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Asthma and

COPD
The wheezers and the
geezers

Wong Yee Ming


ED CME
Asthma COPD
Chronic reversible Chronic airflow limitation
inflammatory airway that is not fully reversible
limitation
Widespread but variable Associated with an
airflow obstruction as a abnormal inflammatory
result of response of lungs to
hyperresponsiveness noxious particles or gases
(esp smoking)
Airway obstruction often Progressive worsening
reversible, either with time
spontaneously or with
treatment
Mixture of small airway
diseases and lung
parenchymal destruction
Sources: Abramson et al., 2001; Greenberger et al., 1993; Hardie et al., 2002; Kallenbach et al.,
1993; Kikuchi et al., 1994; O'Hollaren et al., 1991; Rodrigo and Rodrigo, 1993; Strunk and
Mrazek, 1986; Suissa et al., 1994.
Chest X-Ray is not routinely
recommended in the absence of:
suspected pneumomediastinum or
pneumothorax
suspected consolidation
life threatening asthma
failure to respond to treatment
satisfactorily
requirement for ventilation
Acute exacerbation of asthma/COPD

The aims of management are:


To prevent death
To relieve symptoms
To restore the patients lung function to
the best possible level as soon as
possible
To prevent early relapse
British Guideline of Management of Asthma BTS,SIGN, May2011 Revision
Treatment of Acute asthma(Adults)

British Guideline of Management of Asthma BTS,SIGN, May2011 Revision


Treatment of Acute asthma(Adults)
MDI Salbutamol via
spacer can be equally
as effective as
nebulizer at home in
non life-threatening
asthmaCochrane review 2009.
Holding chambers (spacers)
versus nebulisers for beta-
agonist
treatment of acute asthma

KKMs MDI Salbutamol:


100mcg per puff

British Guideline of Management of Asthma BTS,SIGN, May2011 Revision


Treatment of Acute asthma

Malaysia CPG 2002: 30-60mg od 7-14 days, to taper off


or can be stopped abruptly
*Prednisolone continued more than 14 days should be
tapered off

British Guideline of Management of Asthma BTS,SIGN, May2011 Revision


Treatment of Acute asthma

Recommended:
1 vial of MgSo4: 2.47g
can be infused over 20
minutes

IV aminophylline can be considered as a last resort


following consultation with senior medical staff due
to risk of arrhythmia and vomiting

British Guideline of Management of Asthma BTS,SIGN, May2011 Revision


Treatment of Acute asthma

British Guideline of Management of Asthma BTS,SIGN, May2011 Revision


COPD
Acute exacerbation of COPD
1)Oxygen titration to improve patients hypoxemia is of utmost
importance as it can reduce mortality by 78% compared to HFM.
-Austin et al. 2010

2) GOLD recommends target saturation of 88-92%

3)MDI SABA via spacer 10-20 puffs has equal efficacy to nebulizing
device
-Malaysia COPD CPG, 2009
<- RAAS activation causes peripheral edema

MgSO4 has not found to be useful in AECOPD


Non invasive Ventilation
Less frequent intubation
Decreased complications and mortality
Shorter hospital stay
NIV requires ability for spontaneous breathing effort and
airway patency
Invasive mechanical
ventilation
Theuse of invasive ventilation is influenced
by the likely reversibility of the precipitating
event, the patients wishes and the
availability of ICU facility
Discharge criteria
Inhaled bronchodialtor therapy is required not
more frequently than every 4 hours
Able to ambulate if premorbidly ambulating
Able to eat and sleep without frequent
awakening by dyspnea
Clinically, ABG/Spo2 stable for 12-24 hours
Understands the disease and its management
with good insight
Follow up has been organised