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Old 02-04-2013
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Default Asthma

1) Can anybody please explain the treatment for mild, moderate and severe asthma........Mean at what point we give beta agonists,steroids short and long acting etc......

2) Difference between hydrocortisone and dexamethasone?
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Old 02-04-2013
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Quote:
Originally Posted by aknz View Post
1) Can anybody please explain the treatment for mild, moderate and severe asthma........Mean at what point we give beta agonists,steroids short and long acting etc......

2) Difference between hydrocortisone and dexamethasone?
1. OK - 3 things: the number of nighttime awakenings, the frequency of daytime symptoms (or use of inhaler) and the FEV1 (I can go into this if you're unsure what the criteria are for the diagnosis of each stage). It's really easy when you get this, and you just work off the following step-wise progression: beta-2 agonist -> inhaled steroid -> long acting beta agonist -> oral steroid.

2. Dexamethasone is a heavy duty steroid - far more potent than hydrocortisone. In asthma exacerbations, IV hydrocortisone is typically employed due to its high efficacy and lesser potency. Furthermore, hydrocortisone is short acting, while dexamethasone is long acting. More potency = more adverse effects.
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Old 02-04-2013
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Sorry, I should have clarified in the post above - regarding the step-wise progression:

Intermittent = Beta 2 Agonist
Mild Persistent = Inhaled Steroid
Moderate Persistent = Long Acting Beta Agonist
Severe Persistent = Oral Steroid

Hope this helps.
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Old 02-04-2013
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I remember it this way:

Divide Asthma severity in two: Intermittent & Persistent (Mild, Moderate & Severe).

Intermittent only needs PRN SABA (Short acting Beta 2 Agonist)


All Persistent types (Mild, Moderate & Severe) needs PRN SABA + IS (Inhaled steroids)---> Low, Medium & High doses ((Mild, Moderate & Severe)

For Moderate & Severe Persistent also add LABA (Long Acting Beta Agonist) to above.

Add Oral steroids if Severe Persistent not controlled with above.

Add Omalizumab in patients with high IgE levels

So it will look like this:

Intermittent > Short acting Beta 2 Agonist (SABA)

Mild Persistent > Add LDIS (Low dose Inhaled steroids) to above (SABA+LDIS)

Moderate Persistent > Add LABA (Long Acting Beta Agonist) to above (SABA+LDIS/MDIS+LABA)
................................(can Change LDIS to MDIS (Medium dose Inhaled steroids) if symptoms still not controlled)

Severe Persistent > Add HDIS (High dose Inhaled steroids) to above (SABA+HDIS+LABA)
..............................Add Oral steroids if symptoms not controlled with above.
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Last edited by Novobiocin; 02-04-2013 at 04:48 PM.
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