Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this happens all the time.”
Expert Answer and Explanation
Case Study: Asthma
Short and Long Term Treatment Options
Mrs. Carson’s son is a case of newly diagnosed asthma. The child is visibly stabl12q12qe and without signs of acute exacerbations. However, he has had longstanding respiratory distress and has an audible wheeze.
The initial management of the patient will revolve around the alleviation of symptoms and relief of the suffering due to the distress. White et al. (2018) recommends provision of short-acting beta-adrenergic agonist (SABA), more commonly salbutamol inhalation via a nebulizer, to enhance bronchodilation and provide relief to the patient.
After that, the performance of spirometry is recommended once the patient has stabilized as subsequent management relies on the knowledge of the lung functionality (Mendes & Palmer, 2018; Horak et al., 2016). Mrs. Carson’s son will, therefore, be put after that on maintenance therapy with low dose pediatric inhaled corticosteroids. Provision of corticosteroids follows on the same guidelines, GINA (2015), which recommends provision of the same to children with SABA unresponsive asthma or those with asthma-related symptoms for more than three times a week. The latter provision fits the patient in this case.
As regards the long term therapy, the patient will be put on long-acting inhaled corticosteroids to modify the course of the disease (Ballas, 2018). However, reviews should be done monthly to assess the improvement in lung function as well as look out for the adverse effects of prolonged steroid use (Ballas, 2018).
Patient Education
Involves the following:
- Informing the child and the mother that the condition warrants long term therapy.
- Explaining to them the correct use and disposing of the nebulizers to maximize therapeutic benefits.
- Describing to them the mechanism of control and measures to do so when the condition deteriorates.
- Talking to them about the importance of avoiding allergens.
References
Ballas, Z. K. (2018). Asthma clinical practice guidelines: Time for an update. Journal of Allergy and Clinical Immunology, 142(3), 787.
Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., … & Studnicka, M. (2016). Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines. Wiener klinische Wochenschrift, 128(15-16), 541-554.
Mendes, A., & Palmer, S. J. (2018). NICE overhauls asthma management and treatment recommendations.
White, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 73(3), 293-297.
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FAQs
Nasal spray for enlarged adenoids in adults
Enlarged adenoids in adults can cause nasal congestion, difficulty breathing, and recurrent sinus infections. While nasal sprays can help alleviate symptoms, they may not be the most effective treatment for significantly enlarged adenoids.
If your adenoids are significantly enlarged, you should see an ear, nose, and throat (ENT) specialist for evaluation and treatment recommendations. Treatment options may include medication, surgery, or a combination of both.
However, if your symptoms are mild, a nasal spray may help reduce inflammation and congestion. Nasal steroid sprays such as fluticasone (Flonase) or mometasone (Nasonex) are often prescribed to reduce inflammation and swelling in the nasal passages. Saline nasal sprays or rinses can also help relieve congestion by flushing out mucus and allergens from the nasal passages.
It’s important to follow your doctor’s recommendations and use nasal sprays as directed. Overuse of nasal sprays can lead to rebound congestion and other side effects, so it’s important to use them only as prescribed.
Complications of adenoid hypertrophy
Adenoid hypertrophy refers to the enlargement of the adenoid tissue located at the back of the nose and the roof of the throat. While adenoids are an important part of the immune system, when they become enlarged, they can cause several complications. Some of the complications of adenoid hypertrophy include:
- Difficulty breathing: Enlarged adenoids can obstruct the airway, leading to difficulty breathing through the nose. This can result in mouth breathing, snoring, and sleep apnea.
- Recurrent sinus infections: Enlarged adenoids can block the drainage of the sinuses, leading to recurrent sinus infections.
- Ear infections: Enlarged adenoids can also block the Eustachian tubes, which connect the middle ear to the back of the throat. This can lead to fluid buildup in the middle ear, increasing the risk of ear infections.
- Speech and language problems: Enlarged adenoids can affect the resonance of the voice and lead to speech problems, such as hypernasal speech.
- Facial abnormalities: In rare cases, severe and prolonged adenoid hypertrophy can cause facial abnormalities, such as long, narrow facial structure or open-mouth posture.
- Malnutrition: In children, enlarged adenoids can lead to malnutrition because they may have difficulty swallowing solid foods and may prefer soft, easy-to-swallow foods.
- Dental problems: Enlarged adenoids can cause changes in the position of the teeth and jaw, leading to dental problems such as malocclusion or misaligned teeth.
If you or your child are experiencing any of these complications, it’s important to see an ENT specialist for evaluation and treatment. Treatment may include medication, surgery, or a combination of both, depending on the severity of the adenoid hypertrophy and the underlying cause of the enlargement.
Adenoid assessment
The assessment of adenoids involves a thorough evaluation of the patient’s symptoms, medical history, and a physical examination of the nose and throat. The assessment is typically performed by an ear, nose, and throat (ENT) specialist.
During the physical examination, the ENT specialist will use a lighted instrument called an endoscope to look at the adenoids and other structures in the nose and throat. The endoscope is a thin, flexible tube with a camera at the end, which allows the specialist to see the adenoids in detail.
The specialist will also evaluate the patient’s symptoms, which may include:
- Nasal congestion and difficulty breathing through the nose
- Recurrent ear infections
- Snoring or sleep apnea
- Recurrent sinus infections
- Chronic cough or sore throat
- Speech problems or hypernasal speech
The specialist may also order imaging tests, such as X-rays or CT scans, to get a better view of the adenoids and to rule out other conditions.
Based on the assessment, the ENT specialist will determine the severity of the adenoid enlargement and recommend a course of treatment. Treatment options may include medication, surgery, or a combination of both, depending on the severity of the adenoid hypertrophy and the underlying cause of the enlargement.
Regular follow-up appointments may also be recommended to monitor the adenoid size and ensure that the treatment is effective.
Steam inhalation for adenoids
Steam inhalation is a simple and effective home remedy that can provide relief for some of the symptoms associated with enlarged adenoids. The warm, moist air can help reduce inflammation and congestion in the nasal passages and throat.
To perform steam inhalation, you can follow these steps:
- Boil a pot of water and remove it from the heat source.
- Place the pot on a flat surface, such as a table, and lean over it with your face about 8-10 inches away from the water.
- Cover your head with a towel to create a tent-like structure that traps the steam.
- Breathe deeply and slowly through your nose for about 5-10 minutes.
- Take breaks as needed and do not overexert yourself.
Some people like to add essential oils, such as eucalyptus or peppermint, to the water to enhance the therapeutic effect. However, it’s important to use caution when using essential oils and to follow the instructions carefully to avoid any adverse reactions.
It’s important to note that steam inhalation should not be used in children under the age of 12 without adult supervision. Additionally, steam inhalation should not be used if you have a fever, as it may worsen your symptoms.
While steam inhalation can provide temporary relief for some of the symptoms associated with enlarged adenoids, it is not a substitute for medical treatment. If you or your child are experiencing persistent symptoms, you should see an ear, nose, and throat (ENT) specialist for evaluation and treatment.
