Notes Diagnoses & Therapeutics III RESPIRATORY DISORDERS TREATMENT 2

Notes Diagnoses & Therapeutics III RESPIRATORY DISORDERS TREATMENT 2

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Notes Diagnoses & Therapeutics III : RESPIRATORY DISORDERS TREATMENT Persistent asthma – Step Three Medicate on regular maintenance schedule: Inhaled steroids 400–800 μ g per day If not controlled with inhaled steroid (600 μ g per day), add long-acting beta-agonist. STEROID + LONG ACTING B2 AGONIST Fluticasone/salmeterol (Advair) Consider montelukast. Poorly Controlled asthma: High-dose inhaled steroids; some patients may need alternate-day oral steroids. Salmeterol as long-acting bronchodilator Fluticasone/salmeterol (Advair) Theophylline often useful, particularly for nighttime symptoms Consider montelukast. Consider cromolyn or ipratropium. Mortality risk increases with: More than three emergency room visits per year
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Unformatted text preview: • – Nocturnal symptoms • – History of ICU admission • – Mechanical ventilation • – More than two hospitalizations per year • – Systemic steroid dependence • – History of syncope with asthma • Mortality rates are increasing. If response to treatment is poor, review diagnosis and compliance prior to adding more potent therapy PATIENT MONITORING • Peak expiratory flow rate at home: Record for trend; call if < 70% baseline, ER if < 50% baseline. • pH and arterial blood gases • Oximetry with status asthmatics • Electrolytes: Frequent albuterol lowers potassium. • Written and periodically revised action plan is helpful. Review metered-dose inhaler technique periodically...
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  • Spring '14
  • SUSANKRENITSY-KORN
  • Montelukast, High-dose inhaled steroids, Diagnoses & Therapeutics III: RESPIRATORY DISORDERS TREATMENT

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