Respiratory

Bronchial Asthma

دمہ

Recurrent cough, breathlessness and wheeze, worse at night and with seasonal variation. Managed stepwise: counselling, basic drugs, then inhalers and specialist referral.

ICD-10: —
Source: OPD handbook pp.35–40
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Cough
Shortness of breath (SOB)
Wheezing
Symptoms worse at night
Seasonal variations

Red flags Refer urgently if any are present

Daytime symptoms
Symptoms more than 3 times per week
Daily activities affected
These indicate referral to a pulmonologist

Diagnosis

Take vitals of all patients; respiratory rate raised
Chest shows rhonchi
Differential diagnosis: COPD

Treatment

Step 1 of 7

Acute attack: emergency treatment

Injectable steroid stat
Nebulization with a bronchodilator and a steroid
Discharge if the patient is vitally stable
Antibiotic if productive cough or febrile

Prescription

DexamethasoneCorticosteroid

Dose1 mL IV stat

Brand Inj Dexa / Inj Decadron

Also sold as Decadron, Dexa, D-Cort

Ipratropium bromide (nebulizer)Anticholinergic bronchodilator

DoseNebulization (bronchodilator)

Brand Atem

Beclometasone (nebulizer)Inhaled corticosteroid

DoseNebulization (steroid)

Brand Clenil

Also sold as Clenil, Clenil-C

Step 2 of 7

After discharge: antibiotic if indicated

Indicated by greenish / yellowish sputum, blood-streaked sputum, or fever

Prescription

LevofloxacinFluoroquinolone antibiotic

Dose250 mg BD

Brand L-Cyn

Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo

Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor

Dose625 mg TDS

Brand Augmentin

Also sold as Augmentin, Co-Amoxiclave, Calamox

Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use

Cefixime3rd-generation cephalosporin

Dose400 mg OD

Brand Caricef

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

MoxifloxacinFluoroquinolone antibiotic

Dose400 mg OD

Brand Mofest

Also sold as Mofest, Moxef, Avelox, Moxiget

Step 3 of 7

Step 1: Counselling

The patient has an allergy of the airways (airways narrowing); keep away from dust, smoke, husk (bhoosa) and animals
Wear a mask; avoid pain-killer tablets
Remove carpets and similar dust collectors from the room
Avoid too much tea

Step 4 of 7

Step 2: Basic management

Antihistamine at night
Leukotriene receptor antagonist at night
Bronchodilator (theophylline group) syrup
Nebulization with ipratropium and beclometasone QID when needed

Prescription

CetirizineAntihistamine

Dose10 mg HS (1+0)

Brand Tab Rigix 10 mg / Cetrix / Sedil

Also sold as Rigix, Sedil, Antial, Neo-Antial, Cetrix, Zyrtec

ChlorpheniramineAntihistamine

Dose1+1 (alternative to Rigix)

Brand Tab Piritone 4 mg

Also sold as Peritone, Piritone

MontelukastLeukotriene receptor antagonist

Dose10 mg HS

Brand Montika / Freehale / Montiget

Also sold as Montika, Freehale, Montiget

Acefylline (theophylline group)Bronchodilator

Dose2 tsf TDS (2+2+2)

Brand Syp Acefyl 125 mg/5 mL

Doxofylline (theophylline group)Bronchodilator

Dose2 tsf TDS (2+2+2)

Brand Syp Xofyl

TheophyllineBronchodilator

Doseas per theophylline group

Brand Unifyline

Also sold as Unifyline, Theograd 350, Respro SR 200

Hydraline syrup (bronchodilator cough syrup, as written)Bronchodilator / expectorant syrup

Dose2 tsf TDS

Brand Syp Hydraline

Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist

Doseas per theophylline-group bronchodilators

Brand Terbutaline (e.g. Britanyl)

Also sold as Britanyl, Bricanyl, Muconyl

Step 5 of 7

Step 3: Advanced management

Inhalers (also used in COPD)
Refer to a pulmonologist when: daytime symptoms; symptoms more than 3 times per week; daily activities are affected

Prescription

Budesonide + Formoterol (inhaler)ICS + LABA inhaler

DoseInhaler; 2 puffs (per Urdu note)

Brand Inh Combivair 100/6

Tiotropium (inhaler)Long-acting anticholinergic

Dose1 puff (per Urdu note)

Brand Inh Tiovair 18 mcg

Step 6 of 7

Indications of steroids

Acute exacerbation of disease
Treatment failure with antihistamine, LR antagonist and theophylline compounds
Steroid dependent
Dose 1 mg/kg; plan: taper off every 10th day

Step 7 of 7

Indications of antibiotics

Greenish / yellowish sputum
Blood-streaked sputum
Patient is febrile
Choice: levofloxacin, cefixime, moxifloxacin