A is a 10-year-old girl living in a rural village. She has a history of recurrent respiratory infections and has been experiencing episodes of wheezing and shortness of breath for the past two years. There is no significant family history of asthma, but her family uses a wood-burning stove for cooking inside their small, poorly ventilated home.

A presented to the local health clinic with her mother. She was experiencing an acute exacerbation of asthma, characterized by severe shortness of breath, wheezing, and a persistent cough. Her mother reported that A. had been struggling to breathe for the past two days, and her symptoms were not relieved by rest.

- Vital Signs:
- Temperature: 37.5°C
- Pulse: 110 bpm
- Respiratory Rate: 30 breaths per minute
- Oxygen Saturation: 92% on room air
- Physical Examination:
- General: A. appeared distressed and anxious.
- Respiratory: Diffuse wheezing throughout all lung fields, with reduced air entry bilaterally.
- Other systems: No significant findings.

- Acute exacerbation of asthma.

1. Immediate Management:

   - Administered nebulized salbutamol (2.5 mg) and ipratropium bromide (500 mcg) to relieve bronchospasm.

   - Started supplemental oxygen via nasal prongs at 2 liters per minute to maintain oxygen saturation above 94%.

   - Oral prednisolone (1 mg/kg) was given to reduce inflammation.

2. Environmental Management:

   - Educated the family on the importance of reducing indoor air pollution by improving ventilation and using alternative cooking methods, such as outdoor cooking if feasible.

3. Long-Term Management:

   - Prescribed a metered-dose inhaler (MDI) with a spacer for regular use of inhaled corticosteroids (beclomethasone 100 mcg, two puffs twice daily) and as-needed use of a short-acting beta-agonist (salbutamol 100 mcg, two puffs).

   - Scheduled follow-up visits to monitor A’s asthma control and adjust her treatment plan as needed.

4. Education:

   - Provided asthma education to A. and her mother, including recognizing early signs of exacerbation, proper inhaler technique, and the importance of adherence to prescribed medications.

A returned for a follow-up visit two weeks later. She had significantly fewer symptoms and no further exacerbations since starting her new treatment plan. Her mother reported improved breathing and reduced frequency of nighttime symptoms. A’s peak flow readings had also improved, indicating better asthma control.

Conclusion:

This case highlights the importance of a comprehensive approach to asthma management in a low-resource setting, addressing both medical treatment and environmental factors to improve patient outcomes.

This case is designed to illustrate the challenges and considerations of managing asthma in a sub-Saharan African context