Download Child Asthma Case Study

Lilly Wheezer, a 3-year old child, was diagnosed with asthma after she was hospitalized for two
days at age 7 months for respiratory syncytial virus (RSV) and complications of acute wheezing.
At age 14 months, she was again hospitalized for one day due to an acute asthma attack; and she
again was treated in the emergency room 3 months later for another acute asthma attack. There
are records from the second emergency room treatment. At that time, the treatment notes
indicated that examination of her lungs showed expiratory wheezing bilaterally; and that she was
prescribed Albuterol, budesonide and Singulair. The hospital notes indicated the following final
diagnoses: 1. Reactive airway disease with acute exacerbation secondary to RSV; 2. upper
respiratory tract infection and acute bronchiolitis secondary to RSV; 3. bilateral otitis media; 4.
dehydration; 5. viral process and syndrome secondary to RSV.
During her follow-up appointment a few days later, she was advised to increase the frequency of
use of the inhaler. The claimant was seen by a specialist 6 months later at which time the mother
reported that her wheezing and asthma attacks were as often as twice per week. It was noted that
on several occasions, the claimant did not respond to nebulizer treatments and oral steroids were
administered (Id.).
The claimant’s mother testified that her daughter has chronic asthma attacks requiring doctor
visits 3-4 times a month. She stated that she has these attacks despite the use of a nebulizer,
which she uses every night. Moreover, she testified that she had to quit her job to care for her
child. She further noted that the claimant wakes up every night and she gives her nebulizer
treatment. Moreover, she testified that the claimant is taking steroids, which does not appear to
be resolving her attacks. The record also contains the mother’s response to a Child Asthma
Questionnaire. In the questionnaire, she reported that the claimant’s asthma attacks occurred
about twice a month, and sometimes multiple times per week. In addition, she noted that she
was using Albuterol, Budesonide and ProAir as well as treatments with a nebulizer machine; and
that sometimes she has to see a doctor twice a week for her asthma.
Lilly Wheezer’s treating pulmonologist, Dr. Clearwater, signed a letter, dated April 20, 2014, in
which she stated that Lilly has been seen seven times for asthma since January 2014. She further
stated that Lilly’s current daily medication is Albuterol and Budesonide twice a day; and that she
has also been treated with Prelone two times since January 2014 (Id.). Dr. Clearwater concluded
that given her chronic daily use of corticosteroids, it appears her asthma condition meets the
requirements of Listing 103.03C2.
QUESTIONS:
1. Listing 103.03 requires a diagnosis of asthma with:
A. FEV1 equal to or less than the value specified in table 1 of 103.02A: or
B. Attacks (as defined in 3.00C), in spite of prescribed treatment and requiring physical
intervention, occurring at least once every two months or at least six times a year. Each
patient hospitalization for longer than 24 hours for control of asthma counts as two attacks,
and an evaluation period of at least 12 consecutive months must be used to determine the
frequency of attacks; or
C. Persistent low grade wheezing between acute attacks or absence of extended symptomsfree periods requiring daytime and nocturnal use of sympathomimetic bronchodilators with
one of the following:
1. Persistent prolonged expiration with radiographic or other appropriate imaging
techniques evidence of pulmonary hyperinflation or peribronchial disease; or
2. Short courses of corticosteroids that average more than 5 days per month for at
least 3months during a 12-month period; or
D. Growth impairment as described under criteria in 100.00.
Did you agree with Dr. Clearwater’s opinion that the claimant’s asthma condition meets the
requirements of Listing 103.03C2?
2.
If you felt the condition did not meet the requirements of the Listing, would you consider
whether the condition “equaled” in severity the requirements of the Listing?
3.
Is budesonide a corticosteroid? If so, would the claimant’s daily use of budesonide alone
meet the criteria of Listing 103.03C2?
4. Is budesonide prescribed in the form of an inhaler or is it generally used in a nebulizer?
Would it make a difference if a corticosteroid were administered in an inhaler form or
liquid form in a nebulizer in terms of meeting the requirements of Listing 103.03C2?
5. What are other brands of medications that are considered corticosteroids?