2. Objectives
ï±Describe the treatment of acute exacerbation of
asthma and COPD ??
ï±How can lung volumes be used to differentiate
between obstructive and restrictive lung
disease ?
ï± What are the emergent investigations are to be
performed on an emergency basis to reach the
diagnosis ?
4. ACUTE EXACERBATION OF ASTHMA
Treatment
ï§ Oxygen 40-60%
ï§ High doses of inhaled bronchodilators .
ï§ Systemic corticosteroids.
ï§ Intravenous fluids.
ï§ Subsequent management.
5. OXYGEN
The patient should supply by High concentrations
of oxygen:
ï Goal: SaO2 > 92%
ï Failure to achieve appropriate oxygenation ï assisted
ventilation.
6. INHALED BRONCHODILATORS
o Short-acting ÎČ2 agonist agent (SABA) :
(Salbutamol 5 mg/hr) or (terbutaline 10mg/hr)
ï via nebulizer driven by oxygen
ï via metered dose inhaler through a spacer device
o Inhaled anti-cholinergics (SAMA)
(Ipratropium bromide 0.5 mg):
8. ARTERIAL BLOOD GASES
We should correct ABG especially If patients ..
o Initial PaCO2 measurement was raised ( >7 kPa)
o PaO2 was < 8 kPa (60 mmHg)
o the patient deteriorates.
9. SUBSEQUENT MANAGEMENT
If patients fail to improve:
o Intravenous magnesium sulphate (1.2â2 g over 20 min)
o Intravenous ÎČ2 agonists (e.g. Salbutamol)
o Intravenous aminophylline (5mg/kg loading dose over 20
minutes)
Chest x-ray
ï To exclude
pneumothorax
10. MANAGEMENT OF COPD
The goals of effective COPD management are to:
1. Prevent disease progression
2. Relieve symptoms
3. Improve exercise tolerance
4. Improve health status
5. Prevent and treat complication
11. OXYGENATION AND VENTILATION
âą Oxygen therapy:
ï the oxygen saturation level should be at least 90%.
âą Respiratory support:
ï Non-invasive positive pressure ventilation (NIPPV) ï BiPAP
ï improves blood gases.
ï indicated if adequate ventilation cannot be achieved using a
high-flow mask.
Nasal oxygen therapy ï Non- invasive mechanical ventilation ï
invasive mechanical ventilation
12. Con..
âą SHORT-ACTING BRONCHODILATORS (nebulization)
1. Inhaled short-acting ÎČ2 agonist agent (SABA).
2. Inhaled anti-muscarinic (SAMA).
âą CORTICOSTEROIDS:
Short courses of systemic corticosteroids.
âą ANTIBIOTICS
with bacterial infection
14. Objectives:
ï±How can lung volumes be used to differentiate
between obstructive and restrictive lung disease ?
15. OBSTRUCTIVE VS. RESTRICTIVE
Obstructive disorders
âą Characterized by: reduction in
airflow.
âą So, shortness of breath ï in
exhaling air.
( the air will remain inside the
lung after full expiration )
1. COPD
2. Asthma
3. Bronchiectasis
Restrictive disorders
âą Characterized by a reduction
in lung volume.
âą So, Difficulty in taking air
inside the lung.
( DUE TO stiffness inside the lung tissue
or chest wall cavity )
1. Interstitial lung disease.
2. Scoliosis
3. Neuromuscular cause
4. Marked obesity
16. SPIROMETRY ï measures the rate of lung volume changes
during forced breathing maneuvers
The diagnosis and distinguished between
obstructive and restrictive lung diseases.
Confirmed by ï Spirometry
17. DIFFERENT BETWEEN OBSTRUCTIVE
VS. RESTRICTIVE
Obstructive disorders
âą Decrease in both FEV1 and
FEV1/FVC ratio .
Restrictive disorder
âą Normal FEV1/FVC ratio .
Forced vital capacity (FVC):
The maximum volume of air forcibly exhaling from the point of
maximal inhalation.
Forced expiratory volume in 1 second (FEV1):
Forced expiratory volume in 1 second during FVC maneuver.
Ratio of FEV1 and FVC (FEV1/FVC):
Expressed as percentage
18.
19.
20. Objectives:
ï± What are the emergent investigations
are to be performed on an emergency basis
to reach the diagnosis ?
22. 2- ARTERIAL BLOOD GASES:
o hypoxemia, hypocapnia, and respiratory alkalosis due to
hyperventilation.
ï PO2 and A-a gradient
most often abnormal Profound hypoxia with normal chest X-ray
in the absence of preexisting lung disease is highly suspicious of
pulmonary embolism.
23. 3- D-DIMER
âą D-dimer: A degradation product of fibrin.
âą is a substance in the blood that is often increased in people
with PE.
ï D-dimer levels are abnormal in patients with PE; a person
with a normal D-dimer level is unlikely to have a PE.
ï Positive D-dimer indicate abnormal high level of fibrin
degradation product ( indicate significant blood clut)
Nebulization ï administration a drug by inhalation
metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs
anti-cholinergicsï block the action of the neurotransmitter acetylcholine in the brain
kilopascalÂ
Millimeters of mercury
Oxygen supplementation should be titrated to an oxygen saturation level of at least 90 percent
BiPAP stands for Bilevel Positive Airway Pressur ï example of Non-invasive positive pressure ventilation
ï increase the time to subsequent exacerbation, decrease the rate of treatment failure
So, the patient will present with shortness of breath ï particularly in in exhaling air
P- Pulmonal, RVH, RAD, RBBB ï the right ventricle doesÂ
Right Bundle Branch Block
Alveolarâarterial gradient
Absence of D-dimer provides a strong evidence against thromboembolism