Bronchial Asthma

Introduction
Bronchial asthma is a chronic inflammatory disorder of the airways associated with
airway hyper responsiveness that leads to recurrent episodes of wheezing,
breathlessness, chest tightness and coughing particularly at night or tin the early
morning. These episodes are usually associated with widespread but variable airflow
obstruction that is often reversible either spontaneously or with treatment.
Management

Secure ABC
Sit the patient upright in bed
Oxygen: High flow > 10lts per minutes by mask
Intravenous access
Blood for investigations
Nebulisation (Salbutamol 1ml + Ipratropium 1ml + Normal saline 1 ml) repeat
3 times
Steroids: Hydrocortisone 200mg iv
Antibiotics should be given if there is evidence of infection

Management of bronchial asthma

1st Hour

2nd Hour

Oxygen Administration if Spo2 is less than 90% otherwise leave

on air.
Inhaled Salbutamol + Ipratropium one nebulisation every 15
minutes for one hour
Oral prednisone 40-60 mg (1-2 mg/kg/day in children)
In patients who cant tolerate oral meds, give IV hydrocortisone
200mg 6 hourly
Four more doses of inhaled salbutamol and ipratropium
Terbutalinesc 0.3-0.5mg (0.01mg/kg for child) (only if not able
to tolerate nebulizers or not responding to nebulizers)
IV Aminophylline 6mg/kg over 20-30 mins as loading dose (not
required if on deriphylline) and maintenance dose 0.4 to 0.7
mg/kg/hr (*to be used with caution)
IV Magnesium sulphate 2gm over 20 mins

Patient with signs of severity or life threatening sings should be admitted, others
can be discharged if they are stable.
Discharge Medication

Oral steroid 1-3 week

Inhaled corticosteroid at high ode 1000-1500gm

Inhaled long acting beta agonist (salmetrol)

Oral theophyllines if required

Admission criteria

Persistent respiratory distress

Patient without subjective improvement
Patients with continued wheeze and diminished air movement
Recent and multiple ED visit
Symptoms for more than 1 week
Pneumothorax
Pneumomediastinum
Pneumonia
Fatigue

Discharge criteria

Patient reports subjective improvement

Clear lungs with good air movement