Management Bronchial Asthma

Procedure Of Bronchial Asthma
Non-pharmacotherapy

• Provision of O2
• Fluid
• Postural Drainage
• Avoiding exposure to allergens
• Guidance on patients and families about asthma, causes, and how to overcome them.
• Avoid the trigger factors (diet, medication, living habits, allergens)
• Immunotherapy / desentisisasi
• Physiotherapy breath, vibration and / or thoracic percussion, an efficient cough.

Pharmacotherapy:
1. Bronchodilators:

- Adrenaline; solution of adrenaline 1: 1000 subcutaneous

0.3 cc waiting for 15 minutes, if it has not subsided again given
0.3 cc if it has not abated, can be repeated once again 15 minutes later
0.3 cc.
For children can be given smaller doses: 0.1 to 0.2 cc.
Caution in elderly patients (coronair heart disease), hypertension, hyperthyroidism.

-  Beta 2 agonists (oral, injection, inhalation / MDI, nebulizer)

Orsiprenalin (alupent) 3 x 20 mg orally; subcutan 3 x 0.25 mg; 3 x 3 spray inhalation.
Bricasma subcutan 3 x 0.5 cc.
Heksoprenalin (Ipradol) 3 x 0.50 mg orally.
Salbutamol 2 mg orally 3 times.

- Methylxanthine (oral, suppository, injection):

a. Aminophyllin, given intravenously slowly 5-10 minutes, give 5-10 cc.
b. Aminophyllin can be granted if after 2 hours by administration of adrenaline did not give results.
c. Aminophyllin drip / iv 3 x 250 mg, drip: loading dose 5 mg / kg, followed by drops of 0.9 mg / kg / hour, or 20 mg / kg BB/24 hours.
d. Oral Aminophyllin 3 x 120-150 mg.

- Anticholinergics

a. 3 x 0.25 mg atropine subcutaneously
b. Ipatroprium bromid 3 x 2 puffs metered dose aerosol.

2. Anti-inflammatory:

- Corticosteroids (oral, injection, aerosol form of metered-dose inhaler / MDI):
- Intravenous dexamethasone 3 x 1 ampoule

3 x oral prednisone 50-10 mg, once achieved dose effects lowered slowly

- cromolyn (sodium cromoglycate), nedocromil and others.

3. Antihistamines:
- CTM 3 x 2-4 mg.

4. Antibiotics are given if there is an infection:
-  4 x 250 mg Amoxicillin
-  4 x 250 mg Tetracycline
-  Cotrimoksazole 2 x 2 tablets
-  Erythromycin  3 x 250 mg

5. Expectorant - mucolytic:

- Ordinary drinking water (diluent secretions)
- Glyceril guaiacolat (expectorans)
- Potassium Jodide (expectorans)
- N-Acetyl-cysteine ​​(secretolytic)

6. Immunotherapy:
Accomplished by repeated subcutaneous injection, allergen extracts with increasing concentrations, in patients with allergic asthma due to high levels of IgE.

How to use inhalers (MDI) is right:

1. MDI opened the lid, shake 3-4 times
2. Place in front of the mouth is open wide (4 cm) or a "spacer" that is inserted in the mouth.
3. Perform up to a maximum expiratory then push the MDI, while spraying the medicine, do inspire slowly for 5 seconds or more.
4. When it reaches a maximum inspiration, hold breath for 10 seconds.
5. Then breath usual 3-5 minutes. Further repeated measures a. when needed.
6. We recommend that you rinse after using the inhaler.

Reference :

1. Brashear RE. Chronic Obstructive Lung Disease. Clinical Treatment and Management. Mosby Co, St Louis, 1982, pp. 4 – 17.
2. Baum GL. Textbook of Pulmonary disease. 3 rd ed. Little Brown Co. Boston, 1983. pp. 405 – 407.
3. Harrison’s Principles of Internal Medicine. 10 th ed. McGraw Hill, Tokyo, pp. 1512 – 1519.
4. Kay AB. Asthma : Clinical Pharmacology and therapeutic Progress. 1 st ed. Blackwell Scientific Publ. London, 1986, pp. 28 – 282.
5. Sluiter HJ. Leerboek Longziekten. Van Gorcum, Assen, 1985, pp. 191 – 224.

Special Treatment of Bronchial Asthma

Tags : Management of asthma , management of asthma bronchial , procedure of asthma,  asthma bronchial  Procedure,