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Asthma. Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of Emergency Medicine Jesse Brown VA Medical Center, Chicago, IL. Asthma: Why We Do What We Do. Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of EM, Jesse Brown VA Clinical Asst. Professor, UIC Dept. of EM. Overview.
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Asthma Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of Emergency Medicine Jesse Brown VA Medical Center, Chicago, IL
Asthma: Why We Do What We Do Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of EM, Jesse Brown VA Clinical Asst. Professor, UIC Dept. of EM
Overview • What do we do • Nebs • Steroids • Mg2+ • NIPPV
Overview • Why do we do it? • Nebs • Steroids • Mg2+ • NIPPV
Inhaled Bronchodilators • B2 agonist • Albuterol • Continuous • Intermittent • Levalbuterol • Anticholinergic • Ipratropium
Albuterol http://www.healthy-oil-planet.com/asthma.html
Albuterol • Intermittent unit dose nebs • 2.5mg q 15m • Repeat ad lib • Continuous • 10-20 mg / hr How do you decide?
Continuous vs intermittent AnythingGoes!
Levalbuterol • L-isomer of albuterol (“regular” albuterol is racemic) • $$$$$: 2- to 6-fold price difference • Marketed to have • Less tachycardia • More efficacy • Should we use it?
Ipratropium • Smooth muscle relaxation • Blocks muscarinic receptors • Anticholinergic • How efficacious? • What’s the best delivery? • When should we use it?
Ipratropium • No significant improvement • No change in admission rates
Ipratropium • Proven benefit in airflow • Trends toward clinical significance • May have late-onset benefit • Cheap and almost completely harmless So………….. • Use it! • (any way you like!)
Steroids • Should I give them? • When should I give them? • Which route? • How much? • For how long?
Steroids: The Pitzele Way • Should I give them? • Yes! • When? • If they don’t get back to baseline after the first neb
