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hma
Life-threatening attack (intensiv e care)
– Insert an IV line.
– A d m inister: saturation betw een
• oxygen continuously, at least 5 litres/ m inute or m aintain th e2O
9 4 and 9 8 % .
• salbutamol (solution for nebulisation):
C h ild ren und er 5 years or 1 5 kg : 2 .5 m g / nebulisation, to be repeated ev ery 2 0 to
3 0 m inutes if necessary until clinical im prov em ent is ach iev ed ; sw itch to
salbutam ol aerosol (using a spacer) as soon as possible.
C h ild ren ov er 5 years and ad ults: 2 .5 to 5 m g / nebulisation, to be repeated ev ery
2 0 to 3 0 m inutes if necessary until clinical im prov em ent is ach iev ed ; sw itch to
salbutam ol aerosol as soon as possible.
Salbutam ol m ust be ad m inistered v ia an oxyg en-d riv en nebuliser.
• hydrocortisone I V ev ery 6 h ours ( ch ild ren: 5 m g / kg / injection, ad ults:
1 0 0 m g / injection).
– F or patients w h o d o not respond rapid ly to nebulised salbutam ol:
• In ad ults, ad m inister a sing le d ose of m ag nesium sulfate (infusion of 1 to 2 g in
0 .9 % sod ium ch lorid e ov er 2 0 m inutes).
• In ch ild ren, use continuous nebulisation rath er th an interm ittent nebulisation.
Notes:
– In preg nant w om en, treatm ent is th e sam e as for ad ults. In m ild or m od erate asth m a
attacks, ad m inistering oxyg en red uces th e risk of foetal h ypoxia.
– F or all patients, irrespectiv e of th e sev erity of th e asth m a attack, look for und erlying
lung infection and treat accord ing ly.
Chronic asthma
Clinical features
– A sth m a sh ould be suspected in patients w ith episod ic respiratory sym ptom s
(w h eezing , ch est tig h tness, sh ortness of breath and / or coug h ) of v ariable frequency,
sev erity and d uration, d isturbing sleep, and causing th e patient to sit up to breath e.
T h ese sym ptom s m ay appear d uring or after exercise.
– C h est auscultation m ay be norm al or d em onstrate d iffuse sibilant w h eezes.
– A topic d isord ers or a personal or fam ily h istory of atopy ( eczem a, allerg ic
rh initis/ conjunctiv itis) or a fam ily h istory of asth m a increases probability of asth m a
but th eir absence d oes not exclud e asth m a.
P atients w ith typical sym ptom s of asth m a and a h istory of d isease th at is ch aracteristic
of asth m a sh ould be consid ered as h av ing asth m a after exclusion of oth er d iag noses.
T h e assessm ent of th e frequency of d aytim e and nig th tim e sym ptom s and lim itations
of
ph ysical activ ity d eterm ines w h eth er asth m a is intermittent or persistent.
76
Life-threatening attack (intensiv e care)
– Insert an IV line.
– A d m inister: saturation betw een
• oxygen continuously, at least 5 litres/ m inute or m aintain th e2O
9 4 and 9 8 % .
• salbutamol (solution for nebulisation):
C h ild ren und er 5 years or 1 5 kg : 2 .5 m g / nebulisation, to be repeated ev ery 2 0 to
3 0 m inutes if necessary until clinical im prov em ent is ach iev ed ; sw itch to
salbutam ol aerosol (using a spacer) as soon as possible.
C h ild ren ov er 5 years and ad ults: 2 .5 to 5 m g / nebulisation, to be repeated ev ery
2 0 to 3 0 m inutes if necessary until clinical im prov em ent is ach iev ed ; sw itch to
salbutam ol aerosol as soon as possible.
Salbutam ol m ust be ad m inistered v ia an oxyg en-d riv en nebuliser.
• hydrocortisone I V ev ery 6 h ours ( ch ild ren: 5 m g / kg / injection, ad ults:
1 0 0 m g / injection).
– F or patients w h o d o not respond rapid ly to nebulised salbutam ol:
• In ad ults, ad m inister a sing le d ose of m ag nesium sulfate (infusion of 1 to 2 g in
0 .9 % sod ium ch lorid e ov er 2 0 m inutes).
• In ch ild ren, use continuous nebulisation rath er th an interm ittent nebulisation.
Notes:
– In preg nant w om en, treatm ent is th e sam e as for ad ults. In m ild or m od erate asth m a
attacks, ad m inistering oxyg en red uces th e risk of foetal h ypoxia.
– F or all patients, irrespectiv e of th e sev erity of th e asth m a attack, look for und erlying
lung infection and treat accord ing ly.
Chronic asthma
Clinical features
– A sth m a sh ould be suspected in patients w ith episod ic respiratory sym ptom s
(w h eezing , ch est tig h tness, sh ortness of breath and / or coug h ) of v ariable frequency,
sev erity and d uration, d isturbing sleep, and causing th e patient to sit up to breath e.
T h ese sym ptom s m ay appear d uring or after exercise.
– C h est auscultation m ay be norm al or d em onstrate d iffuse sibilant w h eezes.
– A topic d isord ers or a personal or fam ily h istory of atopy ( eczem a, allerg ic
rh initis/ conjunctiv itis) or a fam ily h istory of asth m a increases probability of asth m a
but th eir absence d oes not exclud e asth m a.
P atients w ith typical sym ptom s of asth m a and a h istory of d isease th at is ch aracteristic
of asth m a sh ould be consid ered as h av ing asth m a after exclusion of oth er d iag noses.
T h e assessm ent of th e frequency of d aytim e and nig th tim e sym ptom s and lim itations
of
ph ysical activ ity d eterm ines w h eth er asth m a is intermittent or persistent.
76
