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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
Step | Description | Details of management |
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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. |