Anesthesia Patients With Asthma

Pre-operation / Pre-anesthesia Assessment
Anamnesis

History about whether patients had received previous anesthesia is very important to know if there are things that need special attention, for example: allergies, nausea, vomiting, itching or shortness of breath after the surgery, so that we can design the next anesthetic well.

Physical examination

State of dentition examination, action open mouth, the tongue is relatively large is very important to know whether the action would make it difficult laryngoscopy intubation. Another routine systemically check about the general course should not be missed such as inspection, palpation, percussion and auscultation of all organ systems of patients. Examination of inspection, palpation, percussion and auscultation on the cardiopulmonary system is a major clinical examination of much help in the assessment of asthma. With this examination can be known frequency of breathing, respiratory pattern, presence of wheezing / ronchi.

ECG examination

In addition to knowing about the state / heart disease, especially the picture ECG can also determine the influence of lung function.

Radiological examination

Includes images of the thorax and CT-scan (if necessary). This examination is not to assess lung function disorders but it is important for supporting the diagnosis of pulmonary disease, signs of lung hyperinflation and congestive heart disease, also to help determine abnormalities in the mediastinal cavity (CT-scan).

Laboratory examination

Include routine blood tests, blood gas analysis of blood sugar.

Pulmonary Physiology Tests

• Without tools: although simple but can provide information on respiratory function and are useful as an assessment of "fronss for operation" such as the ability to climb stairs without shortness of breath while talking. Snider match test: the ability to hold breath for 30 seconds.

• Using a spirometer.

Physical Status Classification

Classification is commonly used to assess a person's physical fitness is derived from The American Society of Anaesthesiologist (ASA). Physical classification is not a forecasting tool ratio of anesthesia, because the side effects of anesthesia can not be separated from the side effects of surgery.

• Class I   : Patients healthy organic, physiological, psychiatric, biochemistry.
• Class II  : Patients with mild or moderate systemic disease.
• Class III : Patients with severe systemic disease, so that routine activities are limited.
• Class IV : Patients with severe systemic disease can not perform routine activities and the disease is life threatening at any moment.
• Class V  : dying patient who is expected with or without surgery her life would not be more than 24 hours
• In Cito or emergency surgery is usually imprinted letter E.

Pre-Operative Preparation
Fasting
Laryngeal reflexes decreased during anesthesia. Regurgitation of gastric contents and impurities contained in the airway is a major risk in patients undergoing anesthesia. To minimize this risk, all patients scheduled for elective surgery should dipantangkan of oral input (fasting) during a certain period before induction of anesthesia.

Perioperative Management
For anesthesia and elective surgery in patients with a history of asthma, then asthma should be controlled and the patient was not suffering from an infection or severe wheezing attacks. If a patient takes medication on a regular basis, then the drug should not be stopped. Particular attention should be given pad of patients who use steroids, systemically or by inhaler.
Bronchospasme may be induced by anxiety, pain, drugs, endotracheal intubation, foreign body or irritation. Drugs that are contraindicated are: tubocurarrine and anticolinesterase, Sodium thiopental (Pentothal™), morphine, papaverin, trimethaphan and beta blockers.
Many drugs that can be used as a premedication such as diazepam, pethidine, promethazine and atropine, an estimated free from bronchospatic activity. Bronchodilator and steroid therapy is continued.

