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.

Current evidence concerning the relationship between undiagnosed respiratory conditions in patients and the potentially magnified hazards of asthma suggests that sufficient investment had not been paid to Judith's early symptoms. Indeed, "early detection and treatment might improve the long-term prognosis of these patients and this secondary prevention may also prevent irreversible loss of function." (Schayck, 1) This pairs the two primary flaws in a continuum of sub-par treatment for the subject, suggesting that her unmanaged allergies and the failure of physicians to help remove her from contexts where triggers invoked these allergies may have contributed to the onset of her asthma later in life.
More importantly, it seems that the failure to address the issue of her new cat is a central shortcoming in the management approach which must be corrected in a future management plan. It is here that we are inclined to consider the implications of Judith's new cat, which seems to be a likely trigger for the new symptoms which she has experienced. It is thus that a future management plan involves first and foremost the removal of this stimulus, with careful monitoring and visitation in a week's time for consideration of progress in the absence of the suspected stimulus.

This would be done in combination with the recommended use of Beconase in combination with Symbicort. This is a drug combination which, contrary to Becotide and Salbutamol, tends to reduce the danger of negative interaction. With respect to Symbicort, it is warned that "rarely, serious (sometimes fatal) asthma-related breathing problems may occur in people with asthma who are treated with drugs similar to the formoterol in this product (long-acting inhaled beta agonists). In patients with asthma, the manufacturer recommends using this product when one long-term medication (e.g., inhaled corticosteroids)" (WebMD1, 1) This denotes that monitoring is necessary during the initial and lonterm use of the medication. This recalls the role of the NP.

The subject is also required to continue to use the allergy medication, identified as Cetirizine, in conjunction with the medicine course prescribed for her asthma.

Living with Chronic Illness:

Another aspect of Judith's health outlook which is of use in helping her to develop a daily living strategy is her relative physical capabilities where engagement in exercise is concerned. Her profile denotes that the subject is in relatively good physical health and maintains the ability to engage in reasonable exercise without significantly adverse health consequences. So denotes the article by Norton (2010), which finds that "adults whose asthma is not fully controlled by medication might gain some benefits from adding an exercise routine to their lives, a small study suggests. While exercise can trigger asthma symptoms in some people, there is also evidence that physically active asthmatics tend to have better overall asthma control than their sedentary counterparts." (Norton, 1)

This is a useful point of strategy for Judith and her husband, who might significantly benefit from light training in some exercises that can help to improve respiratory abilities without causing too great a physical strain on the subject. Given Judith's otherwise good health, this would seem a valuable opportunity to capitalize on her abilities. By helping to outline a plan for more active physical engagement, a nurse can significantly aid in the improvement of control over symptoms and maintenance of quality of life. So is this denoted in Norton's article, which finds that the use of light jogging, treadmill running and stationary cycle all can have significant benefits to the asthma sufferer. Norton finds that between its control group and the experimentally cast exercise group, "the exercise group improved its average score on a standard questionnaire gauging asthma-symptom control -- a change that moved the group from the category of 'relatively well-controlled' to 'well-controlled.' Similarly, the exercisers reported gains in a questionnaire on asthma-related quality of life -- which measures, for example, how much a person's symptoms limit his or her daily activities or affect emotional well-being." (Norton, 1)

This seems a useful point of consideration for Judith, who appears to be in the relatively well-controlled category with the potential for improvement as she adjusts to the symptoms of her new condition. For Judith, a significant aspect of living with a newly developed chronic condition will be in adjusting her lifestyle to manage and control her symptoms.…