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

Similar of Hospital Based Care of Asthma

Asthma Control Plan

Name of Patient ........................................ Prepared by Dr. ......................................... This plan will help a patient control his

Misconception about Asthma

There are some common concerns about Asthma prevailing in the society. In majority of cases, these are misconceptions or baseless fears. For optimum control of

Emergency Management of Asthma

What is emergency management of asthma? Emergency management is the management plan for acute exacerbation of asthma. Severe acute asthma should always be

Investigation of Asthma

Why we investigate asthma patients? For classification and assessment of severity For diagnosis of concomitant illness For exclusion of other causes of

Home Management of Asthma

Why management at home ? Since asthma is a chronic disease, it can be and should be managed at home up to a certain level. If home management plan is applied

Rules You Should Follow While Taking Medicine

USE MEDICINES WISELY About 30% to 50% of those who use medicines do not use them as directed. This causes more doctor visits, hospital stays, lost wages and

Use of Peak Flow Meter

A peak flow meter is a device that measures how well air moves out of a patient's lungs. During an asthma episode, the airways of the lungs begin to narrow

Topics:

• Disease and Treatment