Guidelines for treatment of asthma | medical energency condition Features | Acute management of COPD  | MBBS SIMPLIFIED HANDWRITTEN TO TEXT NOTES |

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Guidelines for treatment of asthma

 1.mild episode asthma- step 1
 2.seasonal astma-step 2 
3.mild chronic asthma with occasional exacerbations -step 2
 4.moderate asthma with frequent excerbations -step 3 
5.severe asthma -step 4,5
  • Step1- inhaled short acting b2 agonist 
  • Step 2- low dose glucocorticoids or sodium chromoglyacate +inhaled long acting b2 agonist 
  • Step 3- add leukotrine antagonist 
  • Step 4- inhaled high dose glucocorticoid+ipratropium bromide 
  • Step 5-add oral prednisolone +omalizumab

Status asthmaticus 

-medical energency condition Features

 - chest pain,cynosis,bradycardia, hypotension,pulsus paradoxus Management 
- correct dehydration
 -O2 adminstration
 -nebulise salbutamol and ipratropium bromide
 -oral glucocorticoides
 -if poor response is seen after one hour then following treatmanets are required •hospitalized the patient 
•marked ventilation 
•correct dehydration 5%glucose in saline.
•corect acidosis-sodium bicarbonate 
•repeat nebulization 3omin
 •iv hydrocortisone 200-300mg every 4 to 6 min or methylprednisolone 30-40 mg iv slowly •if improved switch to oral 40 to 50 mg prednisolone single dose
 •antibiotics for chest infection
 •chest xray


Acute management of COPD 

  • Oxygen therapy 
  • nebulized bronchodilator (Salbutamol 5mg/4hr and ipratropium 500 mg /6 hr) 
  • steriods Iv hydrocortisone 200mg and oral prednisolne 40 mg 
  • antibiotics use for infection i.e amoxycillin 500 mg per 8 hourly 
  • if no response repet nebulizer and iv aminophyllin 
  • if no response to above treatment then start ppv by nasal mask and flow generator if RR is greater than 30 
  • intubation and ventilation 
  • respiratory stimulants drug doxapram 3 to 4 mg per min iv 
  • see confusion,tachycardia,nausa, may not b suitable for mechanical ventilation

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