 years ago
B) Increase oral fluid intake to loosen the secretions
NO
Noelia
2 years ago
A) Perform chest physiotherapy every 4-6 hours
KA
Kanisha
2 years ago
But wouldn't changing Fluticasone to intravenous hydrocortisone be a better option?
JE
Jerilyn
2 years ago
I agree, adding Salmeterol can help improve the symptoms.
EL
Elin
2 years ago
I think we should add Salmeterol metered-dose inhaler to the treatment regimen.
LU
Luz
2 years ago
Hmm, I think option D makes the most sense. Adding a long-acting bronchodilator like Salmeterol to the Fluticasone inhaler should help improve symptom control.
FR
Frederica
2 years ago
Performing chest physiotherapy every 4-6 hours could be beneficial for the child's asthma management.
CH
Chi
2 years ago
I think increasing oral fluid intake might also help in loosening the secretions.
AG
Agustin
2 years ago
I agree, adding Salmeterol can provide better control over asthma symptoms.