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Medspresso #Episode 51: Asthma

Dr Swapnil Pawar June 21, 2022 17


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    Medspresso #Episode 51: Asthma
    Dr Swapnil Pawar

Asthma

Written by Dr Andrew Lam

 

Classification of Asthma Severity

Mild/Moderate Severe Life Threatening
O2 Saturations >94% 90-94% <90%
Auscultation Wheeze May be similar to mild/moderate Silent chest
Speech Can finish a sentence Phrases Single words
Respiratory Distress Minimal Some use of accessory muscles Severe respiratory effort
Level of Consciousness Alert May be similar to mild/moderate Drowsy

 

Acute Management of Asthma 

Mild/Moderate

PRN Salbutamol (4-12 puffs) as required

 

Severe/Life Threatening

  • Salbutamol 5mg Nebulised (or 12 puffs) q20mins

PLUS

  • Ipratroprium 500mcg Nebulised (or 8 puffs) q20 mins

Continue this for the first hour. If therapy ineffective:

  • 10 mmol MgSO4 infused over 20 minutes

 

And consider further salvage therapy:

  • IV Adrenaline infusion
  • IV Ketamine infusion
  • IV Aminophylline

 

Also give Hydrocortisone 100mg QID IV for prevention of secondary reaction and bronchospasm

Prevention of Asthma

Prevention of asthma flares occurs in a step-wise approach:

 

Step 1 – PRN SABA

Step 2 – Low dose ICS + PRN SABA

Step 3 – Low dose ICS + LABA + PRN SABA

Step 4 – Medium dose ICS + LABA + PRN SABA. Alternatively low dose ICS + LABA + LAMA

 

Past this, referral to a respiratory physician is often warranted.

SABA – short acting beta agonist, ICS – inhaled corticosteroid, LABA – Long acting beta agonist, LAMA – Long acting muscarinic antagonist

 

 

 

 

 

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