A condition in which a person’s airways become inflamed, narrow and swell and produce extra mucus, which makes it difficult to breathe.Asthma can be minor or it can interfere with daily activities. In some cases, it may lead to a life-threatening attack.

Essentials of Diagnosis:-


• Recurrent attacks of dyspnoea, cough with mucoid tenacious sputum and wheezing.
• Expiratory rhonchi all over chest.
• Symptoms promptly reversible with bronchodilators.
• X-ray chest—normal in early cases. Emphysematous
changes with pneumothorax in late cases.

Investigation:-

-BLOOD TEST -CBC ,ESR ,CRP

-CXR

-CT CHEST PLAIN 

-ECG

-BRONCHSCOPY

-ABG

Treatment:-

Acute attack:-
-Get out of bed.
-Take extra puff of aerosol inhaler.
-Take some hot tea or beverage or sips of warm water.
-Injection of Adrenaline 0.5 ml subcutaneously.
-If aerosol is ineffective, prolonged repeated attacks at night causes immobilisation then start course of Prednisolone 5 mg tablet, 2 tablets tds. Then reduce dose gradually.
-Asthaline inhalation—Take deep breath for 5-10 seconds. Two puffs to be inhaled at the interval of 5 minutes. Alternative is Terbutaline inhalation.
If no relief—hospitalise


Severe acute asthma:-

Diagnostic features are: -Lack of response to normal medication.
-Inability to talk or complete a sentence.
-Increasing tachycardia and respiratory rate. -Pulsus paradoxus.
-Hypotension.

-Silent chest.

-Cynosis.

Increasing distress and exhaustion.

-Hospitalise

-Arterial blood gas estimation.
-X-ray chest to rule out pneumothorax.
-Oxygen at high flow rate 6-8 litre per minute by nasal prongs or mask.
-Injection Aminophylline 250 mg IV or 6 mg/kg IV slowly over 30 minutes followed by 0.6 mg/kg/hr.
-Injection Hydrocortisone 5 mg/kg IV six hourly.
Double dose if no improvement in 8 hours.
-Nebulisation by Salbutamol or Terbutaline 2.5 mg,2-4 hourly.If improvement is seen, reduce nebulisation to 6 hourly.
If no response
-Injection Salbutamol 200 mg/IM or 100 mg IV. or
-Injection Terbutaline 0.25-0.5 mg SC or IV over 10 minute followed by maintenance dose of 12.5 mg/ minute.
-Antibiotics if evidence of infection-fever, purulent sputum.
After attack subsides
-Tab Tedral SA or Asthalin SA twice a day. or
Tablet Terbutaline 2.5-5 mg tds.

-Phensedyl linctus 1 tsf hs.

Chronic asthma:-


-Avoid known allergens.
-Stop smoking.
-Drugs.
Preventives—Beclate inhalation, metered dose inhaler 50 mg per metered dose, 2 inhalations 3-4 times daily.
or
Rotacaps 200 mg inhaled in rotahaler 3-4 times daily.
or
Oral Prednisolone or Betamethasone at minimum effective dose.
-Sodium Cromoglycate inhalation by metered dose inhaler 2 puffs 4 times daily.
-Ketofen 1 mg tab, 1-2 tablets with food. Relievers Salbutamol 2-4 mg bd

or

Theophylline SR 200 mg bd Exercise induced asthma.Inhalations of Salbutamol.

or


Terbutaline prior to exercise or Sodium chromo- glycate inhalation.

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