Iv steroids for asthma attack

Perioperatively drugs used to treat asthma should be continued, sometimes in a different format (see table).  Patients taking more than 10mg of  prednisolone daily will require steroid supplementation perioperatively, and may require IV maintenance doses until absorbing drugs. 

Perioperative recommendations for asthma medications      
Class of drug Examples Perioperative recommendation  Notes ß2 agonists  Salbutamol, terbutaline, salmeterol  Convert to nebulised form High doses may lower K + . Causes tachycardia and tremor Anticholinergic drugs 
Ipratropium 
Convert to nebulised form    Inhaled steroids 
Beclomethasone, budesonide, fluticasone  Continue inhaled formulation 
If patient on >1500 mcg/day of beclomethasone, adrenal suppression may be present  
Oral steroids   
Prednisolone Continue as IV hydrocortisone until taking orally (1 mg prednisolone equivalent to 5 mg hydrocortisone) 
If >10 mg/day, adrenal suppression likely Leukotriene inhibitor (anti-inflammatory effect) 
Montelukast, zafirlukast 
Restart when taking oral medications    Mast cell stabilizer 
Disodium cromoglycate 
Continue by inhaler    Phosphodiesterase inhibitor 
Aminophylline 
Continue where possible  Effectiveness in asthma debated. In severe asthma consider converting to an infusion perioperatively (checking levels 12-hrly)

In the randomised trials, intravenous magnesium sulfate was given as a single dose of g or 2 g over 15 to 30 minutes. Used in this way the overall evidence showed that there were improvements in lung function and a reduction in the risk of hospital admission. Even though the recent trial was not conclusive, the sum of the evidence from all randomised trials does suggest benefit from intravenous magnesium sulfate on lung function and the risk of hospital admission, in adults with acute asthma exacerbations that have not resolved with current first line treatments.

Increasing tachycardia generally denotes worsening asthma, whereas a fall in heart rate in life-threatening asthma is a pre-terminal event. Although wheezing initially becomes more apparent as airway obstruction increases, severe airway obstruction decreases air flow, with wheezing becoming softer and then diminishing completely (silent chest).

I find that the fatigue hits almost immediately after the attack, while the depression and despair hit during the attack.
In the ER today, I could feel the despair/ helplessness/hopelessness hit like a wave, and had to fight mentally to overcome it and stay calm. My attack took place out of town, and I had to walk 15 minutes to the ER, as I couldn’t talk on the phone (in my hand!!) nor would anyone respond to my attempts to flag down help. I truly didn’t think I would make it–inhaler didn’t even make a dent.

Dose reduction
The common practice of tapering the dose of oral corticosteroid after recovery from an exacerbation is complex for the patient and may be unnecessary. Several studies have compared abrupt cessation of corticosteroid after 7-10 days' therapy with a tapering dose. 9 There was no difference in lung function or relapse rate between the steroid tapering group and the abrupt cessation group. Tapering is not necessary provided that the patient is not using oral corticosteroids chronically, and is protected by high-dose inhaled corticosteroid after the oral steroid is stopped. It takes an average of 7-10 days for symptoms and lung function to stabilise after an asthma exacerbation. 7 , 9 Because of this, immediately tapering the corticosteroid could actually lead to rebound asthma. Although biochemical evidence of partial hypothalamic-pituitary axis suppression can be detected after short courses of oral corticosteroid, this is rarely of clinical significance unless the patient has been taking steroids long term.

Iv steroids for asthma attack

iv steroids for asthma attack

I find that the fatigue hits almost immediately after the attack, while the depression and despair hit during the attack.
In the ER today, I could feel the despair/ helplessness/hopelessness hit like a wave, and had to fight mentally to overcome it and stay calm. My attack took place out of town, and I had to walk 15 minutes to the ER, as I couldn’t talk on the phone (in my hand!!) nor would anyone respond to my attempts to flag down help. I truly didn’t think I would make it–inhaler didn’t even make a dent.

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