Related Subjects:
Asthma
|Acute Severe Asthma
|Exacerbation of COPD
|Pulmonary Embolism
|Cardiogenic Pulmonary Oedema
|Pneumothorax
|Tension Pneumothorax
|Respiratory (Chest) infections Pneumonia
|Fat embolism
|Hyperventilation Syndrome
|ARDS
|Respiratory Failure
|Diabetic Ketoacidosis
Definition
Aetiology
Pathology
Precipitating factors
Clinical Classification
Clinical
Diagnosis:Clinical history compatible with asthma and
Investigations
Management
Standard escalation process
Step Description Details of management
Step 1 Mild intermittent Asthma Short acting beta agonist as required such as a Salbutamol [US Albuterol] inhaler. Teach inhaler technique.
Step 2 Regular preventer medication Add Inhaled corticosteroid 200-800 mcg/day - start at 400 mcg/day eg Beclametasone, Budesonide, Fluticasone. Advise to rinse mouth after to avoid oral candidal infection or hoarseness.
Step 3 Add on therapy Long acting beta2-agonist (LABA) e.g. Salmeterol and/or Increase inhaled steroid to 800 mcg/day if still not controlled. No response to LABA then stop it, continue steroid and consider SR Theophylline or Leukotriene receptor antagonist (Montelukast, Zafirlukast).
Step 4 Persistent poor control Increase inhaled steroid dose to 2000 mcg/day - Add Leukotriene receptor antagonist/ Oral beta2 agonist tablet/SR Theophylline
Step 5 Continuous or frequent oral steroid usage Increase inhaled steroid dose to 2000 mcg/day to minimise oral steroids. Consider other treatments - refer to specialist. Methotrexate has been used in severe Asthma.
Patient involvement and education is fundamental at all stages.
References
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Asthma - General Management
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