Anesthesia Techniques
Whenever possible, choose regional anesthesia with continuous epidural block with a low of 1% lidocaine (analgesia only) so that the respiratory muscles are not disrupted.
If general anesthesia is required then given premedication with antihistamines such as promethazine together with hydrocortisone 100 mg. What is important to avoid laryngoscopy and intubation with a shallow anesthesia, because it can cause bronchospasm. Ketamine is good enough for intravenous induction, because it is a bronchodilator. For a brief action, you should use a face mask after induction techniques and avoid intubation. Use of oxygen with a concentration of 30% or more for air inspiration. If intubation is required, then deepened with inhalation anesthesia, and then do the intubation without muscle relaxants. In the anesthetized patient in laryngoscopy can be done without causing bronchospasm when intubated. Vecuronium may be administered as a muscle relaxant is good because it does not release histamine. Ether and halothane is bronchodilator good, but ether has the advantage, that is if there is bronchospasm, epinephrine (0.5 mg subcutaneously) can be administered safely (but this is dangerous if given in conjunction with halothane or trichlorethylene, because it can cause heart rhythm disturbances due to effects of catecholamines). As an alternative to epinephrine, aminophylline 250 mg can be administered intravenously slowly to mature; drug is compatible with all inhaled medication.
At the end of the action when using intubation, extubation done on his side and with anesthesia in, because stimulation of the larynx can cause bronchospasm.

Post Operative Care
Provision of adequate analgesia postoperative care is vital. Adequate oxygenation. Maintenance intravenous fluids. Usually anti-asthma drugs are still needed. Form of steroid drugs given intravenously as a temporary substitute for oral medications and inhalers brochodilator nebulizer as a substitute if the patient can not breathe in, or not yet maximal lung function after surgery. In the event of failure of achieving adequate ventilation and oxygenation after surgery, the patient to go to Intensive Care Unit (ICU).

Tags : Anesthesia and Asthma, Anesthesia With Asthma, Ketamine and asthma,

Benefits and Risk of Asthma Drugs

Talk about the asthma medication, not separated from the wide selection of types of drugs available. Starting from the class of drugs, intended use, as well as dosage forms. Different classes of drugs will show different effects. Different effects will affect the intended use, whether the drugs used to prevent or to cope with current asthma relapse. While the dosage form influencing onset (time taken from drug to drug consumption have an effect) and the effectiveness of medications so usually adjust to the goals of treatment and the patient's condition. But keep in mind the drug in addition to having the benefit, of course not separated from the risk of side effects.
Class of steroids. Examples of drugs known as steroids include budesonide, dexamethasone and beclometason. First-line drugs in asthma therapy is commonly used for the purpose of preventing a recurrence of asthma. But can also to address the current state of asthma relapse. In preventive therapy that requires patients take medication regularly should use inhalation dosage form, or better known as the metered dose inhaler (MDI). The use of inhaled has a faster onset compared with the use of oral (taken drugs thus bypassing the gastrointestinal tract). Side effects can be minimized because the drug only works around the respiratory tract. Regarding the issue of children's growth disorders and the onset of osteoporosis due to steroid use over and over, there are no facts for asthma drugs used in inhalation dosage forms. In addition to the inhalation dosage form, still it was likely to receive the steroid drug in oral dosage forms. Side effects of drugs known as steroids, among others, increasing pressure and blood sugar levels, so the use of steroids in people with hypertension and diabetes mellitus (DM) needs special attention. These drugs also have effects as steroids imunosupressan that can lower immunity. So you should still maintain the condition and stamina during its use. While the use of steroids to pregnant and lactating women is safe as long as the drug is given on the recommendation of doctors. Even before giving birth is often performed intravenous injections of drugs known as steroids to prevent asthma relapse during childbirth. Noteworthy is the time patients receive preventative therapy that requires the use of steroids on a regular basis. During steroid therapy received from outside bodies / exogenous system resulting in endogenous (hormones) in the body does not produce steroids. Therefore, the use of steroids should not be stopped abruptly, and the dose should be lowered slowly to give time to the endogenous system to get back to work producing steroids.
To overcome the acute attack, the drug class of beta-agonists such as salbutamol to be first-line drugs that work as bronchodilators (relaxing the bronchi). These drugs were already widely available in the form of inhalation so that the work is more effective in treating acute attacks. In an emergency where the patient has severe breathing difficulties that are used in nebulizer drug delivery methods. Nebulizer is a method of curing such a drug given to patients so that drugs can enter the respiratory tract even in difficult breathing. Unfortunately not all health facilities have the tools nebulizer because it is relatively expensive. In addition to the use of short-acting, there are also beta-agonist class of drugs that works long-acting, such as salmeterol or formeterol, onset and duration of which has a longer effect than salbutamol. Usually for the prevention of recurrence of asthma therapy. Side effects of beta-agonist group is quite diverse as: tremors / trembling of the hands, headache, hypokalemia (potassium deficiency), and tachycardia (accelerated heartbeat). However, these side effects do not always happen every time the use of drugs. Side effects appear or not depending on the clinical condition of each individual. If the beta-agonist drugs used in excessive long-term and may decrease its effectiveness. This is because the occurrence of drug receptor desensitization, so that the receptors become less sensitive. Therefore need larger doses to obtain the same effect. For that doctors will consider the most appropriate dose for patients according to clinical circumstances.
Beta-agonist drug therapy is sometimes combined with anticholinergic drug classes to achieve a better effect. Same with beta agonists, anticholinergic drugs such as ipratropium bromide group working with bronchial relaxing. Commonly used to treat acute attacks. Side effects that arise include: dry mouth, drowsiness, and impaired vision. Primarily on the use of inhalation technique in which patients perform less precise spraying. In a moment the eye can become blurred. Therefore, patients should know the proper technique of using inhaled eg by asking your doctor or pharmacist. One more familiar drug in the treatment of asthma, namely theophylline. Theophylline drugs classified as 'old' in the sense already used for therapy for a long time. Theophylline has a range of therapeutic dose and toxic dose is narrow. It can be dangerous if patients take excessive doses. Theophylline poisoning symptoms include: insomnia, headache, nausea, and tachycardia. Therefore at this time of theophylline has a lot left in asthma therapy. But sometimes still used for example in an emergency, theophylline administered by injecting in the form of aminophylline. Use of theophylline is considered because the price is economical. Theophylline was still there as one of the active ingredients-the-counter asthma medication. In conclusion asthma medications are quite safe. Recommended for use inhalation, because the effect is more rapid, appropriate target because it directly into the respiratory tract, side effects were minimal when compared to oral use so it is quite safe. And the proper technique of using inhaled greatly affect the success of therapy

