cpg for asthma
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CPG-03
-
CPG - 03
1/11
PCT
CPG - 03
2/11
o Cardiogenic Conditions : - Congestive Heart Failure, MI
o Pulmonary Conditions : - Pulmonary edema, Foreign
Body, Pneumothorax, Hemothorax, Pleural Effusion,
Pulmonary Tuberculosis, Pneumonia
o : GERD, Anaphylaxis
o
Asthma Bronchiectasis COPD (Emphysema +
Chronic Bronchitis)
(Asthma)
Rhinitis, Conjunctivitis
Dermatitis
-
CPG - 03
3/11
- ----
Wheezing
Chest X-ray : - normal
- Bronchodilator test :- PEFR >
- -
COPD )
Emphysema
Chronic Bronchitis
---
Lungs :- Ronchi, Crepitation
Wheezing
- Decreased Breath sound
- Barrel chest
- Chest X-ray
CPG - 03
4/11
-
Emphysema : - AP
diameter
-
-
-
Chronic Bronchitis :- Peribronchial
thickening
(Bronchiectasis)
-
Chronic Bronchitis
-
Lungs :- Ronchi,
Crepitation, Wheezing
:
-- - - -
CPG - 03
5/11
Chest X-ray :- Peribronchial Thickening
Chronic Bronchitis Lower
lobe
- Honeycomb appearance
1.
2.
3.
1. ER, Admit)
2.
3.
4.
5.
1.
1)
2)
3)
4)
2.
CPG - 03
6/11
3.
1)
2) Care Plan
4.
Asthma
Controllers Relievers
1. Controllers
Persistent
Inhaled Corticosteroids (ICS)
1.1 Corticosteroids
Inflammation
mucous
- action ß2-against
CPG - 03
7/11
--
Hypersensitivity
Side effect Steroids
adrenal
gland Bone mass
- -
-
Long - acting ß2- agonist
Salmeterol Fluticasone ( ICS )
Seretide 2 25/50 25/125
Corticosteroids
Inflammation
- ICS
ICS
-
Xanthine Sustained release (Thophylline SR)
Inflammation
2. Relievers
CPG - 03
8/11
--
2.1 Short-acting ß2- agonist Salbutamol
Inhaler, NB
hypokalemia
- Pregnancy
2.2 Anticholinergic drug + ß2 - agonist Berodual
Inhaler NB Ipratropium bromide
Fenoterol
- -
Hypokalemia
- Prostate hyperplasia
- Narrow angle glaucoma
- Pregnancy Lactation
<12
2.3 Methylxanthine (Aminophylline)
acute
severe asthma Status asthmaticus ß2-agonist
- --
CPG - 03
9/11
Budesonide
MDI
200 mg/puff 200-1600 mg /
Prednisolone 5 mg 5-60 mg /
0.1-2 mg/kg /
Dexamethasone 4 mg/Amp 5 mg
Hydrocortisone 100 mg/vial 1-2 mg/kg
6
0.5-1 mg/kg
6
Berodual Forte
(4cc)
Ipratropium 500
mcg Fenoterol
125 mcg
1-4
Berodual
Inhaler
Ipratropium 200
mcg
Fenoterol 500
mcg
1-8 Puff /
Salbutamol
Inhaler
Salbutamol 100
mcg/puff
1-2 Puff 4-
6
CPG - 03
10/11
Salbutamol NB Salbutamol
0.5
> 12 0.5-1
cc 4-6 < 12
> 20 0.5 cc
4-6
< 12 < 20 0.25
cc 4-6
Salbutamol 2 mg/ 1
2 mg/ 1
Dose -
< 2 0.1-0.2 mg/kg
2-6 0.1-0.2 mg/kg
Max 12mg/day 6-12
2 mg. Max
24mg/day > 12
2-4 mg. Max
32mg/day
>70 2 mg.
Max mg/day
Seretide Salmeterol 25
mg
Fluticasone
50 125 mg
1-4 Puff /day
CPG - 03
11/11
Aminophylline 250 mg/ 10 ml 4 mg./kg/dose
8 (
mg)
1.
Asthma, COPD PEF
Bronchodilator Bronchodilator
PEFR
2.
PEFR
PEFR – PEFR
____________________ x 100
PEFR
Chest X-ray
CPG - 03
12/11
Asthma , COPD
Bronchiectasis
2.
Intermittent Persistent
1. ≥ 1
2. ≥ 2
3. PEFR < 80 %
- Persistent
ICS ( step 2 )
- Intermittent
Reliever as needed
Easy Asthma Clinic
Step
1.
2.
CPG - 03
13/11
3.
4.
5.
Step
ß2- agonist as needed
2. ICS (low dose)
3. ICS (low dose) +
LABA
4. ICS (low dose) +
LABA + Xanthine
5. ICS (medium dose)
+LABA + Xanthine
6. ICS (high dose)
+LABA + Xanthine
Step
Salbutamol Inhaler prn
Budesonide 1 2 Puff / day
Budesonide 1 x 2 + Seretide (25/50)
1 2 P / day
Seretide (25/50) 2 x 2
Seretide (25/50) 2 x 2 +
Theophylline
Seretide (25/125) 2 x 2 +
Theophylline
Budesonide 1 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
Budesonide 2 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
Budesonide 3 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
CPG - 03
14/11
7. ICS (high dose)
+LABA + Xanthine +
Prednisolone
Budesonide 3 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
+Prednisolone dose
Steroid Step
Budesonide 1x1
1.1. Intubation
- Unstable vital signs
- Respiratory Rate > 35 /min
-
-
- Respiratory failure
- Hypoxia = Cyanosis, Air hunger
- O2 Sat < 95
- Cardiac or Respiratory arrest
CPG - 03
15/11
-
- Secretion obstruction
ß2 agonist NB ê O2 6 /min O2
Sat
-
Dexamethasone mg stat Prednisolone
6 Tb stat
- IV Fluid
- Lab CXR, CBC, U/A
1.2 Severity
> 5
-
RR < 30
RR 30-40
RR > 40
≤ 5 RR < 40
RR 40-60
RR > 60
CPG - 03
16/11
Retraction
Retraction 1
Retraction > 1
Wheezing
Expiratory wheezing
Inspiratory Expiratory
4.
O2 Sat ≥ 95
-
Scores
Total Score ≥8
- Salbutamol NB Stat
- Dexamethasone 8 mg v Stat
CPG - 03
17/11
- Admit Refer
2. Total Score 4-7
Dexamethasone 8 mg v Stat-
Salbutamol NB
Severity Score
o Severity Score < 4 D/C
o Severity Score > 4
o Severity Score > 4
Admit
Total Score < 4
-
Prednisolone 6 tab stat
Salbutamol NB Severity Score
< 4 D/C
--
Prednisolone 2x3
Antibiotics,
Antihistamine
-
CPG - 03
18/11
--
≥ 8 ≤ 7
Bronchodilator
NB Stat
Dexamethasone
8 mg v stat
Bronchodilator
Asthma Severity
Score
CPG - 03
19/11
ADMIT REFER
≥4
<4
Discharge
with F/U
Bronchodilat
or 2
≥4
≥ 4
<4
< 4
Discharge
with F/U
Bronchodilat
or 3
≥4 <4
4
Discharge
with F/U
Admit
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20/11
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