- Albuterol-Ipratropium (DueNeb): breathing treatments
- Montelukast (Singular)
- Proventil (Albuterol)
- Symbicort (budesonide/formoterol – steroid/long acting beta agonist)
- Start only on outpatient basis when patient is stable, not when acutely symptomatic.
- Tudorza Pressair (Aclidinium, treats COPD – long-acting anticholinergic bronchodilator)
Asthma Exacerbation, acute
Ex: Acute exacerbation of chronic bronchitis is setting of probably underlying Severe Persistent Asthma:
- Continue Xopenex (Levalbuterol) breathing treatments
- Steroids (Solu-Medrol/Prednisone)
- ***Pulmicort (budesonide – inhaled steroids) – Neb form while hospitalized (start while acutely symptomatic, inpatient!)
- Many patient will forego maintenance inhalers in favor of only rescue inhalers and have to be educated about the importance of using maintenance inhalers daily (yes, even when they feel fine and are not wheezing).
- Azithromycin: Anti-inflammatory in addition to treating atypical PNA and bronchitis infections.
- Patient is also encouraged to use incentive spirometer.
- Following resolution of acute symptoms, the patient will need PFT to further evaluate for exertional hyperreactivity asthma. Patient may need a Metacholine Challenge Test to induce bronchoconstriction for further assessment.
- Can ordered IgE level to assess for Asthma.
- PE ruled out on chest CT.
- The patient is encouraged to quit smoking and to keep her pets out of her bedroom to help mitigate allergic reaction.
- Start Pulmicort (budesonide – inhaled steroids) during acute exacerbation. Do NOT start Symbicort (budesonide/formoterol – steroid/long acting beta agonist) during acute exacerbation due to long acting beta agonist only being beneficial in stable state and harmful in acute exacerbation.
- Do breathing treatment (DuoNeb: Ipratropium-albuterol) in the office and check the O2 Sat
- Recommended ProAir q4-6 hrs PRN wheeze or cough
- [If severe exacerbation]: Solu-medrol 125mg IM and then continue Prednisone (Pak) 10mg PO taper at home for 1 week.
- F/U in 2-3 days.
- Spirometry (confirm diagnosis of asthma)
- Notify MD/call 911 if symptoms are getting worse.
Asthma exacerbation may be triggered by URI:
- Zyrtec – scheduled, daily (not sure PRN)
- may benefit from nasal saline rinses