Tags: asthma treatment, asthma medications, asthma therapy, Nebulizer therapy, Beta-agonist drug therapy, Risk of Asthma Drugs, Benefits of Asthma Drugs

COPD (Chronic Obstructive Pulmonary Disease)

COPD(Chronic Obstructive Pulmonary Disease) is a broad classification of disorders that includes chronic bronchitis, bronchiectasis, emphysema and asthma, which is an irreversible condition associated with dyspnea on exertion and decreased air flow in and out of the lungs.
Chronic obstructive pulmonary disease is a disease that causes airway obstruction, including therein is asthma, chronic bronchitis and emphysema Pulmonum.
Chronic obstructive pulmonary disease is a lung disorder characterized by impaired lung function in the form of prolonged expiratory period caused by the narrowing of the airways and not much changed in the period of observation for some time.
Disease chronic obstructive lung is a term used for a group of lung diseases that last long and is characterized by increased resistance to air flow as the main pathophysiological picture.

Classification
Diseases included in chronic obstructive pulmonary disease group are as follows:
1. Chronic Bronchitis
Bronchitis is a clinical definition to cough almost every day accompanied by sputum expenditure, at the lack of 3 months in a year and occurred at least 2 consecutive years.
2. Pulmonary emphysema
Pulmonary emphysema is an anatomic definition, namely a change of anatomic lung characterized by abnormal widening of the distal bronchial airways terminalis, which is accompanied by alveolar wall destruction.
3. Asthma
Asthma is a disease characterized by hypersensitivity tracheobronchial branches of various types of stimuli. This condition manifests as narrowing the channels of periodic breathing due to bronchospasm and reversible.
4. Bronchiectasis
Bronchiectasis is a chronic dilatation of bronchi and bronchioles yan may be caused by various conditions, including pulmonary infections and bronchial obstruction, foreign body aspiration, vomit, or the objects of the upper respiratory tract, and the pressure of the tumor, which dilates blood vessels and lymph node enlargement.

