Explore asthma management strategies in the ED, from risk stratification to MDI vs nebulizers. Learn about aggressive treatment approaches with inhaled meds and steroids. Discover the importance of steroid inhalers post-discharge and optimizing inhaler techniques for improved patient outcomes.
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Quick takeaways
Thorough history and physical exam aid in stratifying asthma risks for better treatment decisions.
Using MDIs with spacer over nebulizers improves medication delivery and reduces exposure risks.
Assessing asthma severity through history, exacerbation frequency, and physical exams helps in guiding treatment choices.
Deep dives
Asthma Exacerbations Consequence of Forest Fires
Increased air pollution from forest fires leads to higher incidence of asthma exacerbations, supported by a study from Calgary showing a 13% rise in asthma cases during wildfire episodes.
MDIs vs. Nebulizers in Asthma Treatment
Using metered dose inhalers (MDIs) with a spacer is preferred over nebulizers due to better medication delivery and reduced risk of exposure. Continuous treatments are now favored, emphasizing the importance of proper inhaler technique for patients.
Risk Stratification in Asthma Management
Assessing asthma patients' history, exacerbation frequency, hospitalizations, critical care needs, medication use, and physical exam findings help in determining asthma severity and guiding treatment decisions.
Treatment Algorithm for Moderate to Severe Asthma Exacerbations
Initial treatment includes inhaled beta-agonists, ipratropium bromide, and systemic corticosteroids along with considering magnesium sulfate for severe cases. Non-invasive positive pressure ventilation may be needed if the patient fails to respond to initial treatments.
Reassessment and Discharge Instructions for Asthma Patients
Frequent reassessment of respiratory rate, symptoms, and response to treatment is crucial, with consideration for non-invasive ventilation if needed. Discharge instructions should emphasize proper inhaler use, smoking cessation, and trigger avoidance strategies to prevent relapses.
In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity associated with asthma exacerbations. We answer questions such as: which patients, if any, require peak expiratory flow measurements in the ED? Why is it so important to add steroid MDI therapy to oral steroid therapy in patients being discharged from the ED after an asthma exacerbation? What are the most predictive variables to risk stratify patients with asthma exacerbations to help guide treatment and disposition? and many more. Stay tuned for Part 2, where we'll delve deep into the management of the crashing asthmatic.
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