Asthmatic attack is mild

Ali is a 37 yo man, who presents to the nurse practitioner at the Family Care Clinic.
Case
Ali presents to the clinic citing symptoms of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 200 to 240 L/minute (baseline, 340 L/minute) and often have been at the lower limit of that range in the morning.
Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer sufficient treatment for this asthmatic episode.
PMH significant for:
• Diagnosed with asthma at age 18 months
• Moderate persistent asthma since age 19
• Has been hospitalized 3 times (with 2 intubations) in the past 3 years for acute bronchospastic episodes and has reported to the emergency room twice in the past 12 months
• Perennial allergic rhinitis 15 years
Questions
Advanced Pathophysiology

1. Describe the course of disease (signs, symptoms, physical exam, lab and diagnostic studies) that you expect if he remains untreated?
2. Do Ali’s arterial blood gas determinations indicate that his asthmatic attack is mild, moderate or bordering on respiratory failure?
3. Identify the metabolic state reflected by the patient’s arterial blood pH.
4. What is the cause of this metabolic state?
   Advanced Pharmacology
5. Is there an initial medication that you might attempt to use while Ali is in the clinic?
6. Presuming Ali’s symptoms improved with the initial medication, what would you prescribe/furnish?
7. When would you see Ali next for follow-up?

Sample Solution