Etiology
The etiology of this disease is unknown. The disease is associated with the risk factors contained in people include:
1. Cigarette smoking is a long
2. Air Pollution
3. Peru recurrent infections
4. Age
5. Gender
6. Race
7. Alpha-1 antitrypsin deficiency
8. Deficiency of anti-oxidants
The effect of each risk factor for COPD is the occurrence of mutually reinforcing factors and smoking are considered the most dominant.

Pathophysiology
Lung function decline with the advent of old age are caused by elasticity of lung tissue and chest wall dwindle. In a more advanced age, the strength of respiratory muscle contraction can be reduced making it difficult to breathe.
Lung function to determine a person's oxygen consumption, ie the amount of oxygen bound by blood in the lungs to the body uses. Oxygen consumption is closely related to blood flow to the lungs. Reduced lung function is also caused by reduced function of the respiratory system such as pulmonary ventilation function.
Risk factors mentioned above will bring the process of bronchial inflammation and bronchial wall damage apda terminalis. Damage will occur as a result of the small bronchial obstruction (terminal bronchioles), which experienced early closure or obstruction of expiratory phase. The air that easily fit into the alveoli during inspiration, during expiration many trapped in the alveoli and there was a buildup of air (air trapping). This has led to complaints of shortness of breath with all its consequences. Obstruction in the early expiration will cause trouble and cause a lengthening expiratory expiratory phase. Pulmonary functions: ventilation, gas distribution, gas diffusion, and perfusion of blood will have the disorder (Brannon, et al, 1993)

Examination Support
Investigations required are as follows:
A. Radiological Examination
In chronic bronchitis radiological there are some things to note:

1. Tubular shadows or farm lines visible shadow lines are parallel, out from the hilum toward the lung apex. The shadow is the shadow of a thickened bronchus.
2. Pattern of increased lung

In pulmonary emphysema there are two forms of abnormal chest images are:

1. Picture of arterial deficiency, occurs overinflasi, pulmonary oligoemia and bullae. This situation is more often found in panlobular emphysema and pink puffer.
2. Pattern lung is increased.

B. Examination of Lung Physiology
In chronic bronchitis there is a KV VEP1 and declining, VR is growing and a normal ID card. In pulmonary emphysema there is a decrease VEP1, KV, and KAEM (arum expiratory maximum speed) or MEFR (maximal expiratory flow rate), KRF and VR increases, whereas KTP increased or normal. The situation above is more clearly at an advanced stage, being at an early stage changes only to the small airways (small Airways). In emphysema decreased diffusion capacity of the alveoli due to surface diffusion is reduced.

C. Blood Gas Analysis
In bronchitis PaCO2 increased, decreased hemoglobin saturation, arise cyanosis, pulmonary vascular vasoconstriction occurs and the addition eritropoesis. That chronic hypoxia stimulate erythropoietin formation, giving rise to polycythemia. At the age of 55-60 years polycythemia conditions causing right heart must work harder and is one of the causes of right heart trouble.

D. ECG
Abnormalities of the earliest was a clock wise rotation of the heart. If there is a cor pulmonale was found to right axis deviation and P pulmonale on delivery II, III, and aVF. Low QRS voltage ratio in V1 R / S is more than 1 and V6 ratio R / S is less than 1. There are often incomplete RBBB.

E. Cultures of sputum, to determine the cause of infection petogen.


F. Complete blood laboratory


Management of COPD


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How to Diagnose Occupational asthma

To make a diagnosis Occupational asthma, please note a history of atopy, exposure assessment, immunology (molecular and cellular), photograph and physiology as hipereaktivitas lung bronchus, lung function series, the specific inhalation test is the gold standard.

The diagnosis of occupational asthma in principle is to connect the clinical symptoms of asthma in the working environment is therefore a need for a good history and appropriate investigations. Thorough history of what happened in the work environment is essential, such as: when to start work somewhere this time, what the job before at work today, what is done every day, the process of what happens in the workplace, the materials used in the production process and the data material. And that is not less important is the field review by the examiner (doctor) to better understand the field situation.



