热闹考研背后冷了做学问.ppt

Treatment of Asthma Exacerbations 6 Aminophylline and Theophylline Controversial: Added no benefit to inhaled beta agonists Increased complications Loading dose for aminophylline: 5 – 6 mg/kg over 20 - 30 min Maintenance dose: 0.4 mg/kg/hr (adjust for heart and liver disease) Try to achieve 5 - 15 μg/ml, monitor plasma levels to adjust dose Doses for theophylline similar but slightly less Treatment of Asthma Exacerbations 7 Leukotriene Modifiers Few studies Suggest usefulness in reducing hospitalizations Montelukast, 10 mg orally Zafirlukast, 20 mg orally Treatment of Asthma Exacerbations 8 Magnesium Sulfate Controversial: Inconsistent data Used in very severe asthma in emergency settings: FEV1 25% predicted Other signs of severe disease 1.2 - 2 gm IV over 10 - 20 min in 50 ml saline Minor side effects Preventing Exacerbations 1Oral Corticosteroids Oral corticosteroids are the most powerful medications available to reduce airway inflammation Use until attack completely abated: PEFR and FEV1 at baseline levels Symptoms gone Taper to QOD and determine if patient can remain well if corticosteroids are withdrawn completely Preventing Exacerbations 2 Inhaled Corticosteroids Place patient on high dose inhaled corticosteroids Fluticasone, 880 - 1760 μg Budesonide, 800 - 1600 μg Once oral corticosteroids are withdrawn, reduce the inhaled dose incrementally, while maintaining PEFR at personal best level Consider combination of long acting β2-agonist and inhaled corticosteroid in order to achieve the lowest dose of corticosteroid possible Preventing Exacerbations 3Underlying Causes and Patient Education Evaluate patient for: Allergy Infection Compliance Inappropriate concomitant medications Social factors Tobacco, drugs, irritants, fumes Psychiatric disorders Patient education ? www.anafylaxis.nl World Allergy Organization (WAO) For more information on the World Allergy Organization (WAO), please visit or contact the: WAO Secretariat 555 East Wells Street, Su