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Bronchial Asthma can be:
- Mild - Moderate - Sever (Status Asthmaticus)
Also can be divided into acute or chronic.
Another classification into Atopic (Extrinsic) or Non-Atopic (Intrinsic).
Common features of asthma in general:
They are the symptoms/signs of airway narrowing/obstruction/inflammation/mucus
production & their sequels:
• Dyspnea (with or without Tightness of the chest)
Your history must include any precipitating cause of asthma like allergens, seasonal variation, drugs and weather. Also search about family history of Asthma, Allergy, Dermatitis, Sinusitis and Rhinitis. Hallmark feature of Asthma in the history:
Nocturnal and early-morning awakenings (especially around 4:00 am)
Related features to Sever Asthma (Status Asthmaticus):
The features mentioned above in sever pattern plus:
- Patient Exhaustion & confusion - Fatigability - Can’t lying back - Silent chest - Pulses paradoxus - Cyanosis - Bradycardia
Eosinophilia, Leucocytosis, Decreased pH (especially sever asthma).
- Chest X-ray:
Piegon chest (hyperinflation).
- Arterial Blood Gases ABG.
- Respiratory function tests like PER.
Due to multi-drugs availability of asthma, you can see a variation in the treatment plans. Treatment of Acute asthma:
- Mild-Moderate acute attack of asthma:
* If it is the 1st attack in the life of patient, you should give him/her Salbutamol or
Albuterol (Ventolin) 1-2 puffs/qid (Not exceeding 12puffs/day), The duration of days not exceed 7 days.
* If the patient has past Hx, give the patient a combination between Salbutamol +
Corticosteroids (Aerocort) 2puffs/bid /7days. - Sever acute attack:
* Combivent (Albuterol+Ipratropium) Neubelizer (or inhaler) 2INH/qid.
* Treat of Status Asthmaticus in hospital/ICU with more senior staffs.
Treatment of Chronic asthma:
By step-wise control of asthma, start from the step that you imagine it is favorite to your
patient then go up or down steps according to the case improvement or failure (Best
results by Starting high & step down).
1- Occasional use of Salbutamol or Albuterol (Ventolin) 1puff per day as required
(i.e. some days without medication), If the patient using it more than once move to step2.
2- Regular low dose of corticosteroid: Beclometasone 100-400ug/bid (inhaler)+
Short acting B2 agonist (e.g. Ventolin) as required (not exceeding single dose per day & should not be used as a maintenance), if patient need more move to step 3.
3- Regular high dose of corticosteroid: Beclometasone 800-2000ug/bid (inhaler) +
Short acting B2 agonist (e.g. Ventolin) as required (not exceeding single dose per day & should not be used as a maintaince). If there is a problem in using high dose of corticosteroids (e.g. oral candidiasis) switch to Regular low corticosteroid + long acting B2 agonist Salmeterol 1-2puffs/bid. If no improvement move up to step 4.
4- High dose corticosteroid + long acting B2 agonist. 5- Oral Prednisone or Prednisolone (once daily 5-60mg/d in the morning) + step 4.
If there is a good improvement, you can step down after 3 months or more. But if there is
no improvement, step up immediately.
Asthma management is a matter of experience & individual variation.
Also in asthma treatment don’t forget to treat the complications or the causing agents
(if possible) like antibiotics for chest infection.
In our discussion about asthma TTT we missed many drugs(e.g. theophylline) you can
refer to your resource for using.
Editor: Dr. Hamied Abou Hulaikah Contributors: Dr. Amen Ali Dr. Ahmed Al-Riashy Dr. Saif Abdulkareem
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