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Asthma

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

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  1. Asthma Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of Emergency Medicine Jesse Brown VA Medical Center, Chicago, IL

  2. 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

  3. Overview • What do we do • Nebs • Steroids • Mg2+ • NIPPV

  4. Overview • Why do we do it? • Nebs • Steroids • Mg2+ • NIPPV

  5. Inhaled Bronchodilators • B2 agonist • Albuterol • Continuous • Intermittent • Levalbuterol • Anticholinergic (ipratroprium)

  6. Albuterol

  7. Albuterol http://www.healthy-oil-planet.com/asthma.html

  8. Meat

  9. Albuterol

  10. Albuterol

  11. Albuterol

  12. Albuterol

  13. Albuterol

  14. Albuterol • Intermittent unit dose nebs • 2.5mg q 15m • Repeat ad lib • Continuous • 10-20 mg / hr How do you decide?

  15. Albuterol

  16. Continuous vs intermittent AnythingGoes!

  17. Which B2 agonist?

  18. 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?

  19. Levalbuterol

  20. Levalbuterol

  21. Levalbuterol

  22. Peds?

  23. Fail!

  24. Ipratropium • Smooth muscle relaxation • Blocks muscarinic receptors • Anticholinergic • How efficacious? • What’s the best delivery? • When should we use it?

  25. Ipratropium

  26. Ipratropium

  27. Ipratropium

  28. Ipratropium

  29. Ipratropium • No significant improvement • No change in admission rates

  30. 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!)

  31. Steroids

  32. Steroids • Should I give them? • When should I give them? • Which route? • How much? • For how long?

  33. Steroids: The Pitzele Way • Should I give them? • Yes! • When? • If they don’t get back to baseline after the first neb

  34. Steroids: Give Them!

  35. Steroids: Give Them!

  36. Steroids: Give Them!

  37. Steroids: Give Them!

  38. Steroids: Give Them!

  39. Steroids: Give Them!

  40. Steroids: Give Them!

  41. Steroids: What route? vs

  42. Steroids: What route? • PO = IV

  43. Steroids: What route? • PO = IV

  44. Steroids: What route? • PO = IV

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