ASTHMA DEFINITION OF ASTHMA 1 CHRONIC AIRWAY INFLAMMATORY

4 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND BRONCHIAL ASTHMA
AN UPDATE ON EMERGING DRUGS FOR ASTHMA GARRY M
ASTHMA DEFINITION OF ASTHMA 1 CHRONIC AIRWAY INFLAMMATORY

ASTHMA BRONCHIALE DEF KRONISK LIDELSE MED FORSNÆVRING AF LUFTVEJENE
ASTHMA INHALER ADMINISTRATION AUTHORIZATION FORM STUDENT’S NAME DOB SCHOOLGRADE
DOCUMENTO ONLINETABLA 4 FIABILIDAD TESTRETEST DEL CUESTIONARIO NEWCASTLE ASTHMA

Criteria for Hospitalization

Asthma


Definition of Asthma:

1. Chronic airway inflammatory disorder

2. Recurrent episodes of wheezing, chest tightness, shortness of breath, and coughing at night or in the early morning

3. Reversible airway limitation



Diagnosis of Asthma[5]

1. History:: cough worse at night, recurrent wheezing/chest tightness

recurrent difficult breathing

2. Symptoms occur or worsen at night, awakening the patient

3. Physical examination: wheezing, silent chest when severe asthma

4. Lung function test ( FEV1 and PEFR )

- PEFR increases > 15% after inhalation of short-acting β2 –agonists 15~20 mins

- PEFR varies > 20% from morning to 12 hours later

- PEFR decreases > 15% after 6 mins of exercise

5. Risk factors:

- Allergic IgE-mediated diseases, allergic rhinitis, atopic dermatitis, and eczema

- Familial members with asthma

- exacerbation associated with weather change, foods, drugs



Classification of Asthma Severity [5]


Classification

Clinical Features Before Treatment

Days Symptoms

Night-time Symptoms

Lung Function Test

STEP 1:

Intermittent

< 1 times/week


< 2 times/month

-FEV1 or PEF > = 80% predicted

-PEF variability < 20%


STEP 2:

Mild persistent

> 1 times /week, but

< 1/day


> 2 /month

-FEV1 or PEF > = 80% predicted

-PEF variability 20-30%


STEP 3:

Moderate persistent

Daily symptoms

> 1 /week

-FEV1 or PEF in 60%~80% predicted

-PEF variability > 30%


STEP 4:

Severe persistent

Continual symptoms

Frequent

-FEV1 or PEF < 60% predicted

-PEF variability > 30%





Stepwise Approach for Managing Asthma in Adult [5]

Quick Relief

All Patients

- Short-acting bronchodilator with inhaled β2 -agonists as needed for symptoms.

- Intensity of treatment will depend on severity of exacerbation.

- Use of bronchodilator > 1/week over a 3 months period in intermittent asthma may indicate the need to step-up therapy

Classification

Daily Control Medicines

Other Treatment Options

STEP 1:

Intermittent

- No daily medication


STEP 2:

Mild persistent

- Anti-inflammatory: inhaled corticosteroid (low doses)

- Sustained-release theophylline to serum concentration of 5-15 μg/mL

- Cromone or

- Leukotriene modifier

STEP 3:

Moderate persistent

- Low~mideum-dose of inhaled corticosteroid + long-acting inhaled β2 –agonist


- Medium-dose of inhaled corticosteroid + sustained-release theophylline, or

- Medium-dose of inhaled corticosteroid + long-acting oral β2 –agonist, or

- High-dose inhaled corticosteroid, or

- Medium-dose of inhaled corticosteroid

+ leukotriene modifier

STEP 4:

Severe persistent

- Inhaled corticosteroid (high dose) + long-acting inhaled β2 –agonist + if needed:

sustained-release theophylline

leukotriene modifier

long-acting inhaled β2 –agonist

oral glucocorticosteroid


* Step down: Review treatment every 1 to 6 months. If control is sustained for at least 3 months, a gradual stepwise reduction in treatment may be possible.

* Step up: If control is not achieved, consider step up. Inadequate control is indicated by increased use of short-acting β2-agonists and in:

- step 1 when patient uses a short-acting β2-agonist more than two times a week;

- steps 2 and 3 when patient uses short-acting β2-agonist on a daily basis OR more than three to four times a day.

- But before stepping up: review patient inhaler technique, compliance, and environmental control (avoidance of allergens or other precipitant factors).





Criteria for Hospitalization [1-2]

1.Any symptoms of asthma with a FEV1 or peak-expiratory flow rate (PEFR) < 50% of predicted value

2.PaCO2

3.Prolonged attack of asthma of > 24 hours duration

4.Age > 40 years

5.Poor response after 4 hours of bronchodilator therapy

6.Recent or multiple emergency department or hospitalizations for treatment of asthma that occurred within the last year

7.History of ET intubation for asthma

8.Poor access to medical follow-up

9.Psychiatric conditions that are interfering with medical compliance


The initially quick assessment of ASTHMA in admission [2,5]

Examination finding

Level of Severity

Mild

Moderate

Severe

Conscious State


Normal

Normal

Altered

Speaking Ability


Sentences

Phrases

Words

Respiratory rate (b/min)

<20

20 – 30

>30

ABGs:

PaO2

PaCO2

SaO2



Normal

< 45 mmHg

> 95%


> 60 mmHg

< 45 mmHg

91 – 95%


< 60 mmHg, cyanosis

> 45 mmHg

<90%

Air Entry


Good

Moderate Poor

may have

silent chest


Recommendations regarding initial treatment of an acute episode [2]

1. Oxygen therapy at a minimum of 6 L/min via face mask to achieve SaO2 > 95%. (Grade B)

2. Administration of high-dose inhaled bronchodilator (salbutamol 5mg via nebuliser, q15 minutes up to a maximum of 20mg). (Grade A)

3. Corticosteroids should be given within 1 hour of presentation. (Grade A)

4. Antibiotics are not required unless there is radiological evidence of pneumonia or proven or suspected bacterial bronchitis. (Grade B)


Quick Reference Guide - In Hospital Management of Asthma [2]ASTHMA  DEFINITION OF ASTHMA 1 CHRONIC AIRWAY INFLAMMATORY References:

  1. Status asthmaticus and hospital management of asthma, Spagnolo SV - Immunol Allergy Clin North Am - Aug; 21(3); 503-533, 2001

  2. Guidelines for the Hospital Management of Acute Asthma, Evidence Based Guidelines in Royal Melbourne Hospital, Review date: October 2000

  3. Acute Asthma in Adults-A Review, CHEST 125:1081–1102, 2004

  4. BTS/SIGN. British guideline on the management of asthma. Thorax; 58 (Supple I ):i1–94. 2003

  5. Global Initiative for Asthma: Guideline for Asthma Management and Prevention - updated November, 2003.

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EMERGENCY ASTHMA GUIDELINE MANAGEMENT OF THE ACUTE ADULT ASTHMA
FETAL AND INFANT GROWTH AND ASTHMA SYMPTOMS IN PRESCHOOL
INVITATION TO APPLY FOR CHAIR OF ASTHMA UK’S RESEARCH


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