Asthma

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Asthma

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Symp:

SOB (in)
cough (물 out)
wheeze (공기 out)
inability to speak (소리 out)


Tests:

PEFR
Sats
+- ABG / CXR


Criteria:

mild: PEFR > 70% - dyspnoea only with exertion
moderate: PEFR 40~70 % - dyspnoea limits daily activity
severe: < 40 % - interferes conversation

(peadiatric crteria
PEFR is the same.
mild: talks in sentences
moderate: talks in phrases
severe: talks in words/ can't talk
)

Sat < 90 %
-> at least severe to life threatening asthma

Rx:

Oxygen

Inhaled Short-acting Beta2 agonists
Oral corticosteroid
Inhaled Anticholinergic
Magnesium

{데이빗 "배컴"
BACOM - Beta agonist, Anticholinergic, Corticosteroid, Magnesium

AA - Adrenaline, Antibiotics (adjuntive therapies)
}

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--mild--

-Salbutamol 2.5 ~ 5 mg nebulized every 20 min X 3

-Oral corticosteroid - prednisone 40 ~ 80 mg / day X 7 days

(
Pead dose:
Oral corticosteroid - prednisone 1mg/kg/day (max 40mg) (IV dose is the same)
)


--moderate to severe--

-Ipratropium bromide 0.5 mg nebulized in combination with salbutamol as above (every 20 min X 3)

-MgSO4 - 2 g IV over 20 min


---Life threatening ---

-IV hydrocortisone mg IVI 8 hrs (can be switched to oral as soon as possible)


-adjunct -
epinephrine: 0.01 mg/kg IMI as a single dose, if  anaphylaxis suspected
antibiotics if infection suspected ( mycoplasma penumonia most common - erythromycin 50mg/kg/day in 4 divided doses)

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Asthma

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criteria:

mild:
-FEV1 >  80 %
-symptom <= 2 per wk
-night symptom <= 2 per month

(mem tip 2, 2)

moderate:
-FEV1 60~80 %
-symptom daily
-night symptom > 1 per wk

(mem tip 1, 1)

severe:
-FEV1 < 60 %



DX:

Low in both FEV1/FVC and FEV1.
( FEV1/FVC < 80 % predicted
  FEV1 < 80 % predicted )

FEV1 improves by 200 ml AND 12 % after bronchodilator.


Rx:

mild - short acting beta agnoist (e.g. salbutamol)

persistent mild - short acting beta agonist + corticosteroid inhaler

moderate - short acting beta agonist + corticosteroid inhaler + long acting beta agonist (e.g. salmeterol)

severe - short acting beta agonist + corticosteroid inhaler + long acting beta agonist (e.g. salmeterol) + oral corticosteroid