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<table class="wikitable">
<table class="wikitable">
<tr class="v-firstrow"><th>Clinical course</th><th>Stable</th></tr>
<tr class="v-firstrow"><th>Drug</th><th>Adult dosage</th></tr>
<tr><td>Physical examination</td><td> No evidence of heart failure</td></tr>
<th>Inhaled Short Acting β Agonists (SABA)</th>
<tr><td>Functional class</td><td> I/II</td></tr>
<tr><td>6MWD</td><td> Greater than 400 m</td></tr>
<tr><td>Echocardiogram</td><td>RV size normal</td></tr>


<tr><td>Albuterol/Bitolterol/Pirbuterol <br> a) Nebulizer solution <br> b) MDI</td><td> <br> ♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously. <br> ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. </td></tr>
<tr><td>Levalbuterol <br> a) Nebulizer solution <br> b) MDI </td><td> <br> ♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed. <br> ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. </td></tr>
<th>Anticholinergics</th>
<tr><td>Ipratropium bromide <br> a) Nebulizer solution <br> b) MDI <br> </td><td><br> ♦ 0.5 mg every 20 mins for 3 doses, then as needed. <br> ♦ 8 puffs every 20 mins as needed for upto 3 hours.</td></tr>
<tr><td>Ipratropium with albuterol <br> a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol) <br> b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol) </td><td> <br> ♦ 3 ml every 20 mins for 3 doses, then as needed. <br> ♦ 8 puffs every 20 mins as needed for 3 hours</td></tr>
<tr><td>Hemodynamics</td><td>RAP normal <br> CI normal</td></tr>
<tr><td>Hemodynamics</td><td>RAP normal <br> CI normal</td></tr>



Revision as of 17:22, 14 January 2014

DrugAdult dosage
Inhaled Short Acting β Agonists (SABA)
Albuterol/Bitolterol/Pirbuterol
a) Nebulizer solution
b) MDI

♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously.
♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Levalbuterol
a) Nebulizer solution
b) MDI

♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed.
♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Anticholinergics
Ipratropium bromide
a) Nebulizer solution
b) MDI

♦ 0.5 mg every 20 mins for 3 doses, then as needed.
♦ 8 puffs every 20 mins as needed for upto 3 hours.
Ipratropium with albuterol
a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol)
b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol)

♦ 3 ml every 20 mins for 3 doses, then as needed.
♦ 8 puffs every 20 mins as needed for 3 hours
HemodynamicsRAP normal
CI normal
BNPNear normal or stable
TreatmentOral therapy
Frequency of evaluation Q 3 to Q 6 months
FC assessment Every clinic visit
6MWT Every clinic visit
Echocardiogram2Q 12 months/center dependent
BNPcenter dependent
RHCClinical deterioration and center dependent


Clinical courseUnstable
Physical examination Signs of heart failure
Functional class IV
6MWD Less than 400 m
EchocardiogramRV Enlargement
HemodynamicsRAP high
CI low
BNPElevated/Increasing
TreatmentIntravenous prostacyclin and/or combination treatment
Frequency of evaluation Q 1 to Q 3 months
FC assessment Every clinic visit
6MWT Every clinic visit
Echocardiogram2Q 6 to Q 12 months/center dependent
BNPcenter dependent
RHCQ 6 to Q 12 months or clinical deterioration