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A 65 year old asthama paitent comes to opd he has also diabeties mellitus type 2 and a exacreabtion of asthama attack how should i manage the paitent Genrare a ppt for managemet

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Asthma Exacerbation T2DM Management

Presentation · PPTX

What's Inside (9 Slides)

SlideContent
1Title Slide — Patient Profile (65yr, T2DM, acute asthma)
2Initial Assessment — Severity classification table (Mild/Moderate/Severe) with SpO₂, PEF, FEV₁ cutoffs
3Immediate Management — SABA (Salbutamol), Ipratropium, O₂, Corticosteroids, IV MgSO₄; with Diabetes Alert on steroids
4Diabetes Management — Steroid-induced hyperglycemia mechanism, glucose monitoring protocol, drug adjustment table (Metformin, SU, GLP-1, Insulin)
5Drugs to AVOID (β-blockers, NSAIDs, high-dose theophylline) and Use with CAUTION (dark theme, clearly flagged)
6Stepwise Algorithm — 4-step OPD protocol (0–20 min → 20–60 min → 1–2h → Decision), plus long-term controller therapy
7Monitoring Parameters + Referral Criteria (SpO₂ <90%, PEF <40%, silent chest, etc.) + Discharge criteria
8Discharge Prescription + Patient Education (inhaler technique, Asthma Action Plan zones, diabetes self-monitoring)
9Clinical Summary — 6 key take-aways

Key Management Points for This Patient

  1. SABA first — Salbutamol 2.5–5 mg nebulized q20 min × 3 doses + Ipratropium 0.5 mg
  2. Steroids are mandatory — Prednisolone 40–60 mg PO (unavoidable even in diabetics)
  3. Glucose monitoring is critical — Steroids cause hyperglycemia peaking 4–8h post-dose; check CBG q4–6h; target 7–10 mmol/L
  4. Adjust antidiabetics — May need to initiate/intensify insulin while on systemic steroids
  5. Never use β-blockers — Even cardioselective ones risk bronchospasm in asthma
  6. Discharge with ICS controller + written action plan + 48h follow-up
Source: Textbook of Family Medicine 9e, Management of Asthma Exacerbation, p.465

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