24 February, 2011 by: colinparker

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Asthma in kids is common… very common.  So we should know how to manage it in our Emergency Departments.  Occasionally we see a child with severe or critical asthma; when this happens it is useful to know what your plan is – a plan you can make beforehand, rather than in the heat of the moment…

Join us for this PEMcast as we navigate the current conventional wisdom on management of acute asthma, including what to do when things are not going as well as you would have liked…

Outline of this podcast: Asthma

CP: welcome, disclaimer

CP: intro (not discussing diagnostic controversies in infants & toddlers)

SF: definition (recurrent reversible wheeze?)

KB: incidence (worldwide vs WA – seems high in Perth)

CP: chronic stable asthma assessment & management

SF: assessment of acute asthma attack – overview (Asthma Management Handbook pg 43-46 – table 5)

KB: signs of severe / critical asthma

CP: put into context of treatment prior to attending ED

SF: management of mild & moderate: salbutamol (=albuterol), review response (is fall in SpO2 always bad?), decide disposition

CP/all: why spacers, not nebs?

All: Who should get steroids? What dose? How long? (controversy of steroids in under 5’s to be discussed another time)

KB: treatment options in severe / critical asthma (Atrovent, IV salbutamol, aminophylline, magnesium, mechanical ventilation)

All: any advantage of Adrenaline (=epinephrine) neb, IM or IV)?

CP: Non-Invasive Ventilation vs Intubation & IPPV (risks/complications)

All: Options for intubating drugs (midazolam, fentanyl, thiopentone, propofol, ketamine, muscle relaxant)

SF: Initial ventilator settings

CP/all: Resources (NAC, RCH asthma action plan generator), Summary, goodbye for now

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One Response to “Asthma”
  1. Acupuncture for asthma may sound like an odd combination. One is a common disease that affects approximately 20 million Americans; the other is a mysterious, esoteric, alternative medicine technique. Lots of people have asthma, but not many people have tried acupuncture.

    But if you are an asthma sufferer, it can seem at times that anything – even something as mysterious as acupuncture – is worth trying. Breathing is something that most us never think about. It’s an unconscious process and unless we’re ill, we easily get the oxygen we need. But for people with asthma, breathing is always on their minds. There is always the chance that an asthma attack will leave them gasping for air. Sometime these attacks are predictable and sometimes they are not, sometimes they are minor and easily handled at home, and sometimes asthma suffers end up in an emergency room. It’s no wonder that some asthma sufferers have turned to acupuncture for asthma.

    Asthma is a chronic disease with no cure. There are different types of asthma, but they all produce the same signs and symptoms: rapid breathing, sweating, rapid heartbeat, and the uncomfortable sensation of suffocation. The exact cause of asthma is not known (there may be a genetic factor at work), but there is no doubt that environmental factors – cold, dust, pollution, etc – trigger the attacks. During the attacks, inflammation and constriction of the respiratory passages limit the amount of air that can be inhaled, the attacks can last for minutes or hours and as mentioned earlier, there is no cure. But although there is no cure, there are constant efforts to find new methods of treatment, and there are practitioners and patients who believe that acupuncture for asthma is the answer.

    Acupuncture (the word comes from the Latin words acus, meaning needle, and pungere, meaning to puncture) is a very old system of medicine. It is not clear where acupuncture originates from, but it has been most closely associated with China. In acupuncture, very narrow needles are inserted into the skin (just barely penetrating the surface) at certain key points in the body. The needles are said to correct a disharmony in the flow of energy through the body, a disharmony that is said to be the cause of disease. Traditional, Western medicine has several theories about how acupuncture works (e.g., it may stimulate the release of natural pain relievers, endorphins) but has not yet completely explained how acupuncture.

    Of course, the big question is, does acupuncture work? And can acupuncture successfully treat asthma? Well, not unlike the search for an explanation for how asthma works, the answers are not clear – and they depend on whom you ask. According to traditional acupuncturists, yes, acupuncture for asthma is an effective treatment, especially with asthma in young children. There are dozens of websites and thousands of testimonials that all attest to the effectiveness of acupuncture as a treatment for asthma. Acupuncture, they say, has worked where nothing else has.

    But ask the same question – does acupuncture for asthma work – of doctors and scientists who have been trained in traditional, Western medicine and scientific methodology, and the answer will be quite different. Acupuncture, they say, is as interesting phenomenon, but the question of how it works is less important than the question does it work, and their answer to that is no. There is no conclusive evidence that acupuncture for asthma works, and a review of the scientific studies that have attempted to answer this question have not proven acupuncture to be a viable technique for treating asthma. If there are reports that it works, these can be explained by the placebo effect (The placebo effect states that medications or medical techniques/ procedures may be perceived by the patient as effective because they believe they are effective, but there is no measurable effect).

    So can acupuncture truly help someone who suffers from asthma? That seems to depend on your point of view. If you feel that illness is caused by disruption in energy flow and you are convinced by anecdotal reports, the only reasonable answer is: try it and find out. Acupuncture for asthma is very safe; serious adverse effects are very rare. But if you are the type of person who needs proof in the traditional sense, it may make more sense to stick with the medications/therapies you are taking and wait for solid evidence that acupuncture can help treat your asthma. your car receiving a tune-up before it is in need of a repair.


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