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A Standardized versus an Individualized Approach in Managing Difficult Asthma: A Dilemma

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Background: The adherence to clinical practice guidelines often aids in improving clinical decisions. However, doctors at times have to look beyond clinical practice guidelines to treat their patients. Situational awareness and clinical experience often put doctors in a better position to treat and manage asthmatic patients.

Case presentation: A 52-year-old Indian lady with chronic persistent asthma was treated in the Department of Respiratory Medicine, Hospital Pulau Pinang. Despite her initial improvement, using the treatment strategy based on asthma guidelines, the patient continued to be poorly controlled with frequent exacerbations and severe impairment to daily activities. 

The patient's spirometry results did not correlate with her clinical behaviour. The patient IgE levels were significantly elevated at 590 KU/L. A decision was made to commence her on anti-IgE monoclonal antibody, Omalizumab (Xolairâ). After 12 months, the patient made significant improvement in her asthma control and quality of life.

Conclusion: Making appropriate and timely clinical decision results in reducing asthma morbidity and mortality. 

18 Mar, 2015
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e-Published: 12 Nov, 2015


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