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MANAGEMENT OF ASTHMA
Dr. Theja Huruggamuwa
DEFINITION Intermittent lower-airway obstruction
that is reversible either spontaneously or as the result of treatment Inflammation and edemaBronchial smooth-muscle spasmMucous plugging
Asthma exacerbation:symptoms that require a change in medication from baselineStatus asthmaticus: increasingly severe asthma that is not responsive to drugs that are usually effective
DIAGNOSING ASTHMA
Medical History Symptoms
Coughing Wheezing Shortness of breath Chest tightness
Symptom Patterns Severity Family History
DIAGNOSING ASTHMA Troublesome cough, particularly at night Awakened by coughing Coughing or wheezing after physical
activity Breathing problems during particular
seasons Coughing, wheezing, or chest tightness
after allergen exposure Colds that last more than 10 days Relief when medication is used
DIAGNOSING ASTHMA Wheezing sounds during normal
breathing
Hyperexpansion of the thorax
Increased nasal secretions or nasal polyps
Atopic dermatitis, eczema, or other allergic skin conditions
DIAGNOSING ASTHMA:
SpirometryTest lung function when diagnosing asthma
MEDICATIONS TO TREAT ASTHMA
Medications come in several forms. Inhalations Oral drugs Parenteral drugs
Two major categories of
medications are:Long-term controlQuick relief
DRUGS USED IN ASTHMA
1. Broncho dilatorsI. Adrenoreceptor agonistII. AntimuscarinicIII. TheophillineIV. compound
2. Corticosteroids3. Cromoglicate4. Leukotrine receptor antagonist5. Anti histamine
Dosage forms of drugs • Aerosol solutions• Oral tablets, capsules• Parenteral preparations
I. ADRENORECEPTOR AGONIST (sympathomemitic)
Selective beta 2-agonists - Short Acting - Salbutamol - Terbutaline - Long Acting - Salmetarol - Formetarol
Non selective drenoreceptor agonist - Adrenaline - Ephedrine
II. ANTIMUSCARINIC - Ipratropium Bromide ( MDI, Nebulizer solution)
III. THEOPHILLINE - Theophilline (Oral) - Aminophilline (IV)
IV. COMPOUND PREPARATIONS - Ipratropium with salbutamol
2. CORTICOSTEROIDS -Betamethasone dipropinate -Budesonide -Fluticasone -Mometasone -Prednisolone -Hydrocortizone
3. CROMOGLICATE -Sodium cromoglicate -Nedocromil
4. LEUKOTRINE RECEPTOR ANTAGONIST -Montelukast
5. ANTI HISTAMINE Sedative - Promathazine - Chlorpheniramine Non Sedative - Cetrizine - Leocetrizine - Loratadine - Desloratadine - Fexafenadine - Ketotifen
MEDICATIONS TO TREAT ASTHMA:LONG-TERM CONTROL
Taken daily over a long period of time Used to reduce inflammation, relax airway
muscles, and improve symptoms and lung function Inhaled corticosteroids Long-acting beta2-agonistsLeukotriene receptor antogonist
MEDICATIONS TO TREAT ASTHMA: QUICK-RELIEF
Used in acute episodes
Generally short-acting beta2agonists
MANAGEMENT ACUTE ASTHMA Moderate acute asthma Severe acute asthma Life threatening acute asthma
Moderate acute asthmaWith Oxygen + Short Acting beta 2-agonists or 4-10 puffs with spacer device + Prednisolone
Severe acute asthmaHigh flow Oxygen + Short Acting beta 2-agonists or 4-10 puffs with spacer device + Prednisolone or IV Hydracortizone + Ipratropium + Aminophilline
Life threatening acute asthmaHigh flow Oxygen + Short Acting beta 2-agonists ( only nebulization) + IV Hydracortizone + Ipratropium nebulization + Aminophilline bolus and infusion + IV MgSO4
MANAGEMENT ASTHMA - CHILDHOOD
1. Occasionally bronchodilators – short acting beta 2 agonist
2. Regular preventer (corticosteroids) + short acting beta 2 agonist
3. Regular preventer(corticosteroids) + short acting beta 2 agonist + leukotrine (2yr-5yr )
<2yr should refer to pediatrician
MANAGEMENT ASTHMA - ADULT 1. Occasionally bronchodilators – short
acting beta 2 agonist2. Regular preventer(corticosteroids) +
short acting beta 2 agonist3. Regular preventer(corticosteroids) +
short acting beta 2 agonist + long acting beta 2 agonist +(one of )leukotrine or Theophilline or oral beta 2 agonist
4. Regular preventer(corticosteroids) + short acting beta 2 agonist+ long acting beta 2 agonist +(one of )leukotrine or Theophilline or oral beta 2 agonist
5. regular oral corticosteroids + no 4
MEDICATIONS TO TREAT ASTHMA:
How to Use a Inhaler…?The health-care provider should evaluate inhaler technique at each visit.
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative for Asthma Created and funded by NIH/NHLBI
1. Take off the cap and shake well2. Stand up or keep the thorax in straight position.3. Keep vertically, hold with thumb and middle or
index finger4. Keep with teeth and seal by lips (should be tightly
closed)5. Inhale through the mouth when breathing in the
medication, not the nose6. Take a slow, deep breath at the same time you press
down on the medication canister7. If using spacer device can exhale inside to device8. Hold the breath for 10sec and then breath out9. If need to use one more puff rest for 1-2 min10.If using corticosteroids should wash the mouth and
throat11.Determine when an inhaler is empty and replace
new inhaler
Technique of using MDI inhaler
1. Remove the cap. For single use devices, load a capsule into the device as directed.
2. Breathe out slowly and completely (not into the mouthpiece).
3. Place the mouthpiece between the front teeth and seal the lips around it.
4. Breathe in through the mouth quickly and deeply over 2-3 seconds.
5. Remove the inhaler from the mouth. Hold your breath for as long as possible (4 to 10 seconds).
6. Breathe out slowly.
How to use a DPIThe instructions for using a DPI depend upon the individual type and brand.
cleaning the mouthpiece 1. At least once per week2. Remove the medication canister and cap from the
mouthpiece. 3. Do not wash the canister or immerse it in water.4. Run warm tap water through the top and bottom of the
plastic mouthpiece for 30 to 60 seconds.5. Shake off excess water and allow the mouthpiece to dry
completely (overnight is recommended). Cleaning the spacer 6. powder particles can deposited in the chamber and should
be cleaned periodically (every 1- 2 weeks) 7. Wash the spacer with warm water and soap. Do not rub. 8. Shake off excess water and air-dry the spacer before the
next use. Cleaning the DPI 9. Most DPIs should NOT be washed with soap and water.10. The mouthpiece can be cleaned with a dry cloth.
Cleaning of inhaler and device
DRUG DELIVERY DEVICES TO TREAT ASTHMA:
Spacers can help patients who have difficulty with inhaler use
Inhalers and Spacers
Metered dose inhalers - MDI Dry powder inhalersDP haler
Inhalers
Mouth piece
Spacers devices
DRUG DELIVERY DEVICES TO TREAT ASTHMA: Machine produces a mist of
the medication
Used for small children or for severe asthma episodes
No evidence that it is more effective than an inhaler used with a spacer
Nebulizer
ASTHMA MANAGEMENT GOALS Achieve and maintain control of symptoms Maintain normal activity levels, including exercise Maintain pulmonary function as close to normal
levels as possible Prevent asthma exacerbations Avoid adverse effects from asthma medications Prevent asthma mortality
• Educate patients and families about all aspects of plan of management
• Recognizing symptoms• Medication benefits and side effects