In addition to the history of the workplace, which should also know is about the clinical happening. When the first occurrence of complaints, since these began to enter the place or what is known as the latent period. Latent period can be several weeks to several years, usually 1-2 year. Clinical tightness, coughing, wheezing may occur during work, after work (evening and night) or both. When the frequency of attacks more often / deteriorated during weekdays than weekends or holidays, it can be suspected asthma that arise related to the workplace.

Investigations Spirometry (FEV1 checks) before and after the shift. Said to be positive if FEV1 decreased by more than 5% between before and after work; on the normal variable is less than 3%. This examination by many experts doubt the sensitivity because one study only 20% of patients with asthma due to colophony which fell during the workshift FEV1nya; while the decline in FEV1 is also found in 10% of a group of people who are not asthmatic (control).

Another way is to measure FEV1 and FVC in workers (suspected occupational asthma) are excluded from the work environment and then measured again at work again. If the results show improvement over leaving the workplace and supported by improvements to the complaints, it can be inferred the existence of the relationship of clinical and workplace grievances.

PEFR: Examination of serial PEFR (peak expiratory flow rate) during weekdays and a few days off at home, an examination of occupational asthma is best. It said the positive response when the curve measurements during the holidays at home is better than during weekdays.

Provocation test

There are two kinds of checks:

1. Namely non-specific bronchial provocation using histamine or methacholine. This examination is only proving the existence of bronchial hiperreaktif.
2. Specific bronchial provocation with allergens is the suspected cause. This examination can be carried out when the best way of proving that the allergen is the cause of the workplace. The difficulty lies in determining the cause and reproduction when allergens are known.

Skin tests and serological tests
This examination can be done if the causative agent of its large molecular weight material as it will stimulate the immunological reactions (IgE).

Management of Occupational asthma

Tags : Occupational asthma Diagnosis, Occupational asthma Provocation test, suspected occupational asthma

Management of Occupational asthma

To prevent the occurrence of occupational asthma is a medical examination prior to employment, use of protective equipment, monitoring air pollutants in the working environment is highly recommended. If occupational asthma has occurred, then transfer to the outside of the work environment is important. If for some reason can not be moved then it must be the prevention and monitoring of lung function decline.

Periodic evaluation of lung function in workers who already suffer from occupational asthma are needed to prevent disability. Clinical asthma will persist until a few years even though the worker has been out of work environment.



Medical treatment in patients with occupational asthma such as bronchial asthma in general:

1. Theophylline, a bronchodilator and may suppress neutrophil chemotactic factor. Effectiveness of the two functions above depend on the serum levels of theophylline.
2. Beta agonists, bronchodilators are the most good for the treatment of occupational asthma in comparison with cholinergic antagonists (ipratropium bromid).
3. The combination of beta-agonists with ipratropium bromid improve lung function is better than just a beta agonist alone.
4. Corticosteroids, from various studies is known to prevent the bronchoconstriction caused by bronchial provocation with allergens. It will also improve lung function, decrease exacerbations and airway hiperesponsivitas and will ultimately improve the quality of life.

How to Diagnose Occupational asthma

Tags : Occupational asthma Management, Occupational asthma treatment,  Occupational asthma therapy

Occupational asthma

Occupational asthma is a respiratory disease characterized by attacks of shortness of breath, wheezing and coughing, which is caused by a variety of materials encountered in the workplace.

These symptoms usually occur due to spasm of the muscles lining the airways, so that the airway becomes very narrow.

Cause
Many substances (allergens, the cause of the symptoms) in the workplace that can cause asthma due to work. The most common are protein molecules (wood dust, grain dust, animal dander, mold particles) or other chemicals (especially diisocyanate).
Exact figures of the incidence of asthma because of the work is unknown, but suspected of approximately 20-20% of asthma in industrialized countries was asthma because of the work.



