Which of the following is drug should never be given in a case of acute severe asthma? (AIPG 2011)
|D||All of the above|
Status asthmaticus (acute severe asthma)
Severe obstruction persisting for days to weeks.
Acute Severe Asthma: Treatment (Ref. Hari-18th ed., Pg 2113)
1). A high concentration of oxygen should be given by face mask to achieve oxygen saturation of >90%.
2). The mainstay of treatment is high doses of short-acting inhaled Beta2-agonists that are given either by nebulizer or via a metered dose inhaler with a spacer.
3). In severely ill patients with impending respiratory failure, intravenous Beta2-agonists may be given.
4). Corticosteroids are used intravenously (hydrocortisone or methylprednisolone) for the treatment of acute severe asthma.
5). An inhaled anti-cholinergic may be added if there is not a satisfactory response to Beta2-agonists alone, as there are additive effects.
6). In patients who are refractory to inhaled therapies, a slow infusion of aminophylline may be effective.
7). Magnesium sulfate given intravenously.
8). Prophylactic intubation may be indicated for impending respiratory failure, when the PaCO2 is normal or rises.
9). These patients may benefit from an anesthetic, such as halothane, if they have not responded to conventional bronchodilators.
10). Sedatives should never be given as they may depress ventilation.
11). Antibiotics should not be used routinely unless there are signs of pneumonia.
Extra edge: In severe acute asthma sedative and montelukast are not given.
Recent Advance: New Drugs
1). Anti-IgE monoclonal antibody Omalizumab is a new drug Q be of use in highly selected patients with persistent allergic asthma (PQ) It is an IgE blocker.
2). MgSO4 is used in severe asthma.
3). Bambuterol, It isa very long acting beta-adrenoceptor agonist (LABA) used in the treatment of asthma; it also is a prodrug of terbutaline. This is a new drug not given in Harrison 18th edition also !!!.