You are seeing Nancy Smith, a 35-year-old female presenting with an asthma exacerbation. She has had asthma since she was a child for which she was hospitalized several times. Her asthma was well controlled until the past couple of years. She has been seen in urgent care a few times over the past year (most recently 4 months ago) and was given a prescription for an inhaled steroid (she never filled), albuterol inhaler, and oral steroids. She had eczema as a child and received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 4 or 5 times a day. She reports shortness of breath when climbing stairs or when walking to the mailbox. She has had nighttime coughing spells every day during the past week and has had to prop up herself up on pillows to breathe. She indicates that she has had similar previous flares in the past.

Health Information
Medications: Proair HFA, Claritin, Flonase PRN
Spirometry:
FEV1: 81% (post-bronchodilator results with 15% increase)
FVC: 88%
FEV1/FVC ratio: 82%
Pulse ox: 96% on RA

Assessment Deliverable
Based on the scenario provided, record yourself in a video that is no more than 5 minutes long. For your video, use slides to present your information.

Address the following in your video:

Patient Interview
Identify follow-up questions you would ask Nancy to better understand her condition and support your diagnosis.

Overall Health and Pathophysiology
Discuss the pathophysiology of asthma, including the 3 core defects.
Explain the significance of atopy and the concept of “one continuous airway” in relation to Nancy’s history and symptoms.
Differentiate between obstructive and restrictive lung disease. Explain how reversibility with a bronchodilator helps distinguish asthma from COPD.

Diagnosis
Interpret Nancy’s spirometry results (FEV1, FVC, FEV1/FVC ratio), and explain what each value indicates.
Based on her symptoms, history, and spirometry, classify Nancy’s asthma severity (intermittent, mild persistent, moderate persistent, or severe persistent), and justify your classification.

Asthma Management
Describe the dangers of overusing rescue medication from a pathophysiological perspective.