Mrs Angela Smith, a 49-year-old female presents to your pharmacy with a prescription for a reducing dose of prednisolone and Symbicort 200/6 from the local hospital. She tells you that over the weekend during a thunderstorm she needed to go to the emergency department with severe shortness of breath, coughing and wheezing, and was feeling very distressed due to her symptoms. She was diagnosed as having an asthma attack and was stabilised and discharged with 2 days’ supply of prednisolone. She was also given a prescription for eformoterol plus budesonide, a combination inhaler, and prednisolone 25mg tablets to be taken as a reducing dose.
Your records show she has not had her preventer inhaler dispensed for several years, and on discussion with Angela, she tells you that she hasn’t used a preventer for a long while, and that her asthma has been a little uncontrolled over the past couple of weeks particularly in the mornings but was relieved with salbutamol. She also discusses how she gets short of breath now even without doing much strenuous work during shifts at the factory. Mrs Smith admits to being a smoker for over 30 years, but doesn’t think there would be much point to giving up now, and doesn’t think she could. Her spouse is also a smoker.
Prescription is as follows:
Prednisolone 25mg take 2 daily and reduce dose as directed. (mitte 30 tablets)
Symbicort 200/6 Inhale 2 puffs twice a day and 1 inhalation when needed; repeat after a few minutes up to a max of 6 inhalations.
She is unsure of how long to continue the combination inhaler and wants to know how she should reduce the prednisolone dose.
Q1. Is Mrs Smith’s asthma well-controlled? Give an explanation for your findings. Explain how she should reduce the prednisolone dose, the rationale for this type of dosing schedule including the Symbicort schedule, and how long she should use the Symbicort inhaler.
Q2. Explain what has contributed to Mrs Smith’s current asthma presentation.
Q3. Write an asthma management plan for Mrs Smith.
Over the next few years, Mrs Smith’s health further deteriorates and she undergoes a number of respiratory tests:
Forced expiratory volume (FEV1) 0.94L
Predicted FEV17 L
FEV1 % predicted 35%
Forced vital capacity (FVC) 1.53 L
FEV1/FVC 62 (62%)
FEV1 Post salbutamol 0.99L