Presentation on theme: "British Guideline on the Management of Asthma. Aims Review of current SIGN/BTS guidelines –Diagnosing Asthma –Stepwise management of Asthma –Managing."— Presentation transcript:
Pharmacological Management Aim for complete control –No daytime symptoms, no night time awakening, no need for rescue meds, no exacerbations, normal activity, normal lung function. Stepwise approach –Start at most appropriate step –Early control –Maintain by stepping up or down
Assessment –Clinical features –PEF –Pulse oximetry –Blood gases (ABG) –Chest X-ray Not routine –Suspected pneumothorax, consolidation, life threatening, failure to respond, requiring ventilation
Management of Acute Asthma Moderate –PEFR >50-75% –No severe features Severe –PEFR 33-50% –RR ≥ 25 (adult), >30 (>5yrs), >40 (2-5yrs) –HR ≥ 110 (adult), >125 (>5yrs), >140 (2-5yrs) –Unable to complete sentences or feed Life threatening –PEFR <33% –SpO2 <92% –Silent chest, cyanosis, exhaustion, altered consciousness
Management of Acute Asthma Oxygen –Hypoxic patients – aim 94-98% –Drive nebulisers with oxygen 2 agonist bronchodilators –As early as possible –Consider continuous nebulisers if poor initial response Oral steroids Ipratropium bromide IV magnesium sulphate –Poor response to 2 agonist or life threatening IV salbutamol/aminophylline - Paediatrics
Admission criteria - Adults Life threatening –Immediately Severe –If any features of severe attack after initial treatment
Admission criteria - Children Severe of life threatening –Immediately Moderate –No improvement after 10 puffs of 2 agonist
Conclusion Asthma is frequently under treated Use current guidelines to aid diagnosis and help in acute and chronic management If patients are not responding as you would expect –Is the diagnosis right? –Are they taking the appropriate medication? –Are psychological or social factors hindering management?