Tuesday, 3 June 2008

Asthma

if you got a patient with asthma,you are likey to be asked about the stepwise treatment:
Step1
Short acting beta agonist as required
e.g salbutamoul PRN

Step 2
Short acting beta agonist as required
+ Standard dose inhaled corticosteroids
e.g salbutamoul inh PRN
Beclomethasone inh regular

Step 3
Short acting beta agonist as required
+standard dose inhaled corticosteroids regular
+long acting beta agonist regular
e.g salbutamoul inh PRN
Beclomethasone inh regular
Salmetrol inhalers regular

If no response, consider increase the dose of regular inhaled corticosteroids to the upper limit of standard dose.

Step 4
Short acting beta agonist as required
+standard dose inhaled corticosteroids regular
+long acting beta agonist regular
+6 weeks trial of one or more of:
Leukotrienes receptors antagonists
Modified released thiophylline
Modified released oral beta agonist

Step 5
Add prednisolone tab

what are the features of acute svere asthma and how would you manage that?
what are the indications for mechanical ventilation?

2 comments:

  1. Life-threatening features:
    1-Silent chest
    2-Cyanosis
    3-Bradycardia (especially despite β2 agonist)
    4-Exhausted appearance
    5-PEFR <30% of predicted

    Immediate management:
    1-Oxygen therapy by tight fitting facemask (60%).
    2-Nebulised salbutamol 2.5 +/- 0.5mg ipratropium
    3-Start glucocorticoid therapy - prednisolone 30-60mg p.o. or hydrocortisone 200mg i.v.
    4-Urgent chest X-ray to exclude pneumothorax
    5-Urgent blood gas
    Reassess in 15 min or if life-threatening features appear
    Consider i.v. aminophylline if life-threatening features or fails to improve after 15-30 minutes
    Discuss all patients with ITU - ventilation needed if PEFR continues to fall despite medical therapy, patient becoming drowsy/confused/exhausted or deteriorating blood gases

    ReplyDelete
  2. role of k+ and MgSO4?

    ReplyDelete