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Download e-book for kindle: Bronchial Asthma in Children: A Clinical, Diagnostic and by Lahiri

By Lahiri

ISBN-10: 8180610799

ISBN-13: 9788180610790

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Fluticasone caused greater adrenal suppression at doses of 400-2000 μgm than budesonide in equivalent doses. Cataracts There appears to be no association between inhaled corticosteroids and posterior subcapsular cataracts. Glucose Metabolism Inhaled steroids failed to affect fasting glucose or glycated haemoglobin at dosages from 400-1000 μgm/day (budesonide). 1: Factors affecting serum theophylline concentrations Factor Viral illness Theophylline concentration ↓ ↑ Action ↓ Metabolism Serum level, ↓ Dose by 50% if level not available ↓ Metabolism Serum level Hypoxia, CCF, cirrhosis Age ↑ Metabolism ↓ Metabolism Serum level (1-9 years) (< 60 month) Food ↓ Delays absorp- ↑ Rate of absotion of SRT rption (fatty food) Diet ↑ Metabolism ↓ Metabolism high protein (high CHO) Phenobarb, ↑ Metabolism phenytoin, carbamazepine Contd...

Decrease the work of breathing. “Permissive Hyperapnea or Controlled Hypoventilation is recommended” • PaCO2 is allowed to remain higher than usual by decreasing ventilator settings. The aim is to reduce hyperinflation and barotrauma. • Tidal volume is set in such a way so as to minimise peak inspiratory pressure (PIP). • Prolong the expiratory phase by increasing expiratory flow and decreasing the respiratory rate. • Elevated PaCO2 levels carries a small risk of cardiac dysrhythmias and hypertension.

Nebulised MgSO4 therapy is ineffective. Magnesium works by modulating calcium channels causing a decrease in acetylcholine with subsequent bronchodilatation and inhibition of histamine release from mast cells. 5 mgm subcutaneously in addition to inhaled short acting β2 agonist. 2 μg/kg/min. Continue to monitor the child for ventricular dysrhythmias or myocardial ischaemia. (iv) Helium and oxygen combination [80:20; 70:30). The lower density of heleox allows this mixture to pass through a narrow airway with less turbulence than oxygen alone and can improve distal oxygen delivery.

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Bronchial Asthma in Children: A Clinical, Diagnostic and Management Primer by Lahiri


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