Asthma Management and References - Medications,Investigations,Other Drugs

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ASTHMA IN CHILDREN

Dr C.T.Deshmukh
Professor of Pediatrics, K.E.M Hospital

Asthma Management and References

Continued...

Medications

Inhaled β 2-agonist by nebulization either 1/2 hr to 1 hourly or continuous (continuous nebulization 0.1 to 0.3 mg/kg/hr to max 10-15mg/hr).

Corticosteroids are the most important drugs in treating asthma

Can be given oral if patient can take PO steroid without emesis

Intravenous methylprednisolone 1-2mg/kg/dose q6hrs, then depending on clinical course should be continued orally.

Inhaled therapy may be as effective as IV in acute therapy.

Anticholinergics: ipratropium bromide can be used and has additive effect to β-agonists. Can be given as 250mcg (1cc) nebulization every 3 - 4 hourly.

Aminophylline drip may be useful by increasing diaphragm contractility, increasing mucociliary clearance, anti-inflammatory properties and bronchodilatation, so it may be of some added benefit in patients with poor response to β-agonist.

Others routes of β 2 agonist

Subcutaneous epinephrine or terbutaline may also be given as an alternative. This route is selected if no other route is available/acceptable.

Salbutamol intravenous may be tried if minimal effect with inhalation therapy.

Intravenous continuous infusion (terbutaline, isoproterenol, albuterol) can be used when no improvement with inhaled bronchodilators. Terbutaline - bolus 10mcg/kg over 30 min, infuse with 0.1mcg/kg/
min. Needs close monitoring of heart rate, cardiogram and oximeter

Other Drugs:

Antibiotics - no role for routine use. May use if there is evidence of
infection(sputum predominantly PMNs , sinus infection, pneumonia, suspicion of Mycoplasma or Chlamydia).

Magnesium SO4 - Used as bronchodilator. The mechanism is not clear, but may be due to inhibition of Ca++ mediated smooth muscle contraction or direct inhibition of smooth muscle contraction. There are no controlled studies in children and has been tried IV in the dose of 30-70 mg/kg over 20-30 min. (max=2g).

Blood gases: Hypoxemia in asthma is because of either V/P mismatch or respiratory failure and only pulse oximetry will not be able to differentiate the two, blood gases are important at this stage. Blood gases should be asked for when:

O2 saturation is less than 94% on room air and patient is dyspneic.

Or if O2 saturation < 90% regardless of signs or symptoms.

Other investigations may be needed:

WBC - demarginated PMNs due to stress, steroids and infection.

Electrolytes - i. hypokalemia due to β agonist
ii. bicarbonate low due to metabolic acidosis

Xray chest to look for complications.

Next : Asthma Management and Refrences(Contd.)

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