Communicating Breathlessness: Outcome Study with Copd and Asthma Patients
Total Page：16
File Type：pdf, Size：1020Kb
1
Kendrick, et al. 2
Protocol for management of patients with acute bronchospasm
Obtain vital signs, O Sat, and 2 peak expiratory flow rate (PEFR), and MBS Category I: PEFR < 50% Triage immediately to ER area
Ascertain Triage Reassess Category II: PEFR >50%<65% Category (I, II, or III, meds and or rest dyspnea see Table) triage seen within 30 min by MD
Category III: PEFR >65% Administer MDI trial* & if no rest dyspnea at rest seen as soon as resources permit Wait 30 min, then repeat PEFR assessment and eval.
YES Responder?*
NO
MDI trial: 6 puffs of Albuterol MDI and 6 puffs of Ipratroprium MDI using spacer device. Administer MDI trial Figure 2. Protocol for management of patients withAcute acute responder: : bronchospasmWait 30 min,at the then Emergency Department and1. Urgent Ppatient with marked clinical Care repeatClinic at PEFR the VA San Diego HealthCare System,improvement San as evidenced by decrease in Diego,assessment California and eval. dyspnea or improvement in audible air movement or 2. PEFR increase by 20% over initial value Responder*? or * NO 3. PEFR >75% predicted or at baseline. Titration should be halted if there is acutetoxicity including tremor, excessive, excessive tachycardia, arrhythmia, palpitations, Repeat MDI trial or or complaints of severe anxiety. Consider use of * Consider steroid therapy immediately agonist/Ipratroprium for patients in category I and after 1-2 MDI Kendrick,combination et al. by nebulizer trials in Category II patients who have not responded. 3
Kendrick, et al. 4
Kendrick, et al. 5
Kendrick, et al. 6
1.
Kendrick, et al. 7
Kendrick, et al. 8
Kendrick, et al. 9
Kendrick, et al. 10
Figure 3. The response to therapy measured by the peak exiratory rate (PEFR) in the asthma and COPD group demonstrated that both groups had an increase in peak flow from pretreatment posttreatment. No significant degree of change in the patients’ PEFR reading occurred when Kendrick,they were et treated al. with a metered dose inhaler with spacer device (MDI) compared with a hand held nebulizer (NEB). 11
Kendrick, et al. 12
Protocol for management of patients with acute bronchospasm
Obtain vital signs, O Sat, and 2 peak expiratory flow rate (PEFR), and MBS Category I: PEFR < 50% Triage immediately to ER area
Ascertain Triage Reassess Category II: PEFR >50%<65% Category (I, II, or III, meds and or rest dyspnea see Table) triage seen within 30 min by MD
Category III: PEFR >65% Administer MDI trial* & if no rest dyspnea at rest seen as soon as resources permit Wait 30 min, then repeat PEFR assessment and eval.
YES Responder?*
NO
MDI trial: 6 puffs of Albuterol MDI and 6 puffs of Ipratroprium MDI using spacer device. Administer MDI trial Acute responder:: Wait 30 min, then 1. Ppatient with marked clinical repeat PEFR improvement as evidenced by decrease in assessment and eval. dyspnea or improvement in audible air movement or 2. PEFR increase by 20% over initial value Responder*? or * NO 3. PEFR >75% predicted or at baseline. Titration should be halted if there is acutetoxicity including tremor, excessive, excessive tachycardia, Repeat MDI trial or arrhythmia, palpitations, or complaints of Consider use of severe anxiety. agonist/Ipratroprium * Consider steroid therapy immediately Kendrick,combination et al. by nebulizer for patients in category I and after 1-2 MDI trials in Category II patients who have not responded. Asthma COPD
MDI (n=17) MDI (n=35) NEB (n=25) NEB (n=25) )
M 400 400 P L (
w o l F
y r
o 300 300 t a r i p x E
k a e 200 200 P
13 PRE POST PRE POST
Figure 3. The response to therapy measured by the peak expiratory flow rate (PEFR) in the asthma and COPD group demonstrated that both groups had an increase in peak
Kendrick, et al. 14
Figure 4. The response to therapy measured by modified Borg scale (MBS) in the asthma and COPD group revealed that dyspnea scores decreased after respiratory treatments. No significant degree of change occurred in the patients’ MBS scores when they were treated with meter dose inhaler with spacer device (MDI) compared with a hand held nebulizer (NEB)
Kendrick, et al. 15
Figure 5. The response to therapy measured cutaneous oxygen saturation (Sao2) in the asthma and COPD group increased from before to after respiratory treatment. A greater increase in Sao2 occurred in the COPD than in the asthma group, concurrently, the post COPD group had slightly higher Sao2 percentages when using a hand held nebulizer (NEB) than when using a metered dose inhaler with spacer device (MDI).
7
Kendrick, et al. 16
Kendrick, et al.