GRI Asthma Management
3.b. Peak Flow at Admission
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Born 00 / 00 / 33 .
This 57 year woman with severe and steroid dependent asthma was admitted with an acute exacerbation which came on 48 hours before admission when she started coughing up green sputum .
She has been attending the respiratory department for many years and is well known to dr yyy and staff .
In 00 / 09 / 90 she had local excision of an intraduct carcinoma of the left breast .
Axillary nodes were clear .
She is currently on tamoxifen .
Drugs on admission : tamoxifen 20 mg daily ; nifedipine retard 10 mg bd ; duovent and becloforte inhalers ; prednisolone 10 mg daily and bendrofluazide .
She was cushingoid and breathless with a pulse of 100 , bp 150 / 100 .
She had reduced air entry and widespread wheezes .
The peak flow could not be recorded .
Blood gases on high flow oxygen ( 8 l / min ) were h+ 33 , pco2 5.0 , bicarb 28 , po2 24.7 .
The chest x-ray showed some increased shadowing at the left base .
She was treated with antibiotics , increased steroids and nebulised bronchodilators .
She made a gradual but slow recovery .
Her peak flow took 48 hours to come up to 100 and her best peak flow was 220 at discharge .
While on the ward she complained of persistent lumbar back pain .
A lumbar spine x-ray and isotope bone scan failed to reveal any abnormality and her local discomfort was probably due to persistent coughing .
Discharged 11 / 04 / 91 .
The drugs on discharge : tamoxifen 20 mg daily ; nifedipine retard 10 bd ; prednisolone 20 mg daily ; bendrofluazide 5 mg daily ; theophylline 250 mg at night ; co-codamol .
She will be seen again in the respiratory clinic in two weeks .
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