Asthma - Management.
British Thoracic Society guidelines: Check inhaler technique: address
any fears of the patient. Prescribe peak flow meter.
Step 1:try occasional ß agonist inhaler. If needed more daily add step 2.
Step 2: add inhaled beclomethasone or budesonide.
Step 3: increase inhaled steroid by a large volume spacer, ± theophylline
Step 4: add ipratropium ± salmeterol.
Step 5: check compliance; add regular prednisolone tabs.
Reference: History taking Asthma.
Pitfalls: failing to prescribe steroids soon enough.
Failing to notice severe morning dips in peak flow.
Always ask about nocturnal waking: it is a sign of dangerous asthma.
Not admitting those with moderate severe attacks to hospital.
Signs of severe asthma: wheeze prevents finishing sentences in 1 breath; > 25 breaths/min; pulse >110; peak flow less then 50% of predicted; pulsus paradoxus >10mmHg.
Life threatening signs: peak flow <33% of predicted; silent chest; coma; BP¯; pulse¯; PaO2 <8kPa;
PaCO2 raised; pH¯.
DD: Respiratory obstruction from inhaled foreign body; swollen epiglottis; mediastinal and neck lumps;
These usually cause inspiratory stridor, rather than expiratory wheeze.