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HEALTH TIPS: Clinical Insights On Asthmatic Case

Asthmatic Case
HEALTH TIPS: Clinical Insights On Asthmatic Case
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Clinical Insights On Asthmatic Case: Asthma attack is a substantial worsening of asthma symptoms. The severity and duration of attacks are variable and unpredictable.

Assessment of the severity of asthma attack

The severity of the asthma attack must be rapidly evaluated by the following clinical criteria. Not all signs are necessarily present.

Assessment of severity in children under 2 years and adults

Professional Way Of It’s Treatment

Treatment and follow-up depend on the severity of the attack and the patient’s response:

Mild to moderate attack

Reassure the patient; place him in a 1/2 sitting position.

Administer:
• salbutamol (aerosol): 2 to 4 puffs every 20 to 30 minutes, up to 10 puffs if necessary during the first hour. In children, use a spacer1to ease administration (use face mask in children under 3 years). Single puffs should be given one at a time, let the child breathe 4 to 5 times from the spacer before repeating the procedure.
• prednisolone PO: one dose of 1 to 2 mg/kg

If the attack is completely resolved: observe the patient for 1 hour (4 hours if he lives far from the health centre) then give outpatient treatment: salbutamol for 24 to 48 hours (2 to 4 puffs every 4 to 6 hours depending on clinical evolution) and prednisolone PO (1 to 2 mg/kg once daily) to complete 3 days of treatment.

If the attack is only partially resolved: continue with 2 to 4 puffs of salbutamol every 3 to 4 hours if the attack is mild; 6 puffs every 1 to 2 hours if the attack is moderate, until symptoms subside, then when the attack is completely resolved, proceed as above.

If symptoms worsen or do not improve, treat as severe attack.

Severe attack

Hospitalise the patient; place him in a 1/2 sitting position.

Administer:
• oxygen continuously, at least 5 litres/minute or maintain the O2 saturation between 94 and 98%.
• salbutamol (aerosol): 2 to 4 puffs every 20 to 30 minutes, up to 10 puffs if necessary in children under 5 years, up to 20 puffs in children over 5 years and adults. Use a spacer to increase effectiveness, irrespective of age.
or salbutamol (solution for nebulisation), see Life-threatening attack.
• prednisolone PO: one dose of 1 to 2 mg/kg
In the case of vomiting, use hydrocortisone IV every 6 hours (children: 5 mg/kg/injection, adults: 100 mg/injection) until the patient can tolerate oral prednisolone.

If the attack is completely resolved, observe the patient for at least 4 hours. Continue the treatment with salbutamol for 24 to 48 hours (2 to 4 puffs every 4 hours) and prednisolone PO (1 to 2 mg/kg once daily) to complete 3 days of treatment.
Reassess after 10 days: consider long-term treatment if the asthma attacks have been occurring for several months. If the patient is already receiving long-term treatment, reassess the severity of the asthma (see table) and review compliance and correct use of medication and adjust treatment if necessary.

If symptoms worsen or do not Continue Reading


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