The workers who are at high risk for suffering from asthma because of the work is;

• Plastic workers
• Metal worker
• Firing workers
• Mill worker
• Workers grain
• Laboratory workers
• Woodworker
• Workers at the pharmaceutical
• Workers at the detergent factory.

Symptoms
Symptoms usually occur shortly after exposure to the allergen and is often reduced or disappear if the patient leaves his workplace.
Symptoms often get worse during the working day and improved on weekends or holidays.

Some patients experienced new symptoms within 12 hours after exposure to the allergen.

Symptoms include:

• Shortness of breath
• Asthma
• Cough
• Feel the tightness in the chest.

Diagnosis
In the history of the disease, patients usually experience a worsening of symptoms when exposed to certain allergens in the environment where she worked.
On examination with a stethoscope would hear a wheezing (asthma, wheezing).

Other tests are usually performed:

• Pulmonary function tests
• Measurement of peak expiratory flow rates before and after work
• Chest radiograph
• Calculate blood type
• Bronchial provocation tests (to gauge reaction to the suspected allergen)
• Blood tests to find specific antibodies.

Prevention
Industries that use substances that can cause asthma, must control dust and air, because to eliminate it is an impossible thing.

Workers with severe asthma, if possible, should change his occupation because of constant exposure will make asthma worse and are settled.

If the allergen / cause has been unknown, to prevent the occurrence of symptoms, patients should avoid the allergen.

How to Diagnose Occupational asthma
Management of Occupational asthma

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Bronchial Asthma

Bronchial asthma is a disease of the lung inflammation in the airways resulting in airway hiperrespon to various stimuli that can cause constriction of the airways that can arise thorough so shortness of breath that is reversible either spontaneously or with therapy.

Etiology

• Genetic factors
• Environmental factors
• Materials allergens
• Respiratory tract infections (especially viruses)
• Air pollution
• Food Factor

Trigger factors

• Allergens
• Physical
• Chemicals
• Infection
• Mechanical factors
• Psychological factors

Pathogenesis
The entry of allergens into the airway will cause a reaction between the allergen with immunoglobulin E. The release of materials from mastosit mediators, which cause the inflammation in the bronchial mucosa and submucosa causing bronchial smooth muscle contraction.

Pathology
Infiltration of inflammatory cells such as eosinophils, neutrophils, and other airway epithelial damage, resulting in expenditures as well as mediators and thickening of the mucosal and submucosal edema. There is hyperplasia of the glands Goblet cells. Happen "mucous plug" on-line the airways.

Clinical Symptoms
Complaints and symptoms depend on the severity at the time of the attack. In bronchial asthma attacks are mild and without complications, complaints and no typical symptoms.

Complaints:

• Breath sounds
• Crowded
• Cough

Physical examination
Abnormalities of the upper airway, bronchi, thoracic, and skins, can be rhinitis, sinusitis, bronchitis, asthma and alveoler broncho-lung hyperinflation.
General state:

• Composmentis
• Anxiety / anxiety / panic / sweating
• Blood pressure increases
• Pulse increased
• Pulsus paradoxus: decrease in systolic blood pressure over 10 mm Hg at the time of inspiration
• Respiratory frequency increased
• Cyanosis
• Auxiliary respiratory muscles hypertrophy

Lung:

• Obtained prolonged expiratory
• Wheezing

Laboratory:

• Increased blood Eosinophils> 250/mm3
• Analysis of blood gases in status asthmaticus

Radiology: there are no typical signs.
Pulmonary Physiology: decreased FEV1
Skin test: to indicate the presence of allergic
Bronchial provocation test: with inhaled histamine, acetylcholine, allergens.

Diagnosis

1. Anamnesa: complaints of shortness of breath by breath sounds ngiik frequent recurrence. The existence of hereditary factors and the presence of precipitating factors.
2. Physical examination: a thorough wheezing or prolonged expiratory phase.
3. Laboratory:

• Sputum: Charcot-Leyden crystals, Spiral Curschmann
• Blood: increased number of eosinophils.
• Physiology lung: airway obstruction (ratio of FEV1 / FVC <75% or PEF <150 liters / minute)
• bronchial provocation tests, skin sensitivity test.

