whose word frequently involves driving cares. Consequently, Jonathan does report some diesel fume exposure and is currently working in Lara where there are canola fields. He is a non-smoker and keeps a pet dog that he has had for the last year.
Jonathan reports a history of childhood asthma with symptoms particularly between the ages of 7 and 10 years. Since that time, his asthma has been largely exercise induced, although over the last 3 or 4 years, he has noted seasonal symptoms in conjunction with allergic rhinitis. This year in particular it has been quite significant. Around three weeks ago, he developed typical allergic rhinitis symptoms shortly followed by dry cough, wheeze and dyspnoea.
I gather a recent chest x-ray was clear and pathology including vitamin D, TSH, CRO, B12, folate and U7Es are essentially normal, whilst FBE …show more content…
In the short-term, I have requested additional pathology including a RAST, IgE and ANCA assays. He will commence a 5-day course of prednisolone 50mg daily and I am happy for him to increase Symbicort Rapihaler to four puffs bd in the short-term. I have instructed him further regarding the use of Ventolin prn and he should acquire a space. He will also trial Dymista nasal spray in conjunction with a saline rinse.
At this point, I will see him again in a month with lung function test, but Jonathan will call me sooner if he is not settling.
Longer-term, I have discussed with him the option of a formal allergy assessment with a view to desensitisation, Jonathan is somewhat reluctant to go down this path as he has had friends who have had this treatment without success. At the very least, I think we need to have a plan prior to next spring where Jonathan is on a regular inhaled corticosteroid in addition to treatment or the allergic rhinitis.
Thank you again for your
Jonathan reports a history of childhood asthma with symptoms particularly between the ages of 7 and 10 years. Since that time, his asthma has been largely exercise induced, although over the last 3 or 4 years, he has noted seasonal symptoms in conjunction with allergic rhinitis. This year in particular it has been quite significant. Around three weeks ago, he developed typical allergic rhinitis symptoms shortly followed by dry cough, wheeze and dyspnoea.
I gather a recent chest x-ray was clear and pathology including vitamin D, TSH, CRO, B12, folate and U7Es are essentially normal, whilst FBE …show more content…
In the short-term, I have requested additional pathology including a RAST, IgE and ANCA assays. He will commence a 5-day course of prednisolone 50mg daily and I am happy for him to increase Symbicort Rapihaler to four puffs bd in the short-term. I have instructed him further regarding the use of Ventolin prn and he should acquire a space. He will also trial Dymista nasal spray in conjunction with a saline rinse.
At this point, I will see him again in a month with lung function test, but Jonathan will call me sooner if he is not settling.
Longer-term, I have discussed with him the option of a formal allergy assessment with a view to desensitisation, Jonathan is somewhat reluctant to go down this path as he has had friends who have had this treatment without success. At the very least, I think we need to have a plan prior to next spring where Jonathan is on a regular inhaled corticosteroid in addition to treatment or the allergic rhinitis.
Thank you again for your