Pulmonary Therapies



Pulmonary Therapies













TABLE 4.1. Asthma—Therapeutic Options

























































Agents Dosage
Inhaled β Agonists
Albuterol 2.5 mg (0.5 ml) diluted in 2–3 ml 0.9% NaCl q2–6h
10–15 mg/h (2–3 ml) diluted to a minimum of 4 ml at gas flow of 6–8 L/min (see Table 4.4)
Levalbuterol 0.63–1.25 mg
q2–6h
Subcutaneous β Agonists
Epinephrine 0.3 mg (0.3 ml)
Terbutaline 0.25 mg (0.25 ml)
Anticholinergic Agents See Tables 4.2 and 4.3
Theophylline See Table 4.5
Corticosteroids
Methylprednisolone or 60–125 mg q6–8h
Hydrocortisone or 2 mg/kg q4h
Hydrocortisone 2 mg/kg then 0.5 mg/kg/h
Inhaled Corticosteroids
Beclomethasone 40–160 μg twice daily
Budesonide 200–800 μg twice daily
Flunisolide 500–1,000 μg twice daily
Fluticasone MDI: 88–220 μg twice daily
PWD: 100–1,000 μg twice daily
Triamcinolone 200 μg 3 to 4 times daily or 400 μg twice daily
IV, intravenous; MDI, metered dose inhaler; PO, by mouth; PWD, powder



























































Route Formulation Comment
Nebulized
Continuous nebulization		 0.5% solution
0.5% solution		 The frequency of intermittent β agonist administration will vary with the severity of illness of the patient; in severely ill patients, the initial interval may be hourly
Nebulized 0.63 mg/3 ml
1.25 mg/3 ml		 No greater benefit over albuterol in acutely ill, critically ill, or mechanically ventilated patients; clinical effects similar to albuterol
Subcutaneous 1:1000 solution May be considered in patients who do not respond to inhaled β agonists; may repeat dose every 15 min as needed up to 3 doses
Subcutaneous 1 mg/ml A second dose may be given after 20 min if necessary
IV/PO    
IV 40, 62.5 mg/ml  
IV 50 mg/ml  
IV
Continuous infusion		    
MDI MDI: 40, 80 μg/puff May be considered as an adjunct to systemic steroid therapy initially; initial dose may be higher
MDI MDI: 200 μg/puff  
MDI MDI: 250 μg/puff  
MDI, Rotadisk
Diskus		 MDI: 44, 110, 220 μg/puff
PWD: 50, 100, 250 μg/puff		  
MDI MDI: 100 μg/puff  









TABLE 4.2. Antibronchospastic Agents—Metered Dose Inhalers






































Agent β2/β1 Potency Dose Per Actuation Recommended Dosage/Interval
Inhaled β-Adrenergic Agents
Albuterol ++++/± 90 μg* 1–2 puffs q2–6h
Salmeterola See note    
Anticholinergic Agents
Ipratropium bromide — 18 μg 2–4 puffs q2–6h
Albuterol and ipratropium ++++/±
—		 90 μg*
18 μg		 2 puffs, 4× daily
Tiotropium — 18 μg One capsule, inhaled once daily
Individual capsules used for each dose
The dosing interval may vary depending on the severity of illness of the patient. The dose may need to be higher for patients on mechanical ventilation (i.e., 4–8 puffs q2–6h).
aSalmeterol is indicated for prophylactic use in chronic stable asthma and is not recommended for the treatment of acute bronchospasm. For maintenance of bronchodilatation and prevention of the symptoms of asthma, the usual dose is 2 puffs (42 μg) twice (in the morning and evening) daily.
*Dose delivered in terms of 90 μg of albuterol base.









TABLE 4.3. Antibronchospastic Agents—Nebulized Drugs


















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Jun 16, 2016 | Posted by in CRITICAL CARE | Comments Off on Pulmonary Therapies

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Agent β2/β1 Potency Formulations Dosage
β-Adrenergic Agentsa
Albuterol ++++/± 0.5% solution 2.5–5 mg diluted in 2–3 ml 0.9% NaCl q2–6h