Steroid refractory asthma

Initial dose based on previous asthma drug therapy and disease severity; 100 mcg via oral inhalation once daily is the usual recommended starting dose for patients not on an inhaled corticosteroid. After 2 weeks of therapy, if asthma symptoms are uncontrolled, increase dose to 200 mcg via oral inhalation once daily. Max: 200 mcg once daily. Administer at the same time each day. The maximum beneficial effect may not be achieved for up to 2 weeks or longer after starting treatment. Titrate to the lowest effective dose once asthma stability is achieved.

Adrenaline has been replaced by the β2-agonists and is rarely indicated for acute asthma attacks. It may, however, be used if no intravenous access is immediately available and the patient is moribund. Subcutaneous adrenaline ( ml of 1/1 000 solution, repeated every 20 minutes if no response) has been successful and side-effects are not significant even when given intravenously under emergency circumstances. It has also been administered via an endotracheal tube if a patient is unable to take inhaled medication and/or there is no intravenous access. 1 It may also be used if there is associated anaphylaxis or angio-oedema. Special care must be taken in the elderly and those with or at risk of cardiovascular disease.

I want to say as an RT I really enjoyed and appreciated this article. I also am very happy that you said MDI’s are just as effective as aerosol’s, I agree whole heartedly. I must say though in my experience I often get complaints from patients that say their MDI’s do not work for them. When I ask them if they are taking them with a spacer I get the the blank stare. It’s important to educate the patient on how to properly take their MDI as after proper teaching and spacer administration they are like “oh wow this does work. I’ve been taking inhalers for years and nobody has told to me about this”. I know our docs always write the rx for spacer and MDI but after talking to pharmacy personnel I found out that they do not carry spacers and only give the patient the MDI. It has now become habit at our hospital that if the patient is to take MDI’s we get an order for MDI and spacer teaching, this way the patient receives a spacer from the therapist and proper education. Thanks again for writing the article.

Total IgE: A measurement of the total amount of IgE circulating in a patient's blood can be helpful but is elevated in only one-half of allergic patients. RAST testing is a more specific blood test for allergy. This is a radio-immune assay where a patient's serum is incubated with different allergens and antigen/antibody complexes are then measured. This is not as sensitive as skin testing and certainly more costly, and cannot therefore be used as a screening tool. A smear of nasal mucus, checked for eosinophils (allergy mediating cells), can be helpful if the percentage of eosinophils is over 5%. An adenoid x-ray to assess how large the airway is at the back of the nose is also helpful. Physical examination can sometimes distinguish allergy from viral upper respiratory infections, but this is often quite difficult.

Steroid refractory asthma

steroid refractory asthma

Total IgE: A measurement of the total amount of IgE circulating in a patient's blood can be helpful but is elevated in only one-half of allergic patients. RAST testing is a more specific blood test for allergy. This is a radio-immune assay where a patient's serum is incubated with different allergens and antigen/antibody complexes are then measured. This is not as sensitive as skin testing and certainly more costly, and cannot therefore be used as a screening tool. A smear of nasal mucus, checked for eosinophils (allergy mediating cells), can be helpful if the percentage of eosinophils is over 5%. An adenoid x-ray to assess how large the airway is at the back of the nose is also helpful. Physical examination can sometimes distinguish allergy from viral upper respiratory infections, but this is often quite difficult.

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