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1. Introduction
2. Outline
3. Case history - chief complaint
4. Case history - recent history
5. Case history - physical exam
6. Case history - initial treatment
7. Outline - prevention
8. The best management is prevention
9. Preventive strategies
10. Traffic-light model: green/yellow/red zones
11. Peak flow meter with adjustable markers
12. Asthma action plan - example
13. Outline - assessment
14. Patient assessment
15. Risk factors for severe, potentially fatal asthma
16. Physical findings in severe asthma attacks
17. Lung function measurements
18. Chest X-ray is of limited value
19. Role of arterial blood gases
20. Lung function & PCO2 in acute, severe asthma
21. Outline - treatment
22. Treatment of acute asthma - overview
23. Principles of care for acute asthma
24. Initial treatment - comparison of three regimens
25. Initial treatment
26. MDI and nebulizer equivalence
27. MDI with spacer vs. nebulizer in severe disease
28. Inhaled beta-agonists in acute asthma
29. Patterns of response to albuterol
30. Additional bronchodilators in acute, severe asthma
31. Intravenous magnesium - meta-analysis
32. Intravenous magnesium - randomized trial
33. Helium-oxygen mixture (Heliox) (1)
34. Helium-oxygen mixture (Heliox) (2)
35. Helium-oxygen mixture (Heliox) (3)
36. Bronchodilator failure - probable causes
37. Steroids in acute, severe asthma
38. Systemic steroids during hospitalization
39. Oral steroids on emergency dept. (E.D.) discharge
40. Intramuscular steroids on E.D. discharge
41. Inhaled steroids following E.D. discharge (1)
42. Inhaled steroids following E.D. discharge (2)
43. Optimal dose of systemic steroids - unknown (1)
44. Optimal dose of systemic steroids - unknown (2)
45. Oral vs. intravenous corticosteroids
46. Optimal duration of systemic steroids - unknown
47. No need for oral steroid "taper"
48. The outpatient "steroid burst"
49. Antibiotics for acute, severe asthma
50. Other therapies of unproven/unlikely benefit
51. Outline - disposition
52. Rationale for in-hospital treatment
53. Indications for admission
54. Unconventional therapies in acute, severe asthma
55. Indications for intubation & mechanical ventilation
56. Discharge criteria
57. Patient education prior to hospital discharge
58. Conclusions
59. Summary
60. Thank you

Topics Covered

• Asthma prevention, assessment, treatment and disposition
• Risk factors and physical findings in severe asthma attacks
• Treatments: Steroids, MDI, Nebulizer, Beta-agonists, Bronchodilators, Magnesium, Heliox & Antibiotics
• Unproven and unconventional therapies
• Rationale for in-hospital treatment and indications for admission
• Indications for intubation & mechanical ventilation
• Discharge criteria and patient education prior to hospital discharge

Links

Series:

• Advances in Asthma

Categories:

• Clinical Practice
• Immunology

Therapeutic Areas:

• Immunology & Inflammation
• Respiratory Diseases

Talk Citation

Publication History

• Published on January 24, 2013

Financial Disclosures

• Dr. Chris Fanta has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.