asthma

• severe asthma characterized by: 1)unable to complete sentences in one breath,2)changed mental status,3)paradoxical chest movement,4)absence of wheezes 5)peak expiratory flow-PEF < 50%
• acute asthma medicine treatment: give oxygen if saturation <94%, give salbutamol,nebulisation,5mg. initially nebulize patient continuously by refilling reservoir every 20min at a rate of 6-8L/min until PEF>60%. once patient reach 60% PEF, give salbutamol 5mg 4hourly
• acute asthma medicine treatment,in severe cases: to salbutamol,add ipratropium bromide,nebulisation 0.5mg. so we use combination of salbutamol/iptratropium, UDV, 5/0.5 mg
• acute asthma medicine treatment in mild to moderate cases or poor response to salbutamol: add ipratropium to salbutamol,nebulisation,0.5mg. then also add prednisone,oral,40mg daily give for 7days. Give hydrocortisone,IV,100mg,6 hourly in patients who cannot take oral prednisone.
• continue nebulisation until PEF is 80%, at this point give salbutamol,MDI,200 mcg. everytime you give salbutamol give inhaled corticosteroids-ICS-Budesonide,inhalation,200mcg
• if patient is on protease inhibitors, replace ICS with beclomethasone, inhilation, 200mcg everytime they take salbutamol
• in patient with poor respond even after giving ipratropium bromide,add: Magnesium sulfate,IV,2g in a 100mL sodium chloride 0.9% over 20minutes-this is as a single dose
• asthma:1)<20yrs 2)have history of hay fever,eczema and allergies 3)family history of asthma 4) symptoms are intermittent 5)symptoms usually worse at night or in the early morning 6) PEF increase by 20% 10 minutes after having b2-agonist-salbutamol
• COPD:1)older age onset >40yrs 2)symptoms take long time to worsen 3)they have long history of coughing frequent cough before onset of SOB 4)symptoms are persistent through out the day 5)have history of heavy smoking >20 ciggars/day for >15years,maijuana use,Tb history 6)little improvement in PEF with b2-agonist
• general measure for chronic asthma:1) advise to stop smoking 2)decrease exposure to triggers-dust,grass,pets,smoke,fumes
• chronic-for patients with asthma symptoms less than 2 times a month: Give Salbutamol,MDI,200 mcg as needed and ICS,Budesonide,inhalation,200 mcg with salbutamol. if patient on protease inhibitors replace ICS with beclomethasone,inhalation,200mcg with salbutamol
• asthma symptoms 2 times or more give: controller therapy-Budesonide,inhalation,200mcg,12 hourly. if patient is well and stable for 6months give budesonide 200 mcg daily. if they take protease inhibitors, replace ICS with beclomethasone,200mcg 12 hourly for 6 months .when they are stable give 200mcg daily-ADD salbutamol,MDI,200mcg 6 hourly as necessary
• chronic-asthma symptoms that occur daily or atleast once a week give:long acting B2-agonists/corticosteroids combination inhaler: Salmeterol/fluticasone, 50/250 mcg, inhalation,12 hourly, max dose 50/500 12hourly. well and stable give budesonide,ihalation 12hourly and formoterol,inhalation,12mcg 12hourly
• failure for chronic therapy give:corticosteroids-intermediate acting-prednisone,oral,10mg daily while waiting to specialist appointment
• for short-term exacerbations if prednisone 10mg is ineffective give prednisone 40mg,oral for 10days while waiting for specialist
• symptoms of asthma: SOB,wheeze,chest tightness and dry irritating cough
• characteristics of asthma: air flow obstruction,bronchohyperresponsiveness-cause of histamine release ,inflammation
• we have atopic-extrinsic and non atopic asthma