Management of status asthmaticus and Chronic Asthma

Treatment of  Status asthmaticus

Propped up position.

Oxygen inhalation by mask

Injection Hydrocortisone 200-500mg I/V routes 6 hourly Or Sodium succinate.

Nebulizer – over 5 minute repeated in 15 minutes.

Injection adrenaline subcutaneously 0.5mg (1000 dilution) 1:1000ml.

Ipratropium bromide ( 0.5mg should be added in nebulizer)

Injection Aminophylline ( 5 mg/kg intravenously very slowly)

If improved this condition then oral prednisolone 30.-60mg daily with inhaler sulbutamol.

Antibiotics if necessary.

No sedative of any kind.

Chest X-ray to exclude pneumothorax

Treatment on discharge:

• Complete the course of antibiotic
• Short course of oral prednisolone
• Inhaled beta agonist + inhaled steroid 

Treatment plan of chronic asthma

It is also called step care management of Asthma.
Step – I : Occasional use  of inhaled short acting β2 agonist bronchodilator ( once daily)
Step – II: Regular inhaled anti-inflammatory agent ( Chromolin or low dose leukotrien antagonist)
Step – III: Regular inhaled corticosteroid + regular long acting inhaled β2 agonist
Step – IV: High dose of inhaled steroid & regular bronchodilator
Step – V: Best of step + oral prednisolone

Bronchodilators administered by inhalation\

• Salbutamol
• Sulmeterol
• Formeterol
• Albuterol
• Isoproterenol
• Metaproterenol
• Terbutaline
• Ipratropium bromide
• Dexamethasone
• Beclomethasone
• Budesonide
• Flunisolide
• Di – sodium chromoglycate
• Fluticasone
• Triamcinolone