Differential Diagnosis

• Upper airway obstruction (stridor)
• Laryngeal dysfunction
• Chronic obstructive pulmonary disease
• Congestive heart failure (asthma cardial)
• Pulmonary embolism
• Pulmonary infiltrates of eosinophils
• Cough caused by medications (beta blockers, ACE inhibitors).

Complications

• Respiratory infection
• Atelectasis
• Pneumothorax, Pneumomediastinum, Emphysema cutis
• Respiratory failure
• Arrhythmias (especially if previously existing cardiac abnormalities).

Management / Procedure of Bronchial asthma

Special Treatment of Bronchial Asthma


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Special Treatment of Bronchial Asthma

Special Treatment of Bronchial Asthma :
a. Mild asthma
Limitations:
Complaints arising tightness or cough less than two times a week, outside attacks asymptomatic sufferers. On physical activity may occur seranagn tightness or coughing which the period is short (<½ hours). Night asthma attacks rarely occur (<2 times a month). Pulmonary Physiology pasa asymptomatic state> / 80%, while the attacks may be decreased 20% or more.

Treatment:
1. Beta 2 agonists: 2 sprays, may be repeated every 3-4 hours.
2. Cromolyn: can be added; before exposure to allergens, physical activity or other exposure.
b. Moderate Asthma
Limitations:
Complaints arise more frequently (> 1-2 times a week), that affect activity and sleep sufferers. Attacks can last several days. Sometimes required emergency treatment. Pulmonary physiology during asymptomatic approximately 60-80%, while time attack decreases to 20-30% or may be even tougher.
Treatment:

• 2 times daily inhaled corticosteroids (400-800 ug / day) or cromolyn sprays 4 times a day 2. Coupled with the beta-2 agonist inhalation with a dose as needed up to 4 times a day. If more than 4 doses a day, need plus other drugs.
• If still arise tightness, the dose of inhaled corticosteroids may be increased (up to 2000 mcg / day dose of> 1000 ug need strict supervision) and / or given oral theophylline (slow-release) and / or supplemented with beta-2 agonists by oral route.
• Sometimes required oral corticosteroids (prednisone) for several days (40 mg / day in single or divided doses 2-4 doses) in a week, then lowered in a dose of next week.

c. Severe asthma
Limitations:
Complaints continued at any time with daily activities are limited. Frequent asthma attacks and often occur at night. Sometimes to require treatment in the emergency department or hospitalization.
Pulmonary Physiology day-to-day less than 60%, the attack can be decreased to 50%.
Treatment:

• Inhaled corticosteroids 2-4 times a day 2-6 sprays (generally> 1000 ug / day) with or without cromolyn sprays 4 times a second and plus with beta-2 agonists. 
• Beta-2 agonist inhalation, the dose is the same as in chronic asthma is. Can be given an additional extra 2-4 sprays in a day when required or given nebulizer.
• To prevent asthma evening coupled with oral theophylline (slow-release) and / or beta-2 agonists by oral route.
• Oral corticosteroids (prednisone) may be added to the dose and how as in chronic asthma is. Can be considered the provision in continuous with the minimal dose that gave the effect of a single repair 24/48 hour every morning.

d. Asthma and pregnancy
Uncontrolled asthma treatment can jeopardize health of mother and fetus. Will become more severe complications.
Treatment:

• Must be optimal and should be given by inhalation.
• Steroid injections can be administered, if necessary. (Risk to the fetus can be ignored).

Prognosis
Generally good, if diagnosis, treatment and prevention is made as early as possible with treatment adcquate.

Bronchial Atshma

Management / Procedure of  Bronchial asthma>

Tags : asthma treatment, asthma bronchial treatment,  treatment of asthma, bronchial  asthma treatment, 

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,