A 10-year-old fifth grader. At the age of 4, he was diagnosed with asthma. He presents to the primary care office with his mother after yesterday’s visit to the emergency room for an asthma exacerbation. He reports worsening respiratory symptoms including coughing, shortness of breath, and chest tightness. These symptoms have worsened since the start of basketball season 2 weeks ago, but they became significantly worse over the weekend, after the adoption of a new kitten. In the emergency room, he was treated with albuterol via nebulizer and was discharged on a course of oral prednisone.

State the two pertinent history questions you, as the provider, should ask to help determine his treatment plan. Also state the questions and comments you would pose to the mother to identify the family’s understanding of patient asthma diagnosis, treatment and care. Explain how you would incorporate an assessment of patient’s social determinants of health needs into the treatment plan.

Solution

Pertinent History Questions to Ask the Patient

1. “How often have you been using your rescue inhaler (albuterol) since basketball season started?”
   • This question helps assess the frequency of asthma symptoms and the level of asthma control. Frequent use of a rescue inhaler indicates poor asthma control and may necessitate adjustments in the treatment plan.
2. “Have you noticed any specific triggers that make your symptoms worse, such as physical activity, being around the kitten, or exposure to cold air?”
   • Understanding the specific triggers that worsen the patient’s asthma can guide the provider in offering targeted advice on trigger avoidance and in making adjustments to the patient’s medication regimen.

Questions and Comments for the Mother

1. “Can you tell me what you understand about your child’s asthma, including what triggers his symptoms and how to manage them?”
   • This open-ended question assesses the mother’s knowledge of her child’s condition, triggers, and the correct use of medications.
2. “How comfortable are you with the current asthma action plan, and do you feel confident in recognizing when his asthma is not well controlled?”
   • This question helps gauge the mother’s confidence in managing her child’s asthma and identifying when he needs medical attention.
3. “It’s important that your son avoids triggers that can worsen his asthma. Are you aware of how the new kitten or other environmental factors might be affecting his symptoms?”
   • This comment emphasizes the importance of trigger avoidance and educates the mother on the potential impact of the new kitten on her child’s asthma.

Incorporating Social Determinants of Health (SDOH) into the Treatment Plan

To incorporate an assessment of the patient’s social determinants of health into the treatment plan, the provider should consider the following:

1. Environmental Factors:
   • Assess the home environment for potential asthma triggers such as pet dander (from the new kitten), dust, mold, or secondhand smoke. Discuss strategies to reduce exposure to these triggers, such as keeping the kitten out of the child’s bedroom, using air purifiers, or implementing smoke-free home policies.
2. Access to Healthcare and Medications:
   • Inquire about the family’s access to medications, including whether they have any difficulties affording or obtaining the prescribed inhalers and oral medications. Ensure that the family understands the importance of adherence to the prescribed treatment plan and knows how to refill prescriptions.
3. Education and Health Literacy:
   • Assess the mother’s and child’s understanding of asthma management, including proper inhaler technique, recognizing early signs of an exacerbation, and when to seek medical attention. Provide clear, written instructions or educational materials tailored to the family’s literacy level.
4. Physical Activity and School Environment:
   • Discuss how the child’s participation in basketball and other physical activities can be managed safely. Coordinate with the school to ensure that the child has access to his inhaler and that school staff are aware of his asthma action plan.
5. Support Systems:
   • Explore whether the family has adequate support, such as help from extended family members or community resources, to manage the child’s asthma effectively. Offer referrals to social services or support groups if needed.

By integrating these considerations into the treatment plan, the provider can help ensure that the patient’s asthma is managed effectively within the context of his social and environmental circumstances.