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Asthma in adult, any CNS sx like confusion aor altered mental or shock or…
Asthma in adult
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Step up of treatment
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Using of short acting as needed plus lowdose of corticosteroids inhaler .. we can use leukotriene 10 mg instead of low dose of corticosteroids if there are side effects
Using of short acting as needed plus low dose of corticosteroids plus long acting.. we can use medium dose of corticosteroids only
Using of short acting as needed plus medium to high dose of inhaler corticosteroids plus long acting plus leukotriene
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Investigations
We can't depend on physical examination and the medical history only but this recommended to do both of testing 1 2
Spirometry, if it is normal it doesn't mean that the patient is not having asthma because the asthma is intermittent so the patient should do PEFM metre two times daily for one week
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stepping down
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any inhaled steriod plus LABA there are two options 50% then to low ---------------------- or stop LABA only
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doses of drugs
montelukast 10 mg
budesonide low 200-400
moderate 400-800
high 800-1600
steroids two times daily
salbutamole as needed 2 puffs
LABA salmetrol 50 micro twice daily
Nebulized Salbutamol 2.5 to 5 mg every 20 minutes x 3 doses
Nebulized Ipratropium Bromide0.5mg every 20 minutes x 3 doses, then 0.5mg every 6 hours
Corticosteroids
IV Hydrocortisone 100mg immediately and then every 6 hours
Magnesium Sulphate
Single dose of 1.2 to 2 grams as IV infusion over 20 minutes
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Not all patients having wheezes are s having asthma because wheezes are found in COPD pulmonary fibrosis emphysema or obstructive diseases stridor or foreign body inhalation drugs as BB OR ACEIS and so on
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You should talk about
number of symptoms
and nocturnal symptoms
and exacerbations and
Effects on lifestyle
percentage of PEFM
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