Evidence based Management of acute severe asthma
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- 1. Dr Rakesh Kumar Asst. Professor Dept. Of Paediatrics
N.M.C.H, Patna Evidence based management of Acute Exacerbation of
Asthma in children aged 0-18 years
- 2. Introduction Asthma is a disease of the respiratory tract
characterized by recurrent and/or chronic episodes of airway
inflammation and obstruction (manifested by wheeze or cough, or
demonstrated upon pulmonary function testing) and evidence of
reversibility of obstruction.
- 3. Epidemiology Prevalence of asthma in children continues to
show an increasing trend with reported rates between 8.5% and 8.9%
(akinbami 2009, kamble 2009) Asthma is most prevalent in children 5
to 14 years Among children younger than 18 years of age, asthma is
more prevalent in males. ( akinbami 2009, moorman 2007)
- 4. Initial history & Physical examination Time of onset of
current exacerbation. Current medications and allergies. Recent
frequent use of beta2-agonists. Risk factors for predicting severe,
uncontrolled disease are : ED visits, admissions to the hospital
and ICU, and prior intubations. exposure to asthma triggers.
- 5. Whenever a child present to ED with acute exacerbation of
asthma we try to classify him into mild, moderate & severe
exacerbation according to -Symptoms -Signs -Functional
assessment
- 6. Asthma exacerbation severity (Symptoms) mild moderate severe
Imminent resp arrest Breathlessnes s While walking Can lie down @
rest (difficulty feed) Prefer sitting @ rest Sits upright Talks in
sentence phrases words Cant talk Alertness normal agitated agitated
Drowsy or confused
- 7. Asthma exacerbation severity (Signs) mild moderate severe
Imminent resp arrest Resp. Rate (according to age) N or Increase
Increased Increased Often > 30 Normal or decreased Acessory
muscle use Usually not commonly usually Paradoxical thoracoabd mov
Wheeze Moderate, end exp Loud, throughout exh Loud or absent
Minimal or absent Pulse rate (@ presentation) < 100 100-120 >
120 bradycardia Pulsus Paradoxus Absent ,= 70% 40-69%