This document provides guidelines for the management of asthma and chronic obstructive pulmonary disease (COPD). It outlines the different types of conditions that can cause wheezing, such as cardiac, pulmonary and allergic conditions. Treatment options are discussed, including different classes of controllers and relievers for asthma. Guidelines are provided for assessing severity of exacerbations and determining the appropriate treatment and disposition. Scoring systems help classify asthma exacerbations as mild, moderate or severe to guide management decisions.

1. CPG-03
-

2. CPG - 03
1/11
PCT

3. CPG - 03
2/11
o Cardiogenic Conditions : - Congestive Heart Failure, MI
o Pulmonary Conditions : - Pulmonary edema, Foreign
Body, Pneumothorax, Hemothorax, Pleural Effusion,
Pulmonary Tuberculosis, Pneumonia
o : GERD, Anaphylaxis
o
Asthma Bronchiectasis COPD (Emphysema +
Chronic Bronchitis)
(Asthma)
Rhinitis, Conjunctivitis
Dermatitis
-

4. CPG - 03
3/11
- ---- Wheezing
Chest X-ray : - normal
- Bronchodilator test :- PEFR >
- -
COPD )
Emphysema
Chronic Bronchitis
---
Lungs :- Ronchi, Crepitation
Wheezing
- Decreased Breath sound
- Barrel chest
- Chest X-ray

5. CPG - 03
4/11
-
Emphysema : - AP
diameter
-
-
-
Chronic Bronchitis :- Peribronchial
thickening
(Bronchiectasis)
-
Chronic Bronchitis
-
Lungs :- Ronchi,
Crepitation, Wheezing
:
-- - - -

6. CPG - 03
5/11
Chest X-ray :- Peribronchial Thickening
Chronic Bronchitis Lower
lobe
- Honeycomb appearance
1.
2.
3.
1. ER, Admit)
2.
3.
4.
5.
1.
1)
2)
3)
4)
2.

7. CPG - 03
6/11
3.
1)
2) Care Plan
4.
Asthma
Controllers Relievers
1. Controllers
Persistent
Inhaled Corticosteroids (ICS)
1.1 Corticosteroids
Inflammation
mucous
- action ß2-against

8. CPG - 03
7/11
--
Hypersensitivity
Side effect Steroids
adrenal
gland Bone mass
- -
-
Long - acting ß2- agonist
Salmeterol Fluticasone ( ICS )
Seretide 2 25/50 25/125
Corticosteroids
Inflammation
- ICS
ICS
-
Xanthine Sustained release (Thophylline SR)
Inflammation
2. Relievers

9. CPG - 03
8/11
--
2.1Short-acting ß2- agonist Salbutamol
Inhaler, NB
hypokalemia
- Pregnancy
2.2 Anticholinergic drug + ß2 - agonist Berodual
Inhaler NB Ipratropium bromide
Fenoterol
- -
Hypokalemia
- Prostate hyperplasia
- Narrow angle glaucoma
- Pregnancy Lactation
<12
2.3 Methylxanthine (Aminophylline)
acute
severe asthma Status asthmaticus ß2-agonist
- --

10. CPG - 03
9/11
Budesonide
MDI
200 mg/puff 200-1600 mg /
Prednisolone 5 mg 5-60 mg /
0.1-2 mg/kg /
Dexamethasone 4 mg/Amp 5 mg
Hydrocortisone 100 mg/vial 1-2 mg/kg
6
0.5-1 mg/kg
6
Berodual Forte
(4cc)
Ipratropium 500
mcg Fenoterol
125 mcg
1-4
Berodual
Inhaler
Ipratropium 200
mcg
Fenoterol 500
mcg
1-8 Puff /
Salbutamol
Inhaler
Salbutamol 100
mcg/puff
1-2 Puff 4-
6

11. CPG - 03
10/11
Salbutamol NB Salbutamol
0.5
> 12 0.5-1
cc 4-6 < 12
> 20 0.5 cc
4-6
< 12 < 20 0.25
cc 4-6
Salbutamol 2 mg/ 1
2 mg/ 1
Dose -
< 2 0.1-0.2 mg/kg
2-6 0.1-0.2 mg/kg
Max 12mg/day 6-12
2 mg. Max
24mg/day > 12
2-4 mg. Max
32mg/day
>70 2 mg.
Max mg/day
Seretide Salmeterol 25
mg
Fluticasone
50 125 mg
1-4 Puff /day

