Disease Process in Asthma Write an imaginary case study for your hypothetical pa
ID: 67300 • Letter: D
Question
Disease Process in Asthma Write an imaginary case study for your hypothetical patient. Explain how the patient moved through the healthcare delivery system. With respect to the costs you calculated last week, describe how the patient will pay for the cost of treatment. Analyze the healthcare delivery system as illustrated in this case. What problems did you notice? Would some people find it difficult to pay for treatment? Are there areas where treatment for this illness is unavailable or unaffordable to the common person?
Explanation / Answer
A three year old comes in with a complaint of coughing for 2 weeks. Coughing is present every night. He has also had a mild fever, but his temperature has not been measured at home. His parents have been using a decongestant/antihistamine syrup and albuterol syrup which were left over from a sibling. Initially the cough improved but it worsened over the next 2 days. He is noted to have morning sneezing and nasal congestion. There are colds going around the pre-school. He has had similar episodes in the past, but this episode is worse. He has no known allergies to foods or medications.
His past history is notable for eczema and dry skin since infancy. He is otherwise healthy and he is fully immunized. His family history is notable for a brother who has asthma. In his home environment, there are no smokers or pets.
Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen saturation 99% in room air. He is alert and cooperative in minimal distress if any. His eyes are clear, nasal mucosa is boggy with clear discharge, and his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in his upper neck. His chest has an increased AP diameter and it is tympanitic (hyperresonant) to percussion. Rhonchi and occasional wheezes are heard on auscultation, but there are no retractions. Heart is in a regular rhythm and no murmurs are heard. His skin is dry, but not flaky, inflamed or thickened.
He is initially felt to have moderately persistent asthma and possible asthmatic bronchitis. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and bronchial inflammation. He is also treated with an antihistamine at night to reduce his morning allergy symptoms. In follow-up, his cough does not improve and he is still having fever (T 38.2C, 101.0F). A chest X-ray is obtained, but no radiographic evidence of pneumonia is present. His cough persists, but only with exercise and drinking cold juice.
His chest now sounds clear in the office. After one week of no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. His exercise induced cough gradually resolves. His nebulized corticosteroid is replaced with nebulized cromolyn twice a day and oral montelukast (a leukotriene inhibitor) is added. He enrolls in a soccer league and plays with minimal coughing. His routine nebulized albuterol+cromolyn is stopped and is used only pre-exercise to prevent exercise induced bronchospasm. No cough is observed at night or with exercise. He is continued on nightly antihistamines, pre-exercise albuterol+cromolyn nebs, and once daily montelukast. He is given an asthma treatment plan which gives his parents clear instructions on which medications to start based on his symptoms and severity.
A survey carried out by Asthma Foundation NSW has found alarming numbers of people are struggling with the cost of vital asthma medication, having to reduce or go without it, resulting in asthma attacks that need urgent medical treatment.
The on-line survey, conducted by Asthma Foundation NSW during April 2012 had one of the biggest responses of any survey - 859 people had something to say about the financial cost of asthma in their family. The survey asked what impact the cost of medications had on them and their family, and the results were eye-opening.
85% of people said that the cost of their asthma medication was an issue, with 38% finding it is usually or always an issue for them; indicating this isn’t something that only happens occasionally. As a result, almost half the people responding admitted they take less medication, or go without entirely, with one in ten saying this happens almost all the time.
“As it is so expensive, I often take half the dose recommended to make the medication last twice as long, which means my asthma isn't always under control.”
The difference in cost between types of medications has a big impact - many people admitted to trying to manage their asthma by using the cheaper reliever medication (usually ~$8), rather than using the more expensive daily preventer ($35/month) which stops symptoms occurring. Although they feel that they are then safe in case of worsening symptoms, not taking preventer medication means that the inflammation can build up in the airways and potentially lead to a very serious attack. Just taking reliever medications isn’t a safe or effective way of managing asthma. Of those who were skipping medications, 80% were not taking their preventer. There were some who even skipped other medications such as oral steroids (for managing more serious attacks), or medications for other conditions. Many parents admitted to not buying medication for themselves so that they could buy their children asthma medication. Skipping medications has a health impact – 64% of people said they’ve had an asthma attack as a result, and a number of those had to get urgent medical assistance.
“i simply cant afford to buy the medication so i have to rely on my pensioner friends to give me some of their meds”
The challenge is multiplied by the genetic factors in asthma – it’s likely that more than one member of a family will have asthma, and some people who completed the survey had 5 people in one house who needed regular asthma medication. Add to that the issue of allergies and eczema, which often go hand in hand with asthma. Medications for allergy and eczema are not commonly on prescription and therefore not subsidised at all. Some households reported spending over $400 per month just on medications and treatments for asthma and allergies. Those with a Health Care Card have some relief, as all medications are a fixed, lower price, but there are many people who don’t qualify and still struggle to keep up with the bills.
This is obviously a big issue for people with asthma, and one which the Asthma Foundations around Australia will be watching closely, and working to improve.
There are a few things that you can do to keep the cost of your medications down: