Understanding Asthma Treatment: Nebulizers, Steroids, and NIPPV Approaches
Dr. Henry Z. Pitzele, Deputy Chief of Emergency Medicine at Jesse Brown VA Medical Center, presents an overview of asthma treatment methods. This session covers the rationale behind using nebulizers, steroids, magnesium, and non-invasive positive pressure ventilation (NIPPV). Key aspects include the use of inhaled bronchodilators such as albuterol and levalbuterol, their administration methods, and when to implement steroids in patient care. The importance of timing and choice of treatment interventions for optimizing asthma management will be discussed.
Understanding Asthma Treatment: Nebulizers, Steroids, and NIPPV Approaches
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Presentation Transcript
Asthma Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of Emergency Medicine Jesse Brown VA Medical Center, Chicago, IL
Asthma: Why We Do What We Do Henry Z. Pitzele, MD, FACEP Deputy Chief, Section of EM, Jesse Brown VA Clinical Asst. Professor, UIC Dept. of EM
Overview • What do we do • Nebs • Steroids • Mg2+ • NIPPV
Overview • Why do we do it? • Nebs • Steroids • Mg2+ • NIPPV
Inhaled Bronchodilators • B2 agonist • Albuterol • Continuous • Intermittent • Levalbuterol • Anticholinergic • Ipratropium
Albuterol http://www.healthy-oil-planet.com/asthma.html
Albuterol • Intermittent unit dose nebs • 2.5mg q 15m • Repeat ad lib • Continuous • 10-20 mg / hr How do you decide?
Continuous vs intermittent AnythingGoes!
Levalbuterol • L-isomer of albuterol (“regular” albuterol is racemic) • $$$$$: 2- to 6-fold price difference • Marketed to have • Less tachycardia • More efficacy • Should we use it?
Ipratropium • Smooth muscle relaxation • Blocks muscarinic receptors • Anticholinergic • How efficacious? • What’s the best delivery? • When should we use it?
Ipratropium • No significant improvement • No change in admission rates
Ipratropium • Proven benefit in airflow • Trends toward clinical significance • May have late-onset benefit • Cheap and almost completely harmless So………….. • Use it! • (any way you like!)
Steroids • Should I give them? • When should I give them? • Which route? • How much? • For how long?
Steroids: The Pitzele Way • Should I give them? • Yes! • When? • If they don’t get back to baseline after the first neb
