Indeed, interaction with the patient on this point would demonstrate a very poor inhalant technique, a factor which the physician failed to consider before increasing the patient's dosage. Additionally, the physician failed to check concordance with respect to the patient's history of medicine use. This might have revealed some shortcoming in the subject's own methods of self-administering medication, including inconsistent usage and occasionally skipped doses. A useful instrument for checking concordance is that provided by the Devon City Council (2010), which offers a line of questioning concerning the habits and patterns of the subject's medicine usage. By prescribing and increasing dosage with both inhalants and an antibiotic without conducting this check of concordance, the physician failed to take all proper steps in validating the particular medication approach selected.
Yet more problematic would be the prescription of this treatment course without a more thorough examination of the subject's health environment. Specifically, the physician failed to investigate the possible presence of new triggers, a process which might have immediately demonstrated a common ground between Judith's immediate situation and current research on asthma triggers. Namely, Judith recently acquired a new cat, an occurrence which almost directly coincides with the onset of her symptoms. It is conceivable that Judith might not have been inclined to suspect this as a cause, given that she had previously owned a cat for 7 years. Upon the death of the old cat and acquisition of the new one, it may be deduced as probable that the latter carries allergies not present in the former.
This deduction confers with present research, which states that "allergic sensitivity to cats, confirmed through skin testing, was associated with a threefold increase in asthma risk in the study, conducted using data from the nationally representative health survey, NHANES III. Cat allergy was the strongest single predictor of asthma risk among the common allergen exposures examined," (Boyles, 1) it should be considered problematic to the assessment of a proper management plan that the initial physician failed to draw an association between Judith's history of sensitivity to allergens -- denoted by her chronic, lifelong hay fever -- and her acquisition of a new cat. This demonstrates a general neglect on the part of the physician to seek to identify possible triggers of the emergent asthma condition.
It also may therefore represent an unnecessary risk in combining the medications initially considered, specifically with indications that a combination of Becotel with albuterol-based inhalants may result in potassium deficiencies and other critical side effects. Where these can be avoided, a management plan might be considered more risk averse.
The treatment methodology here revolves entirely upon the prescription of medication. A counselor may be in a position to evaluate the client as a potential candidate for supplementary psychological support. The prescription of professional anxiety counseling should be discussed with reference to those who experience panic-induces attacks and who could likely benefit from such assistance in preventing the trigger of further attacks. Indeed, this approach to asthma takes something of a more holistic approach to understanding the subject. In the conception of James & Friedman, the approach to inducing recovery from a chronic condition such as asthma will not involve remission from the condition so much as controlling the condition and adjusting to it. Accordingly, the authors contend that "recovery means feeling better. Recovery means claiming your circumstances instead of your circumstances claiming you and your happiness." (James & Friedman, 6) With respect to asthma, this will mean finding ways to control triggers and to reduce the potential to heighten the severity of attacks thusly. The notion of claiming one's circumstances suggests developing personal strategies for preparedness and tactics for maintaining calm in the face of impending attacks.
We also consider here the potential alternative of Prednisolone, which is typically paired with asthma medications as an anti-inflammatory. However, this carries its own known side-effects. Accordingly, "Prednisolone and other corticosteroids can mask signs of infection and impair the body's natural immune response to infection. Patients on corticosteroids are more susceptible to infections, and can develop more serious infections than healthy individuals." (WebMD, 1) This makes it extremely warranting of critique that other possible conditions had not been initially or thoroughly ruled out. The dependency which this drug invokes demands for gradual weaning from the drug as premature withdrawal can cause an intensification of the symptoms of the initial condition. Thus, its use must be very carefully considered in light of an exhaustion of other conditional possibilities.
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