12. CPG - 03
11/11
Aminophylline 250 mg/ 10 ml 4 mg./kg/dose
8 (
mg)
1.
Asthma, COPD PEF
Bronchodilator Bronchodilator
PEFR
2.
PEFR
PEFR – PEFR
____________________ x 100
PEFR
Chest X-ray

13. CPG - 03
12/11
Asthma , COPD
Bronchiectasis
2.
Intermittent Persistent
1. ≥ 1
2. ≥ 2
3. PEFR < 80 %
- Persistent
ICS ( step 2 )
- Intermittent
Reliever as needed
Easy Asthma Clinic
Step
1.
2.

14. CPG - 03
13/11
3.
4.
5.
Step
ß2- agonist as needed
2. ICS (low dose)
3. ICS (low dose) +
LABA
4. ICS (low dose) +
LABA + Xanthine
5. ICS (medium dose)
+LABA + Xanthine
6. ICS (high dose)
+LABA + Xanthine
Step
Salbutamol Inhaler prn
Budesonide 1 2 Puff / day
Budesonide 1 x 2 + Seretide (25/50)
1 2 P / day
Seretide (25/50) 2 x 2
Seretide (25/50) 2 x 2 +
Theophylline
Seretide (25/125) 2 x 2 +
Theophylline
Budesonide 1 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
Budesonide 2 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
Budesonide 3 x 2 + Seretide
(25/125) 2 x 2 + Theophylline

15. CPG - 03
14/11
7. ICS (high dose)
+LABA + Xanthine +
Prednisolone
Budesonide 3 x 2 + Seretide
(25/125) 2 x 2 + Theophylline
+Prednisolone dose
Steroid Step
Budesonide 1x1
1.1. Intubation
- Unstable vital signs
- Respiratory Rate > 35 /min
-
-
- Respiratory failure
- Hypoxia = Cyanosis, Air hunger
- O2 Sat < 95
- Cardiac or Respiratory arrest

16. CPG - 03
15/11
-
- Secretion obstruction
ß2 agonist NB ê O2 6 /min O2
Sat
-
Dexamethasone mg stat Prednisolone
6 Tb stat
- IV Fluid
- Lab CXR, CBC, U/A
1.2 Severity
> 5
-
RR < 30
RR 30-40
RR > 40
≤ 5 RR < 40
RR 40-60
RR > 60

17. CPG - 03
16/11
Retraction
Retraction 1
Retraction > 1
Wheezing
Expiratory wheezing
Inspiratory Expiratory
4.
O2 Sat ≥ 95
-
Scores
Total Score ≥8
- Salbutamol NB Stat
- Dexamethasone 8 mg v Stat

18. CPG - 03
17/11
- Admit Refer
2. Total Score 4-7
Dexamethasone 8 mg v Stat-
Salbutamol NB
Severity Score
o Severity Score < 4 D/C
o Severity Score > 4
o Severity Score > 4
Admit
Total Score < 4
-
Prednisolone 6 tab stat
Salbutamol NB Severity Score
< 4 D/C
--
Prednisolone 2x3
Antibiotics,
Antihistamine
-

19. CPG - 03
18/11
--
≥ 8 ≤ 7
Bronchodilator
NB Stat
Dexamethasone
8 mg v stat
Bronchodilator
Asthma Severity
Score

20. CPG - 03
19/11
ADMIT REFER
≥4<4
Discharge
with F/U
Bronchodilat
or 2
≥4
≥ 4
<4
< 4
Discharge
with F/U
Bronchodilat
or 3
≥4<4
4
Discharge
with F/U Admit

21. CPG - 03
20/11

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21/11

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22/11

24. CPG - 03
23/11

25. CPG - 03
24/11

26. CPG - 03
25/11

27. CPG - 03
26/11

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27/11

29. CPG - 03
28/11

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29/11

31. CPG - 03
30/11

32. CPG - 03
31/11

33. CPG - 03
32/11

34. CPG - 03
33/11

35. CPG - 03
34/11

36. CPG - 03
35/11