🔗Refer Asthma First Aid & Prevention tips on Page 2‼️

ASTHMA

Mild intermittent

💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations when needed.

💊 Anticholinergics (e.g. Ipratropium, Tiotropium) inhalations when needed, alone or in addition to beta-2 agonists

💬 Patient is asymptomatic between the dyspnoea episodes, so no daily medication required!

ASTHMA

Mild persistent

💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations ➕ Corticosteroid inhalation (low dose)

💊 Short acting β2-agonists ➕ Mast cell stabilizer or Leukotriene antagonist or Theophylline sustained release

💬 Beta-2 agonist inhalation is needed every day, so once daily corticosteroid inhalation if given for asthma control.

ASTHMA

Moderate persistent

💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (low to high dose)

💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (medium dose)

💬 The dose of corticosteroid inhalations depends on the severity of symptoms.

ASTHMA

Severe persistent

💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup

💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup

💬 Systemic corticosteroids have significant adverse effects, so after adequate asthma control, are gradually withdrawn.*

ASTHMA

Acute severe asthma

💊 Oxygen 60% ➕ Nebulized beta-2 agonists (e.g. Salbutamol) in high dose ➕ Systemic corticosteroids

💬 An emergency condition, earlier called as status asthmatics. Aminophylline is no longer recommended.

* After adequate control of severe persistent asthma, systemic corticosteroids are withdrawn, and the patient then would be managed as moderate persistent type. This is called "step down" approach of management. In this approach, it is considered better to manage patients assuming in the next higher type and then, after reviewing in 1-6 months, to step-down, instead of "step-up" after failure in asthma control.

Aspirin induced

asthma

💊 Leukotriene antagonists (e.g. Montelukast, Zafirlukast)

Exercise induced

asthma

For Prophylaxis: Mast cell stabilizers or beta-2 agonists or Leukotriene antagonists💊

COPD

• For smoking cessation: I line: Behaviour therapy; II line: Nicotine replacement therapy; III line: Antidepressants e.g. Bupropion
• For respiratory infections: Antibiotics
• For bronchodilatation: I line: Anticholinergics; II line: beta-2 agonists; III line: Theophyline
• For hypoxemia: I line: Ambulatory oxygen; II line: Long term oxygen therapy

Dry cough

💊 Cough suppressants (e.g. Dextromethorphan) + Treat the cause e.g. post nasal drip by antihistaminics and decongestants.

Productive cough

💊 Expectorants (e.g. Pot iodide) &/or Mucolytics (e.g. Acetylcysteine) ➕ Treat the cause e.g. allergy by antihistaminics and bacterial infection by antibiotics

References: CLASSIFICATION OF DRUGS WITH DRUGS OF CHOICE 3RD EDITION BY VIKAS SETH

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