Medical note on Step therapy of asthma and status asthmatics., Slides of Medicine

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STEP THERAPY OF ASTHMA &

STATUS ASTHMATICUS

INTRODUCTION

 What is Asthma?

Chronic inflammatory disorder due to hyper

responsiveness of tracheobronchial smooth muscle

resulting in

 narrowing of air tubes

 ↑sed secretion

 mucosal edema

 mucous plugging.

STEP THERAPY

The goals of drug therapy to :

 relieve the symptoms of breathlessness

 prevent recurrent exacerbations

 minimize need for emergency hospitalizations

 Step wise approach is recommended

STEP 1

Inhaled SABA Mild Episodic Asthma

• Regular low dose ICS (100-500 μg/day)
• Episode Rx: Inhaled SABA

STEP 2 Mild Persistent Asthma

STEP 3

• Low dose ICS + Inhaled LABA
• Alternatively: :LT Antagonists

Moderate Asthma

STEP 4

**High dose ICS(800 - 2000 μg/day + Inhaled LABA

LT antagonists/ Oral Theophylline/Oral β2 agonists/ Inhaled Ipratropium**

Severe Asthma

STEP 5

 Not controlled with Step 4 approach  Requires frequent emergency care  Oral steroid therapy while continuing ICS + LABA

MANAGEMENT  Humidified O2 inhalation  Nebulisation : Salbutamol 2.5 mg + Ipratropium bromide 0.5 mg intermittent inhalation  Inj Hydrocortisone hemisuccinate 100mg I/V statum followed by 100mg 8 th hourly  Inj Salbutamol 0.4mg S/C maybe given - inhaled drug may not reach to smaller bronchi due to narrowing  IV fluids to correct dehydration  IV Sodium bi carbonate to correct acidosis  Antibiotics to treat the underlying respiratory infections

SUMMARY

 In asthma ,the airways narrow and swell producing extra mucus thereby producing breathing difficulty.  Classified into mild , moderate and severe.  Treatment is a step wise approach.  Severe condition of asthma – Status Asthmaticus  Caused by Acute RTI , drugs and infections.  Managed by drugs like Salbutamol , Ipratropium bromide etc.  Other drugs like : Antibiotics to treat RTI , Normal Saline for dehydration , IV sodium bicarbonate for acidosis and Potassium Supplements to correct hypokalemia