Asthma, infection and the World Anti-Doping Agency: a case study

The purpose of this article is to evaluate the challenges posed during the care and management of patients and how it can influence our clinical decision-making. It will seek to explore the evidence behind the treatment plan and explain the reasoning. The case will focus on a twenty eight year old male patient presenting with an exacerbation of asthma following a productive cough. This case was selected as it demonstrates clinical examination and formation of differential diagnoses in addition to highlighting legal and ethical barriers, and will discuss the clinical examination performed and the psychosocial factors affecting the treatment and management plan. It will explore the treatment options with consideration of legal and ethical principles. The case will be anonymous with no identifiable information available (Data Protection Act 1998).

A medical model approach was used to examine the patient, which consisted of thorough history taking (Douglas, Nichol and Robertson 2013). This indicated a one-week history of productive cough with copious thick green sputum, coinciding with an increasing inhaler use of twelve to fourteen puffs of ‘Ventolin’ per day; little effect. The patient reported a reduced exercise tolerance and being short of breath on moderate exertion. No haemoptysis was reported and there was no history of chest pain, recent travel, calf swelling or familial history of hyper-coagulopathy disorders. The patient works as an electrician and smokes ten filtered cigarettes a day with a weekly alcohol consumption of ten to twelve units. In addition the patient is a competitive sportsman with a competition in 3 weeks.