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Acute Severe Bronchial Asthma

Emergency Management of Acute Severe Bronchial Asthma is discussed here. Hospital Admission, Discharge, and Outdoor treatment are described with medicine name.

Acute Severe Bronchial Asthma is a Life Threating condition for patients. Whenever A patient comes to you with complain you with Bronchial Asthma. First Look for it is Acute severe asthma or not.

Acute severe asthma criteria

PEF 33–50% predicted (< 200L/min)

Respiratory rate25 breaths/min

Heart rate110 beats/min

Inability to complete sentences in 1 breath

It is called immediate assessment of Acute severe asthma. Davidson Chart Box 19.25 defines that.

Life Threating Feature of Asthma

Differential Diagnosis of Acute severe asthma

  1. Congestive Heart Failure – Check for Lung basal crepitation
  2. COPD – Chronic Obstructive Pulmonary Disease
  3. Pulmonary Infection ( Eg: Strongyloidiasis, Aspergillosis)
  4. Pulmonary Embolism
  5. Foreign Body Aspiration
  6. Churg-Strauss Syndrome

Rx Treatment Of Acute severe asthma – Admission

  • Diet – Full
  • Bed rest in propped up position
  • O2 Inhalation 4L/Min
  • Nebulization with Windel Plus Soln. (2.5ml)

Each ampoule Windel Plus contains 2.5 ml isotonic, clear solution for inhalation of salbutamol sulfate BP equivalent to Salbutamol 2.5 mg and Ipratropium Bromide BP equivalent to Ipratropium 0.5 mg.

  • Tab. Doxophylline 400mg ( Incepta – Brezofil, Beacon-Doxoven, Doximar, Docopa, Square- Flindof)
    • 1+0+0
    • 1/2 + 0 + 1/2

Child: Children >12 years – 200 mg 2 or 3 times daily. (½ tablet b.i.d/ t.i.d)

  • Injection Hydrocortisone (2ml-10mg) (Cotson – Opsonin)
    • 1 Vial I/V Stat then 1 Vial I/V 6 Hourly

Discharge Rx of Acute severe asthma or Outdoor Treatment of Acute severe asthma

  • Antibiotic – (Quinolones) Tab. Levofloxacin (500mg) (Ovel, Trevox, Evo, Leo) 0+0+1 – 7 Days
  • Anti Ulcerant (Esomeprazole) Cap. Esoral, Tab. Esotid, Cap. Exium (20mg) 1+0+1 – 7 Days
  • Tab. Prednisolone 20mg (Precodil, Cortan) 1+0+0 (after meal) – 7 Days (0.5-1ml/Kg)
  • Tab. Doxophylline 400mg ( Incepta – Brezofil, Beacon-Doxoven, Doximar, Docopa, Square- Flindof)

1+0+0

1/2 + 0 + 1/2

 

Child: Children >12 years – 200 mg 2 or 3 times daily. (½ tablet b.i.d/ t.i.d)

  • Inhaler Beclomethasone dipropionate (Square-Beclomin, Beximco-Decomit) HFA 100,250 mcg
    • 2 Puff TDS (Gargle with water after use)
  • Inhaler Salbutamol (*GSK-Ventolin, Beximco-Azmasol, Asmalin) HFA 100mcg/puff
    • 2 Puff TDS 7 Days after that SOS

Or,

  • Inhaler Salmeterol + Fluticasone (50mcg + 250mcg) (Ticamet-Square, Bexitrol-F 50/250)
    • 2 Puff TDS (Gargle with water after use)
  • Dry Powder Inhalation Capsule (Windel ConviCap)
    • 2 Puff TDS 7 Days after that SOS

How to take Dry Powder Inhalation Capsule

  • Tab. Montelukast (10mg) (Monas – Acme, Odmon – Renata, Telukast – General)
    • 1+0+0 – Continue

If Child:

  • Syp. Levostar (1mg/5ml)
    • 1-2 TSF three times daily.
  • Tab. Montelukast (4mg) (Monas – Acme, Odmon – Renata, Telukast – General)
    • 1+0+0 – Continue

*GSK – GlaxoSmithKline Bangladesh Limited

If you want to add any drugs that will work better in asthma, feel free to discuss that in Comments Section.

Advice For Test

  1. CBC
  2. Chest X-Ray P/A View (100% Digital)
  3. ECG
  4. Arterial Blood Gas Analysis

About Dr. Toufiq Hassan

I am Dr. Toufiq Hassan Shawon, currently working as a medical officer at Trisal Upazilla Health Complex, Mymensingh. I have passed MBBS from Rajshahi Medical College in 2013 January, Batch - 49. My school was B.A.F. Shaheen College, Tejgaon, Dhaka, SSC-2005 and College was Notre Dame College, HSC-2007.

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