Nebulized corticosteroids

Inhaled short-acting beta 2 agonist treatment is the mainstay of office or emergency department treatment of moderate to severe asthma exacerbations. If the patient can tolerate a measurement of PEF or forced expiratory volume in one second (FEV 1 ), an initial value should be obtained and repeated to monitor treatment response. In patients with severe exacerbations, continuous beta 2 agonist administration has been shown to improve pulmonary function measurements and reduce hospital admission with no notable differences in pulse, blood pressure, or tremor. 21 The use of high-dose albuterol ( mg via nebulizer every 20 minutes for three doses) 22 and intravenous beta 2 agonists does not appear to be beneficial and is not recommended. 23

Thyroid storm is a life-threatening condition of the hyperthyroid state. 26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma. 27 It is treated by correcting the hyperthyroidism and treating the precipitating events. 26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T 4 ) to the more potent triiodothyronine (T 3 ). 22 , 26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours. 28

In the context that one major purpose of a staging system is to establish prognosis, attention has focused on the value of including weight (ie, body mass index [BMI]), dyspnea, and exercise capacity (ie, the 6-minute walk distance), with FEV 1 in staging COPD. 19 Indeed, the resultant index, called BODE (for BMI, obstruction, dyspnea, and exercise capacity) has been shown to better predict survival in COPD than FEV 1 alone. BODE scores of 0 to 10 (most impaired) are stratified into 4 quartiles, which discriminate mortality risk better than FEV 1 alone. Other multifactorial prognostic systems (eg, ADO [for age, dyspnea, and obstruction] and DOSE [for dyspnea, obstruction, smoking, and exercise capacity]) have also been proposed. 20,21

Nebulized corticosteroids

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