Case Study: Bridging to Breathe Freely – Managing Bronchial Asthma : This is a demo case study to more understand how bronchial asthma can be treated via physiotherapeutic approach
Also read : Bronchial Asthma : Understanding Condition to better understand the diseases
Patient Information:
- Name: Sarah M.
- Age: 38
- Gender: Female
- Occupation: Office Manager
- Chief Complaint: Chronic cough, wheezing, and breathlessness.
Patient History: Sarah, a non-smoker with no family history of respiratory conditions, has been experiencing recurring episodes of cough, wheezing, and shortness of breath. She reports that her symptoms often worsen at night and during exercise. Sarah’s quality of life is notably affected as these symptoms hinder her daily activities.
Clinical Presentation:
- Chronic, dry cough
- Wheezing upon exhalation
- Breathlessness, particularly during physical activity
- Frequent awakening at night due to coughing and breathlessness
Warning Signs: Sarah’s symptoms tend to worsen under specific circumstances, including exposure to cold air, physical exertion, or when she encounters common allergens such as pollen and pet dander. Her worsening symptoms during sleep suggest nighttime asthma.
Investigations:
- Spirometry:
- Results indicate reduced FEV1 and a lowered FEV1/FVC ratio, consistent with obstructive lung disease.
- Peak Flow Measurement:
- Sarah’s peak flow readings are significantly reduced, indicating airway obstruction.
- FeNO (Exhaled Nitric Oxide) Measurement:
- Elevated levels of FeNO suggest airway inflammation, a hallmark of asthma.
Abnormalities Seen in Investigations:
- Obstructive lung pattern on spirometry.
- Reduced peak flow values.
- Elevated FeNO levels, indicating airway inflammation.
Diagnosis:
- Based on her clinical presentation and diagnostic results, Sarah is diagnosed with allergic bronchial asthma.
Management: Pharmacological:
- Short-Acting Beta-Agonists (SABAs) for quick relief.
- Inhaled Corticosteroids for long-term control.
- Leukotriene modifiers to manage inflammation.
Non-Pharmacological:
- Allergen avoidance.
- Regular exercise.
- Breathing exercises.
Physiotherapy Assessment:
- Subjective Assessment: Gathered information on Sarah’s symptoms, triggers, and medical history.
- Objective Assessment:
- Breathing Patterns: Monitored for signs of distress and assessed respiratory rate.
- Auscultation: Detected wheezing upon exhalation.
- Peak Flow Measurement: Confirmed reduced peak flow values.
Physiotherapy Management:
- Short-Term Goals:
- Immediate relief from symptoms.
- Education on proper inhaler techniques.
- Stress reduction techniques.
- Long-Term Goals:
- Asthma control and prevention of exacerbations.
- Improved lung function through exercise and breathing exercises.
- Enhanced self-management skills.
Sarah’s comprehensive treatment plan involves a combination of pharmacological and non-pharmacological approaches, as well as physiotherapy to help her regain control over her life, breathe easier, and minimize the impact of bronchial asthma on her daily activities.
Step 1: Initial Assessment
Before commencing any treatment, conduct a comprehensive initial assessment. Gather information on Sarah’s medical history, current symptoms, and her level of physical activity. Perform a thorough clinical assessment, including auscultation and measurement of baseline peak flow values. Understand her goals and expectations.
Step 2: Patient Education
Begin by educating Sarah about bronchial asthma, its triggers, and the importance of medication adherence. Explain the role of physiotherapy in asthma management. Teach her how to recognize and respond to warning signs and symptoms.
Step 3: Breathing Exercises
Start with breathing exercises to improve lung capacity and control. Techniques such as diaphragmatic breathing and pursed lip breathing can be beneficial. Instruct Sarah to practice these exercises daily, gradually increasing the duration and intensity.
Step 4: Airway Clearance Techniques
Introduce airway clearance techniques to help clear mucus and improve ventilation. Techniques like the active cycle of breathing or autogenic drainage can be effective. Sarah should perform these under supervision initially and later as part of her daily routine.
Step 5: Exercise Prescription
Design an exercise program tailored to Sarah’s needs. Focus on improving aerobic fitness and strengthening respiratory muscles. Begin with low-intensity activities such as walking and progress to more challenging exercises over time. Ensure that exercises are performed in a controlled and monitored environment.
Step 6: Monitoring and Progression
Continuously monitor Sarah’s progress. Use peak flow measurements and symptom diaries to track improvements or exacerbations. Adjust the exercise program accordingly, increasing intensity and duration as her lung function improves.
Step 7: Allergen and Trigger Management
Provide guidance on allergen avoidance and trigger management. Advise Sarah on creating an asthma-friendly environment at home and work. This step is crucial in preventing asthma exacerbations.
Step 8: Stress Reduction Techniques
Teach stress reduction techniques such as relaxation and mindfulness exercises. Stress can exacerbate asthma symptoms, so helping Sarah manage it effectively is an integral part of the treatment.
Step 9: Self-Management Skills
Empower Sarah with self-management skills. Ensure she understands when and how to adjust her medication based on her symptoms. Provide a written asthma action plan for reference.
Step 10: Regular Follow-up
Schedule regular follow-up appointments to assess Sarah’s progress and address any concerns or questions. Ensure that she remains motivated and engaged in her treatment plan.
By following this step-by-step protocol, we can assist Sarah in managing her bronchial asthma effectively. The personalized exercise program, along with education and self-management strategies, will empower her to lead a healthier and more comfortable life while keeping her asthma symptoms under control