Inpatient Case Study: 15 year old with asthma exacerbation

Background

Patient Information

15 y/o East Indian female admitted to PICU for status asthmaticus

HPI:

• symptoms started 3 days ago
• initially albuterol every 3 –4 hours at home was helping, but symptoms became significantly worse on the day of admission
• second PICU admission for asthma in the past year

Initial Vitals: RR = 36; SpO2 = 85% on RA

Meds:

• albuterol
• daily asthma controller medication (cannot remember which one); uses “most days”

ROS (pertinent positives):

• unable to practice with volleyball team without becoming short of breath
• has used albuterol at least 3 times per week for several months
• parents unaware of any tobacco product use

Other Info:

• heterosexual; pronouns: she/her

Ask

Screen for tobacco use with every youth age 11+ at every clinical encounter.

* Products used may vary between communities. Visit the Considerations for Clinicians page to view illustrations of common products.

Case Study Sample Dialogue: Part 1 of 3

Clinician: Do you use any tobacco or vaping products like cigarettes, e-cigarettes, or dip? Some of my patients use Vuse, JUUL, or Puff Bar.

Patient: Yes, sometimes with my friends at school and on the way home.

Clinician: Thank you for sharing that with me. Do you ever vape when you’re by yourself?

Patient: Yes. A senior at school recently sold me a SuorinVagonBlack.

Clinician: Is that an e-cigarette?

Patient: Yes, it’s a vape pen.

Counsel

Counsel all patients who use tobacco about quitting, regardless of amount or frequency of use.

Case Study Dialogue: Part 2 of 3

Clinician: Thank you for sharing that with me. It takes courage to share something personal. Can you tell me a little bit about why you vape?

Patient: Well, all of my friends vape at school.

Clinician: As your doctor, I care about you and I want to help you stay as healthy as possible. I know you’re playing volleyball this year. Vaping can make it hard to play at your best. It can increase your cough, make your chest feel tight, and weaken your lungs. I’m also concerned about how it’s impacting your asthma, because it can lead to more hospitalizations. How does that make you feel?

Patient: Well, I really like volleyball and want to play varsity next year. I was in the hospital 2 months ago and had to miss a week of practice. If you think quitting will help me play better and not get sick, I can consider it.

Clinician: Quitting vaping can help you feel better and give more effort to volleyball. And I wonder if some of your friends might also want to quit –I bet some of them are in a similar situation to you with volleyball. Are you interested in quitting today?

Patient: I guess so, I’m willing to try.

Treat

Link youth to appropriate behavioral supports

Sample Dialogue: Part 3 of 3

Clinician: I’m glad you’re interested in quitting. Let’s start by choosing a quit date. I want you to pick a day that feels right to you. You can choose today, or anytime in the next 2 weeks.

Patient: Can I start tomorrow?

Clinician: Absolutely! Now, quitting can be a challenge, so I want to connect you to a support system that can help you through it. Would you prefer to get support by text, website, or phone call. Which would you prefer using?

Patient: Text would be best.

Clinician: If you take out your phone, I can show you a text support program. Text DITCHVAPE to 88709. You will receive daily texts that will help you make a quit plan and deal with cravings and triggers that make you want to vape. Let's arrange a follow-up appointment with your primary care provider to check in with you in two weeks.

Patient: Okay thank you.

*Additional behavioral support options can be found at www.aap.org/help2quit

Cessation support & additional follow-up

* Case Study 2 explores the use of NRT in tobacco users < 18 years old."

**AAP Recommendations for NRT Prescription can be found at aap.org/NRT

Download Full Case Study View Full Youth Clinical Considerations

Additional case studies were developed to show the variations in clinical settings, common products, screening techniques, motivational interviewing, patient response, and clinician considerations. Please return to the home page to see additional case studies.