Practice Guidelines, Managed Care, and Utilization Review

"While You Were Wheezing"

Janie, an 8-year-old female, presents to your clinic complaining of a cough and tightness in her chest. Upon questioning, she tells you that for the last month she has had a daily cough and that she is awakened from sleep at least twice a week because of the coughing and tightness in her chest. Her grandmother states that she has heard her wheeze after running.

Janie lives with her paternal grandmother, who does not have legal custody. Janie's father died three months ago. Her mother, who was the primary caretaker until last week, is in jail for drug possession. The maternal grandmother is filing for custody and wants to take Janie to live with her. Janie currently has no health insurance. She has taken various medications for reactive airway disease in the past.  She recalls "a syrup that I took every day for a while, and another syrup I took for 4-5 days after going to the emergency room."

Physical examination shows a temperature of 99.0 º orally, pulse 102/minute, and respirations 28/min.  Janie is alert and cooperative. Examination of her lungs reveals end-expiratory wheezes in all lung fields.
 

Consult the guidelines for asthma management on the National Heart, Lung and Blood Institute website:
(Note: summary information available on pages 4-6.)
 

Mild  intermittent
Mild persistent
Moderate persistent
Severe persistent

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