Home » Posts filed under Respiratory Medicine
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
Approaches of bronchial asthma treatment:
- Prevention of exposure to allergens
- Reduction of bronchial inflammation and hyper reactivity
- Dilatation of narrowed bronchi
Drugs used in Bronchial asthma
A. Bronchodilators:
1. Sympathomimetic drugs:
a. Selective β2 agonist.
Short acting (duration 4-6 hrs) –
- Salbutamol
- Terbutaline
- Metaproterenol
Long acting (duration 12 hrs or more) –
- Salmeterol
- Fenoterol
- Formeterol
- Rimeterol
- Bitolterol
b. Non selective (β1 & β2)
- Adrenaline
- Ephedrine
- Isoproterenol (Isoprenaline).
2. Methyl xanthene group:
Natural –
- Theophylline
- Theobromine
- Caffeine (also used in neonatal apnoea)
Synthetic –
- Aminophylline. (Na salt of Theiophylin)
3. Antimuscarinic bronchodilator:
B. Anti-inflammatory
1. Corticosteroids:
- Hydrocortisone. (Inj.)
- Prednisolone. (Oral)
- Beclomethasone
- Budesonide
- Triamcinolone
- Flunisolide
- Fluticasone
- Mometason
2 . Mast cell stabilizer:
- Nedocromil sodium
- Cromolyn sodium ( disodium chromoglycate) drugs
C. Others:
1. Leukotrine pathway inhibitor –
- Zileuton
- Zafirlukast
- Montelukast
2. Calcium channel blocker –
- Nifedipine
- Verapamil
- Amlodipine
3. Anti IgE monoclonal antibody:
4. Histamin (H1 ) receptor blocker:
Bronchial asthma:
Asthma may be defined as a disorder characterized by chronic airway inflammation and increase airway responsiveness resulting in
sign of wheeze, cough, chest tightness & dyspnoea.
Pathophysiology of bronchial asthma:
Occurs due to external stimulus, such agents are –
- Biological agents
- Environmental /chemical agent
- Virus
Immunopathogenesis of Bronchial Asthma:
- When a person exposed to antigen it stimulates production of antibody ( reaginic antibody – IgE) and bound to mast cell surface.
- When re-exposure to that antigen than antigen –antibody reaction occur and triggers release of some chemical mediators from stored granules of mast cell and also helps in the synthesis and release of other mediators.
Types of bronchial asthma:
There are various types of bronchial asthma.
1. Asthma associated with specific allergic reaction:
Criteria:
- Very early onset.
- Extrinsic type.
- Atopic individual.
Avoid of allergens – we prevent asthma. Here type I reaction occur involving IgE Antibody.
2. Asthma not associated with known allergy:
Criteria:
- Late onset.
- Intrinsic type.
- Non-atopic. (Not individual) occurs in a group.
3. Exercise induced asthma: Criteria: Within a few minutes asthma develops.
4. Asthma associated with chronic obstructive pulmonary disease.
- Chronic bronchitis
- Pulmonary emphysema
Asthma may also be classified into:
1. Intermittent
2. Persistent –
3. Acute
- Mild
- Moderate
- Severe ( Status asthmaticus)
4. Special variant –
- Seasonal
- Drug induced
- Exercise induced
- Cough variant and Pregnancy asthma
