its about asthma and its types and management.

2. Management of Asthma
DR. M. ZAID UR REHMAN
H.O. MU-4
DHQ HOSPITAL FAISALABAD.

3. Aims of treatment
 Abolish symptoms
 Restore normal or best possible lung function
 Reduce the risk of severe attacks
 Minimize absence from school or employment

4. Investigations
 Lung function tests
Peak Expiratory Flow Rate (PEFR)
Spirometry
 Blood & Sputum tests ( Increased Eosinophils)
 Trial of Corticosteroids
 Chest X-ray
 Skin-prick tests

5. Control of extrinsic factors
 Where specific allergen triggers are identified, these
should be avoided if possible.
 Replace Carpets with floorboards
 Use of Mite impermeable bedding
 Avoidance of Smoking
 Avoidance of NSAIDs

6. Pharmacological Treatment
 Stepwise Approach to management of Asthma
 STEP 1 : Occasional Symptoms :-
 Symptoms less than once per week for 3 months and fewer than two nocturnal
episodes per month
 Use of Short Acting Beta-2 Agonists
 Inhaler Salbutamol ( Ventolin) : 1-4 puffs as and when required.

7.  STEP 2 : Daily Symptoms :
 Regular Inhaled Preventer Therapy
 Inhaled low-dose Corticosteroids
 Inhaler Bekson (2-4 puffs 2-4 times daily)
 Inhaler Ventolin ( 1-4 puffs as and when required)

8.  STEP 3 : Severe Symptoms
 Add-on Therapy
 Inhaled Corticosteroids + LABA
 Inhaler Salmicort ( Fluticasone + Salmetrol) ( 2 Puffs BD)
 Inhaler Ventolin ( 1-4 puffs as and when required)
 Tab Myteka ( Montelukast ) 10 mg at bedtime

9.  STEP 4 : Severe Symptoms Uncontrolled
 High-dose ICS + Regular Bronchodilators
 Inhaler Salmicort ( 2-4 puffs BD)
or
 Inhaler Foster ( Formoterol + Beclomethasone) 2-4 puffs BD
 Inhaler Ventolin ( 1-4 puffs as and when required)
 Cap Respro ( Theophylline) 200, 300 mg BD
 Tab Myteka ( Montelukast ) 10 mg at bedtime

10.  STEP 5: Severe Symptoms Deteriorating
 Regular Oral Corticosteroids
 Tab Deltacortil ( Prednisolone) ( 5mg ) ( 3 tab TDS)
 Side effects of Steroids :
1) Osteoporosis 2) Oral Candidiasis
3) Hoarseness
 Steroid sparing Drugs : Methotrexate, Ciclosporin

11. Management of Acute Severe Asthma
Tyoical Features :
1. Inability to complete a sentence in one breath
2. RR > 25 breaths/min
3. HR > 110 bpm
4. PEFR < 50 %
Life threatnening features :
 Silent chest, Cyanosis
 Confusion , Coma
 Bradycardia , Hypotension
 PEFR < 30%
 P O2 < 60 mmHg , P CO2 > 45 mmHg

12. Treatment
 Oxygen
 High-dose Inhaled Bronchodilators ( Neb e Ventolin )
 Nebulize with Ipratropium Bromide ( Atem )
 IV Hydrocortisone ( Solucortif )
If patient dosen’t respond, add
 Inj Aminophylline
 Inj Magnesium Sulphate
 Tab Augmentin ( if there is evidence of infection)

13. If there is still no improvement then Urgent Transfer to ICU.
If patient responding then
Continue Oxygen
Replace Inj Solucortif with Deltacortil ( 3 tablets TDS)
Continue Nebulization with Ventolin & Atem at 4-6 hrs interval.

14. Assess the patient with following
 ABGs
 Chest X-ray to rule out pneumothorax
 Regular monitoring of Oxygen saturation & PEFR

15. Any Question ???