Asthma Latest Guidelines

Asthma
BTS-revised 2014
GINA- 2014

Definition
• Heterogenous disease (variable respiratory symptoms, characterised by chronic airway inflammation
• Defined by history of wheeze, cough, SOB and chest tighntness
• Variable expiratory airflow limitation (GINA)
• Recurrent symptoms of wheeze, SOB, Cough, chest tightness
• Variable airflow obstruction (BTS)

Assess Severity Of Asthma (BTS)
• Moderate asthma Increasing symptoms
• PEF >50–75% best or predicted
• No features of acute severe asthma
• Acute severe asthma
• -- PEF 33–50% best or predicted
• -- respiratory rate ≥25/min
• -- heart rate ≥110/min
• -- inability to complete sentences in one breath

Life-threatening asthma (BTS)
• Any one of the following in a patient with severe asthma:
• Altered conscious level, exhaustion
• Arrhythmia, Hypotension
• Cyanosis, Silent chest, Poor respiratory effort
• PEF <33% best or predicted
• PaO2 < 8 kPa
• ’normal’ PaCO2 (4.6–6.0 kPa)
• SpO2 < 92%

GINA- Mild to moderate
• Talk in sentences/phrases
• Can lie down/ sit
• Not agitated
• RR increased
• HR 100-120
• SPO2 90-95%
• PEFR 50-75

Treatment of mild to moderate
• Short acting B2 agonist
• Ipratropium bromide
• Controlled O2 to maintain SPO2 95%
• Oral corticosteroids
• Measure lung function after 1 hour- PEFR 60-80%, symptoms improved. • consider discharge

GINA- Severe
• Drowsiness, confusion, silent chest
• Talk in words
• Sits hunched forward
• Agitated
• RR>30
• PR>120
• O2 <90%
• PEFR<50%

Treatment of severe Asthma (GINA)
• Short acting B2 agonist
• Ipratropium Bromide
• O2
• IV Corticosteroids
• IV magnesium
• Consult ICU
• Prepare intubation

Salbutamol
• Most cost effective by MDI with spacer (BTS)
• Continuous neb may be more effective (BTS)
• No evidence of routine IV use (reserve for pts when inhaled therapy cannot be used reliably)

Steroids
• Should be given within 1 hour
• No difference btw oral or IV

Ipratropium Bromide (0.5mg 4-6 hourly) • Not necessary in mild attack (BTS)
• Anticholinergic