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ASTHMA

INTRODUCTION
Asthma is a heterogeneous disease, usually characterized
by chronic airway inflammation. It is defined by the history
of respiratory symptoms such as wheeze, shortness of
breath, chest tightness and cough that vary over time and
in intensity, together with variable expiratory airflow
limitation.
Fortunately, asthma can be effectively treated, and most
patients can achieve good control of their asthma. When
asthma under good control patients can.
Avoid Troublesome Symptoms During Day And Night
Need Little Or No Reliever Medication
Have Productive, Physically Active Lives
Have Normal Or Near Normal Lung Function
Avoid Serious Asthma Flare-ups (Exacerbations, Or Attacks)
SYMPTOMS
Coughing, especially at night, during exercise
or when laughing.
Difficulty breathing.
Chest tightness.
Shortness of breath.
Wheezing (a whistling or squeaky sound in
your chest when breathing, especially when
exhaling)
ASTHMA TRIGGER
Infections Particularly Infections Of The Upper Airways, Such As
Colds And Flu
Allergens Including Pollen, Dust Mites, Animal Fur ("Dander") Or
Feathers
Airborne Irritants Including Cigarette Smoke, Fumes And
Pollution
Medicines Particularly Painkillers Called Non-steroidal Anti-
inflammatory Drugs (Nsaids), Which Include Aspirin And
Ibuprofen, And Beta-blockers
Emotions Including Stress Or Laughter
Food Additives Including Sulphites (Often Found In Pickled
Products, Wine, Beer And Dried Fruit) And Tartrazine (A Yellow
Food Colouring)
Weather Conditions Including Sudden Changes In Temperature,
Cold Air, Windy Days, Thunderstorms And Hot, Humid Days
Indoor Conditions Including Mould Or Damp And Chemicals In
Carpets And Flooring Materials
Exercise
SEVERITY OF ASTHMA
EXACERBATION
SEVERITY MILD MODERATE SEVERE RESPIRATO
RY ARREST
IMMNENT
Wheeze Moderate, often Loud Usually loud Absence of
only end wheeze
exporatory
Pulse < 100 100 -120 >120 Bradycardia

Guide to limits of normal pulse rate in children -


Infants 2 12 month = Normal rate <160/min
Preschool 1 2 years <120/min
School age 2 8 years <110/min

PEFR Over 80% Approx. 60 80% <60% predicted or


personal best
(<100L/min in
adults)
Sa02 >95% 91-95% <90%
(under room
air)
INVESTIGATION
1. Chest X-ray - see lung abnormalities.
2. Blood tests ABG - effects of acidosis or
alkalosis.
3. ECG - affects heart rhythm abnormalities.
4. Skin sensitivity tests - the effects of allergies.
5. IgE blood test - the impact of increased IgE.
Management
1) Give privacy to patient
2) Comfort preferences
3) Chaperoned (assist doctor)

1) Giving Nebulizer Eg. Salbutamol, Atrovent, Combivent


2) Drug Administration Eg. T. Prednisolone, IV Hydrocotisone

PRINCIPLE OF 7R
) Right Medication
) Right Dose
) Right Pateint
) Right Route
) Right Patient
) Right Time
) Right Documentation
) Right To Refuse

3) Do Post PEFR (After Nebulizer)


4) Documentation
Monitor the patient continuously after nebulizer

If there are symptoms such as pallor, bradycardia /


tachycardia, sweating, hypotension, chest pain,
etc immediately inform the medical officer

Do assessment

1) Doing post PEFR and check vital sign before


discharge
2) Health education
Eg. The use of inhaler technique, how to prevent
asthma attacks, causation factors / causes of
recurrent attacks
3) Notification of the side effects to medications and
asthma attacks patients
4) Follow up(TCA) to patient
TREATMENT IN THE EMERGENCY DEPARTMENT
Initial PEF > 75% (Mild acute asthma)
Give nebulized bronchodilator or inhaled
bronchodilator eg. Salbutamol 2 puff prn
Observe for 60 minutes. If the patient is stable and
PEF is still >75%, discharge.
Before discharge:
review adequacy of usual treatment and step up if
necessary according to guidelines for treatment of
chronic persistent asthma
ensure patient has enough supply of medications
check inhaler technique and correct if faulty
advise patient to return immediately if asthma
worsens.
make sure patient has a clinic follow-up appointment
Initial PEF < 75% (Moderate asthma)
High concentration oxygen (>40%) in cases with
initial PEF <50% at presentation.
High doses of inhaled beta2 agonist (salbutamol
5mg or terbutaline 5mg or fenoterol 5mg) via
nebuliser driven by oxygen. If compressed air
nebuliser is used, administration of supplemental
oxygen when indicated should be continued.
Consider adding anticholinergic (e.g. ipratropium
bromide 0.5mg) to nebulised beta2 agonist for
patients with acute severe asthma.
Prednisolone tablets 30-60mg. Very ill patients
should be given intravenous hydrocortisone 200mg
stat.
If life threatening features are present:
High concentration oxygen (>40%)
salbutamol 5mg or terbutaline 5mg via nebuliser driven
by oxygen.
adding anticholinergic - ipratropium bromide 0.5mg.
If there is poor response to inhaled bronchodilators,
subcutaneous terbutaline or salbutamol 0.25-0.50 mg
IV hydrocortisone 200mg stat.
IV aminophylline 250mg slowly over 20 minutes or
intravenous terbutaline or salbutamol 250mcg over 10
minutes.(Bolus aminophylline should not be given to
patients already taking oral theophylline).
admission preferably to the intensive care unit (ICU) and
should be accompanied by a doctor.

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