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