🔗Refer Asthma First Aid & Prevention tips on Page 2‼️
ASTHMA
Mild intermittent
💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations when needed.
đź’Š Anticholinergics (e.g. Ipratropium, Tiotropium) inhalations when needed, alone or in addition to beta-2 agonists
đź’¬ Patient is asymptomatic between the dyspnoea episodes, so no daily medication required!
ASTHMA
Mild persistent
💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations ➕ Corticosteroid inhalation (low dose)
💊 Short acting β2-agonists ➕ Mast cell stabilizer or Leukotriene antagonist or Theophylline sustained release
đź’¬ Beta-2 agonist inhalation is needed every day, so once daily corticosteroid inhalation if given for asthma control.
ASTHMA
Moderate persistent
đź’Š Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations âž• Corticosteroid inhalation (low to high dose)
đź’Š Long acting beta-2 agonist tablets or Theophylline sustained release âž• Corticosteroid inhalation (medium dose)
đź’¬ The dose of corticosteroid inhalations depends on the severity of symptoms.
ASTHMA
Severe persistent
đź’Š Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations âž• Corticosteroid inhalation (high dose) âž• Corticosteroid tablets/syrup
đź’Š Long acting beta-2 agonist tablets or Theophylline sustained release âž• Corticosteroid inhalation (high dose) âž• Corticosteroid tablets/syrup
đź’¬ Systemic corticosteroids have significant adverse effects, so after adequate asthma control, are gradually withdrawn.*
ASTHMA
Acute severe asthma
đź’Š Oxygen 60% âž• Nebulized beta-2 agonists (e.g. Salbutamol) in high dose âž• Systemic corticosteroids
đź’¬ An emergency condition, earlier called as status asthmatics. Aminophylline is no longer recommended.
* After adequate control of severe persistent asthma, systemic corticosteroids are withdrawn, and the patient then would be managed as moderate persistent type. This is called "step down" approach of management. In this approach, it is considered better to manage patients assuming in the next higher type and then, after reviewing in 1-6 months, to step-down, instead of "step-up" after failure in asthma control.
Aspirin induced
asthma
đź’Š Leukotriene antagonists (e.g. Montelukast, Zafirlukast)
Exercise induced
asthma
For Prophylaxis: Mast cell stabilizers or beta-2 agonists or Leukotriene antagonistsđź’Š
COPD
- For smoking cessation: I line: Behaviour therapy; II line: Nicotine replacement therapy; III line: Antidepressants e.g. Bupropion
- For respiratory infections: Antibiotics
- For bronchodilatation: I line: Anticholinergics; II line: beta-2 agonists; III line: Theophyline
- For hypoxemia: I line: Ambulatory oxygen; II line: Long term oxygen therapy
Dry cough
đź’Š Cough suppressants (e.g. Dextromethorphan) + Treat the cause e.g. post nasal drip by antihistaminics and decongestants.
Productive cough
đź’Š Expectorants (e.g. Pot iodide) &/or Mucolytics (e.g. Acetylcysteine) âž• Treat the cause e.g. allergy by antihistaminics and bacterial infection by antibiotics
References: CLASSIFICATION OF DRUGS WITH DRUGS OF CHOICE 3RD EDITION BY VIKAS SETH
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