Status asthmaticus medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Mainstay drugs for the management include '''nebulized [[Bronchodilator|β2-agonists]]''' such as [[albuterol]], [[salbutamol]] or [[terbutaline]], '''parenteral [[steroids]]''' such as [[hydrocortisone]] or [[prednisolone]] and '''[[Bronchodilator#Theophylline|theophylline]]''' | |||
*[[Bronchodilator#Anticholinergics|Anti-cholinergics]] such as '''[[ipratropium bromide]]''' may be indicated in patients who are unable to tolerate inhaled [[Bronchodilator|β2-agonists]]. | |||
*In patients non-responsive to nebulized [[bronchodilator]], '''IV-[[aminophylline]]''' or '''oral-[[Leukotriene antagonist|leukotriene inhibitor]]''' may be used.<ref name="pmid1934839">Press S, Lipkind RS (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1934839 A treatment protocol of the acute asthma patient in a pediatric emergency department.] ''Clin Pediatr (Phila)'' 30 (10):573-7. PMID: [http://pubmed.gov/1934839 1934839]</ref> | |||
===Therapy based on the severity of the disease assessed by [[Arterial Blood Gas Analysis]]=== | ===Therapy based on the severity of the disease assessed by [[Arterial Blood Gas Analysis]]=== | ||
====Stage 1==== | ====Stage 1==== | ||
Revision as of 16:23, 25 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Initial severity assessment is evaluated using arterial blood gas and pulmonary function test and aggressive therapy is initiated to prevent progression to respiratory failure
Medical Therapy
- Mainstay drugs for the management include nebulized β2-agonists such as albuterol, salbutamol or terbutaline, parenteral steroids such as hydrocortisone or prednisolone and theophylline
- Anti-cholinergics such as ipratropium bromide may be indicated in patients who are unable to tolerate inhaled β2-agonists.
- In patients non-responsive to nebulized bronchodilator, IV-aminophylline or oral-leukotriene inhibitor may be used.[1]
Therapy based on the severity of the disease assessed by Arterial Blood Gas Analysis
Stage 1
- Hyperventilation with normal PO2
- No hypoxemia
- Patients may benefit from nebulized ipratropium used adjunctive to β2-agonist therapy
Stage 2
- Hyperventilation with hypoxemia (low PO2 and PCO2)
- Patients may require corticosteroids in addition to bronchodilator therapy
Stage 3
- CO2 retention due to respiratory muscle fatigue
- Markedly elevated PCO2 levels are an indicator for mechanical ventilation
- Aggressive β2-agonist therapy along with parenteral steroids and/or theophylline is indicated
Stage 4
- Severe hypoxia with markedly elevated PCO2
- FEV1 lower than 20% predicted is suggestive of an impending respiratory arrest that may require intubation and mechanical ventilation
- Metered-dose inhalation of β2-agonist and anticholinergics are recommended. Administration of parenteral steroids and/or theophylline has also shown to be beneficial.
References
- ↑ Press S, Lipkind RS (1991) A treatment protocol of the acute asthma patient in a pediatric emergency department. Clin Pediatr (Phila) 30 (10):573-7. PMID: 1934839