Acute_asthma presentation slides for education

acute asthma

1. Acute asthma KINGSLEY ELORM DZIKUNU & NII ACQUAYE ADOTEY

2. OUTLINE INTRODUCTION EPIDEMIOLOGY RISK FACTORS AND TRIGGERS PATHOPHYSIOLOGY DIAGNOSIS CURRENT TRENDS IN MANAGEMENT ROLE OF THE PHARMACIST REFERENCES

3. introduction Asthma is a chronic inflammation disease of the airways characterized by shortness of breath, wheezing, chest tightness and cough. Bronchoconstriction associated with asthma is reversible after treatment with a Bronchodilator. Usually described as heterogenous in nature.

4. introduction Acute asthma is the progressive worsening of the asthma symptoms including breathlessness, wheezing, cough, and chest tightness. It is usually marked by the reduction is the baseline measures of pulmonary function, such as the peak expiratory flow rate and FEV1.

5. epidemiology According to estimates by WHO, 235 million people suffer from asthma as of 2016. As at the end of 2017, about 300 million people were reported to be suffering from asthma. (GINA 2017 Report). Over 80% of asthma deaths occur in middle and low income countries Prevalence is high in the affluent (hygiene hypothesis with peak years of 3 to 9years though it can occur at any age.

6. epidemiology According to the latest WHO data published in 2018, Asthma Deaths in Ghana reached 1,317 and accounted for 0.66% of total deaths. The age adjusted Death Rate is 10.12 per 100,000 of population with Ghana being ranked as the 53 rd leading country with asthma death worldwide.

7. Aetiology/Risk factors Family history (of Asthma or Atopy) Allergens e.g. house dust, animal dander, cockroach droppings, grass, pollen, etc. Environmental factors e.g. air pollution, climatic changes, strong scents and smoke (including cigarette smoke and car fumes) Viral infections Exercise Emotions and hyperventilation Drugs e.g. NSAIDS and beta-blockers such as propranolol Occupational exposure to industrial chemicals, dust and other allergens

8. pathophysiology

9. Investigation & diagnosis FBC (high eosinophilia count) Chest x-ray (complications) Spirometry (decreased FEV1) Stool examination ( to exclude helminthiasis )

10. ASTHMA EXACERBATIONS/ACUTE ASTHMA These are asthmatic episodes characterized by progressive increase symptoms of shortness of breath, cough, wheezing and chest tightness with progressive decrease in lung function

11. Classifications of acute asthma

12. Current trends in managements

13. Treatment goal To relieve airflow obstruction Prevent future relapses Treat underlying inflammation or infection Prevent complications.

14. Standard treatment guideline, 2017 ACUTE MODERATE TO SEVERE EXACERBATION OF ASTHMA: INITIAL MANAGEMENT IN HOSPITAL OXYGEN BY Nasal prongs ; 2-6 L/min OR Face mask ; 4-8 L/min OR Non- rebreather mask ; 10-15 L/min AND 2. Nebulize Salbutamol 2.5 – 5mg repeated initially after 15 to 30 mins then, every 2-4 hours until improves. AND 3. IPRATROPIUM BROMIDE nebulized 500mcg 4-6 hourly 4. HYDROCORTISONE IV , 200mg Stat. then 100mg q6-8 hours THEN MAINTENANCE TREATMENT 1. Nebulised Salbutamol 2.5 -5mg every 6 hours until improved 2. Nebulised IPRATROPIUM BROMIDE 500mcg 4-6 hourly 3. Prednisolone PO , 30-40mg mane x7/7

15. Standard treatment guideline, 2017 MAINTENANCE TREATMENT IN HOSPITAL WHERE PATIENT IS STILL IN DISTRESS ASTER 3-4 INITIAL DOSES OF NEBULIZED SALBUTAMOL. AMINOPHYLINE 250mg slow injection over 20mins , repeat after 30 mins with a continuous inf by prefursor at a rate not 0.5mg/kg/hour over 24hour. OR AMINOPHYLINE IV infusion, 250mg in 500ml of 5% Dextrose or 0.9% Sodium Chloride 6 hourly for 24 hour.

16. Standard treatment guideline, 2017 Acute Moderate/Severe Exacerbation of Asthma 1st Line Treatment Oxygen by nasal prongs (2-6L/min), Face mask (4-8L/min) or Non-rebreather mask 10-15 L/min) And Salbutamol, nebulised Adults: 2.5-5 mg repeated initially after 15-30 minutes, then every 2-4 hours until improved Children: 2.5-5 mg every 2-4 hours until improved

17. Standard treatment guideline, 2017 And Ipratropium bromide, nebulized, Adults: 500 microgram 4-6 hourly Children (Max dose: 1mg/24hrs) 6-12yrs: 250 mcg 1-5yrs: 125 mcg And IV Hydrocortisone Adults: 200mg stat then 100mg 6hourly until clinical improvement Children (Max dose: 1mg/24hrs) 12-18yrs: 100mg 6-8hrly 1month -12yrs: 2-4mg/kg 6-8hrly

18. Standard treatment guideline, 2017 And Prednisolone, oral, Adults: 30-40 mg daily for 7 days Taper off dose over a period of 2 weeks if patient has been on long term steroids. Children: 1-2 mg/kg for 3-5 days

19. where patient is still distressed after 3-4 initial doses of nebulized salbutamol Aminophylline, IV, Adults: 250 mg slow injection over 20 minutes Repeat after 30 minutes with a continuous infusion by perfusor (rate not exceeding 0.5 mg/kg/hour over 24 hours). Or 250 mg in 500 ml of 5% Dextrose or N/S, 6 hourly for 24 hours Children: 5 mg/kg over 20 minutes as a slow infusion or by perfusor at 1mg/kg/hour (max. 500 mg)

20. Magnesium Sulphate: 1.2 -2g. Giving intravenously slowly over 20minutes

21. Non pharmacological management Avoid triggers Seize smoking Physical exercise

22. Role of the pharmacist Ensure that all essential medications are available in their right quantities and doses Educate the patient on the his or her condition Educate the patient on the inhaler technique Collaborate with other health care professional to write an asthma action plan for each patient. Reassess patient’s knowledge on the inhaler technique at every review date

23. refernces Oxford emergency medicine handbook Standard treatment guideline, 2017, ministry of health British national formulary, 80th edition GINA Guidelines Update Report 2021