Hospital Based Care of Asthma

Management of Asthma Attacks :

Hospital-Based Care

Initial Assessment:

History, Physical examination (auscultation, use of accessory muscles, heart rate, respiratory rate) and Investigations (PEF or FEV1, Oxygen saturation SaO2, arterial blood gas analysis and other tests)

Initial Treatment:

• Inhaled short-acting b2-agonist, usually by nebulization, one dose every 20 minutes for 1 hour
• Oxygen to achieve O2 saturation >90% (95% in children)
• Systemic corticosteroids
• Sedation is contraindicated in the treatment of attacks. PFT, PEFR, SaO2 and other tests as needed

Repeat Assessment:

PET,PERF,SaO2 and other tests as needed

Moderate episode

Severe episode

 On assessment

• PEFR 50-80% predicted/personal best

• Physical exam: moderate symptoms, accessory muscle use

 On assessment

• PEFR - < 50% of predicted value/personal best

• Physical exam: severe symptoms at rest, chest retraction

• High-risk patient

• No improvement after initial treatment

Treatment

• Inhaled b2-agonist every 60 minutes

• Consider corticosteroids

• Continue treatment 1-3 hours, provided there is improvement

Treatment

• Inhaled b2-agonist, hourly or continuous + inhaled anticholinergic

• Oxygen - 40% (5 Lit/min)

• Systemic corticosteroid

• Consider subcutaneous, intramuscular, or intravenous b2-agonist

Good Response Incomplete Response Poor Response

  Response within 1-2 Hours Within 1 hour

On assessment • Response sustained 60 minutes after last treatment • Physical exam: normal • PEFR >70% • No distress • O2 saturation >90% (95% children)   On assessment • High risk patient • Physical exam: mild to moderate symptoms • PEFR >50% but • O2 saturation not improving     On assessment • High risk patient • Physical exam: symptoms severe, drowsiness, confusion • PEFR <50% • PCO2 >45 mm of Hg • PO2 <60 mm of Hg • O2 saturation <90%  

Discharge Home • Continue treatment with inhaled β2 agonist • Consider , in most cases, corticosteroid tablets or syrup. • Patient education: Take medicine correctly. •Review action plan. • Close medical follow-up   Admit to hospital • Inhaled β2 agonist ± inhaled anticholenergic • Systemic cortic- steroid • Oxygen • Consider intravenous Aminophylline. • Monitor PERF,O2 saturation,pule    Admit to ICU   • Inhaled b2-agonist + anticholinergic      • Inhaled corticosteroid •Consider sub-cutaneous,  intra-muscular, or intra-venous b2-agonists  • Oxygen  • Consider intravenous aminophylline • Possible intubation and mechanical ventilation  

See Also:

Home Management of Asthma

Step Care Management of Asthma

Emergency Management of Asthma

Concomitant Disease management of Asthma

Pitfalls of Asthma Management