Treatment of bronchial asthma. UG medical portion

1. MANAGEMENT OF
BRONCHIAL ASTHMA IN
CHILDREN
D.SRIRAM
120

2. MANAGEMENT OF ASTHMA
 Bronchial asthma cannot be cured but controlled
 GOALS OF THERAPY
1. maintain near normal pulmonary
function
2. maintain near normal physical activity
3.prevent night time cough or wheezing
4.prevent recurences
5,avoid adverse effects of therapy

3. MANAGEMENT
LONG TERM ACUTE ATTACK OF
ASTHMA

4.  EFFECTIVE LONG TERM MANAGEMENT
1.identification and elimination of
exacerabating factors
2.pharmacological therapy
3.education of the patient and parent

5. IDENTIFICATION AND ELIMINATION OF
EXACERABATING FACTORS
1.bedroom should be clean and free from dust
2.caressing of animal pets discouraged
3.adolescent patients should refrain from
smoking
4.periodic cleaning of carpets etc

6. PHARMACOTHERAPY
1.BRONCHODIALATORS
short and long acting
2.CORTICOSTEROIDS
inhaled and systemic
3.MAST CELL STABILISERS
4.LEUKOTRIENE MODIFIER
5.THEOPHYLLINE

7.  BRONCHODIALATORS:
commonly used are short acting such
as salbutamol,terbutaline,adrenaline and has quick
onset of action.
long acting are salmetrol and
formoterol whose action is delayed by 30-60
minutes but lasts12-24 hrs
 CORTICOSTEROIDS:
for long term management
systemic steroids when used early
reduce emergency visists and hospitalisation
inhaled steroids imclude
beclomethasone,budesonide and fluticasone

8.  MAST CELL STABILISERS
cromolyn sodium,indiacation
include mild to moderate persistent asthma and
exercise induced asthma
other agents are nedicromil and
ketotifen
o LEUKOTRIENE INHIBITORS
monteleukast and zafirleukast

9.  INHALATIONAL DEVICES;
1.METERED DOSE INHALER
ACCORDING TO AGE;
1. <4 years-face mask +spacer+mdi
2. 4-12years-spacer+mdi
3. >12 years-only mdi

12. NEBULISER ROTAHALER

13. STEPWISE TREATMENT OF ASTHMA
 STEPS SYMPTOMS
 Severe persistent -continuous
limited physical activity
 Moderate persistent -daily attck affects activity
daily use beta2 agonist
 Mild persistent -low grade symptom 2 a month
night time awakening1 a month
 intermitent -infrequent
asymptomatic and normal PEFR
between attack

14. STEPWISE TREATENT OF ASTHMA

15. STATUS ASTHMATICUS
 Status asthmaticus is a major cause of acute illness in
children and one of the top indications for admission to a
pediatric intensive care unit (ICU)
 Bronchial smooth muscle spasm, airway inflammation,
and increased mucous production are the key
components of acute asthma. This pathophysiology
results in increased pulmonary resistance, small airway
collapse, and dynamic hyperinflation. Unlike during
normal breathing, in status asthmaticus a child’s
inspiratory muscle activity can persist through
exhalation, significantly increasing respiratory muscle
workload and fatigue. Additionally, because of
heterogeneous areas of premature closure and
obstruction, there can be significant ventilation-perfusion
mismatching and hypoxemia

16.  SABA - one puff every min (10 max)/
single nebulisation
O2 IF SPO2 <95%
START ORAL
PREDNISOLONE (1-2NMG/KG)
NEBULISATION OF SALBUTAMOL+ IPRATROPIUM
INJ HYDROCORTISONE(10MG/KG)
SYMP RELIEF AND
RESPONSE+
PEFR INCREASED
THAN 80%
CONTINUE SABA
EVERY
6-8 HRS FOR NEXT 24
HRS
NO RESPONSE
IMPROVE
ASSESS AFTER 2HRS
SABA
ORAL
PREDNISOLONE
FOR 5 DAYS
RESPONSE +
INJ THEOPHYLLINE
MAGNESIUM SULPHATE INFUSION
MECHANICAL VENTILATION

17.  LIFE THREATENING ASTHMA
1.silent chest
2.cyanosis
3.altered sensorium
4.poor resp effort
5.spo2<90%
6.pefr<30%

18.  MANAGEMENT
start straight with inj.adrenaline
terbutaline s.c
inj hydrocortisone
neb salbutamol+ipratropium

19. THANK YOU