Management of Bronchial asthma

Management of bronchial asthma BA can be very frustrating to induce an asthma attack by itself !

From what I understood learned and practiced,  there are two aspects of clinical situations you should be aware to handle ,

1-      During acute exacerbations :

During acute attacks, use first short acting B- agonist inhalers (salbutamol-albuterol), always are first line, then you have

Adrenaline and Isoproterenol,

Ipratropium bromide (anticollinergic): fewer cardiac side effects

Aminophylline : be cautious in using that drug! It has a narrow safety margin, and you may increase toxicity with the use of erythromycin, which is also commonly used during this situation!

Corticosteroids (I.V. shots) and inhalers: Always, always the best though leave it as your last resort! To be given 3 times daily for 2 weeks during and after the attack

2-      Long term control:

Long term control is required for only moderate or severe asthmatic, yet this carries you to know the concepts of a mild moderate and severe attacks!

I haven’t read practical guidelines for asthma managements yet though my knowledge solely dependent on what I learned from review books, your interaction would be valuable in this particular topic,

Mild asthma: attacks occur at a rate1-2 Nights/month – FEV more than 80%

Moderate: 5 Nights / month (isn’t so subjective?)>>> FEV between 60% and 80%

Severe: is more severe than moderate occasional , nearly every day , I don’t know if a first time severe BA attack which required ICU admission, would require follow up or aggressive treatment should start earlier

So in Mild cases: no need for long term therapy, only albuterol inhalers in acute exacerbations

In moderate you will need corticosteroids inhalers, and in the exam he may build up a question of a BA patient and his treatment just to ask you about side effects of corticosteroids!!!

In Severe Cases: I usually forget that: Back to B agonist yet use also a long acting one (salmeterol )you may also add antileukotrienes and mast cell stabilizers , consider desensitization treatment

important note I edited this post in particular because I forgot to mention important thing ,, treatment is always started with administartion of O2 through mask or Nasal line, SO2 should always be kept above 90%