Classification Treatment & Management of Respiratory Illness

Symptoms	Classification	Treatment Management
One or more symptoms given bellows # Very fast breathing # Hyperpyrexia or Hypothermia # Heart rate more than 140/m # Hypotension # Lethargic, Confused, Agitated # Not able to walk without support # Use of accessory muscle in breathing # Speak in word or not able to speak # Blood in sputum more than 200ml Within 24 hour # Severe chest pain	Severe Pneumonia or, Very Severe Disease	# Give first dose of antibiotic IM or Orally # Urgently refer to hospital with oxygen if available.
Any 2 symptoms given bellows # Very fast breathing # Fever 99. C or more # Pleuritic chest pain	Pneumonia	# Give appropriate antibiotic # Give IM antibiotic for 1st & 2nd trimester of Pregnancy & refer immediately # Advice stop smoking for smoker # Advice to come Health Institution if condition Worse # Follow up after 2 days.
# Cough more than 2 weeks # Difficulty in breathing # Haemoptysis in smoker # Weight loss # Recurrent cough in morning , night # Breathlessness on exercise	Possible Chronic Lung Problem	# Refer to Hospital or PHC for diagnosis # If cough presence more than 2 weeks do sputum exam for AFB # Advice stop smoking for smoker
Insufficient symptoms for above classification	No Pneumonia : Cough, Cold or Bronchitis	# Advice safe treatment of common cold # Advice stop smoking for smoker

 

If the patient has COPD diagnosis :

Symptoms	Classification	Treatment Management
One or more symptoms given bellows : New or Old # Breathing 30 or more per minute # Lethargic, Confused, Agitated # Not able to walk without support # Hypothermia # Use of accessory muscle in breathing # Speak in word or not able to speak # Blood in sputum more than 200ml Within 24 hour # Swelling both leg	COPD with Severe Deterioration	# Urgently refer to hospital with oxygen if available
# Yellowish, Greenish sputum # Increase in cough with spuum # Temperature 37.5.c or More	Acute Infection in COPD	# Give appropriate antibiotic # Follow up regularly for COPD case # Check regimen # If COPD treatment card has not make refer to Hospital for assessment # Advice stop smoking for smoker # Advice to come Health Institution if condition Worse
If no symptoms above classification	Stable COPD	# No need of new treatment # Advice stop smoking for smoker # Follow up regularly

 

If the patient has wheezing :

Symptoms	Classification	Treatment Management
# Breathlessness at rest or, # Speaks in single words or, not able to speak or, # Confused, Agitated difficulty in breathing with lethargic # Pulse rate more than120/min # PEFR : < 50% predicted	Severe Wheezing	# Give salbutamol inhaler 10 to 20 times # Repeate dose of salbutamol inhaler every 20 minutes. # If available give oxygen. # If fever, give IM antibiotics. # If available give Nebulizer every 20 minutes. # Refer to hospital with oxygen if available.
# Breathlessness at talking, # Uncomfortable lying down, # Speaks in sentence or, # Use of accessory muscles or, # Pulse rate 100 to 120/min # PEFR: 50% to 70 % predicted.	Moderate Wheezing	# Give salbutamol inhaler or, Neubulizer every 20 minutely for 1 hour, # Give antibiotics orally # Assess the patient after one hour.
Symptoms given bellows : # Breathlessness at walking or, no breathlessness # Comfortable in lying down # Speaks in full sentence # Pulse rate < 100/min # PEFR : > 70 % predictedcted	Mild Wheezing	# Give salbutamol inhaler 4 to 8 times or give Nebulizer, # Re-assessment of patient, # If patient condition is not improve in assessment repeat in 20 minutes .

 

Age	Fast Breathing	Very Fast Breathing
5-12 Years	30/min or more	40/min or more
13 Years or more	25/min or more	30/min or more

 

 

 

 

 

Hypothermia	Fever	High Fever	Very High Fever
35. C or less (<96. F)	37.5. C or more (>100. F)	38.5. C or more (>102. F)	40. C or more (>104. F)

 

 

 

If the patient has Fever :

Risk of Malaria	Symptoms	Classification	Treatment
If patient Has High Risk of malaria	One or more symptoms given bellows : Confused, Agitated Very fast breathing Use of accessory muscles in breath Not able to walk without support Not able to drink Stiffness of neck	Very High Fever	Give Quinine or Artemether IM Give first dose of Antibiotic IM Give Glucose Urgently Refer Hospital If Pregnant Give Antibiotic Orally
	Fever or History of Fever	Malaria	Give appropriate Antimalarial Take Blood Slide Follow Up after 2 days
If patient Has Medium Risk of malaria	Confused, Agitated, Lethargic or, Fast & deep breathing Not able to drink or not able to walk without support or stiffness of neck	Very High Fever	Give Quinine or Artemether IM Give first dose of Antibiotic IM Give Glucose Urgently Refer Hospital If Pregnant Give Antibiotic Orally
	Fever or History of Fever No any cause of fever	Malaria	Give appropriate Antimalarial Take Blood Slide Follow Up after 2 days
	Other possible cause of fever	Fever : No malaria	Treat cause of fever If patient has classified severe pneumonia give antimalarial treatment also
If patient Has Low Risk of malaria	Confused, Agitated, Lethargic or, Fast & deep breathing Not able to drink or not able to walk without support or stiffness of neck	Very High Fever	Give first dose of Antibiotic IM Give Glucose Urgently Refer Hospital
	Fever 5 days or more	Continuous Fever	Treat cause of fever If cause is unknown refer to hospital for assessment
	If no symptoms above classification	Uncomplicated Fever	Treat cause of fever If cause is unknown refer to hospital for assessment

 

Low to Moderate Cost Treatment Regimen For Obstruction

Symptoms	Classification	Treatment
Cough, Chronic sputum production	Chronic bronchitis without obstruction (Stage 1)	Inhaled salbutamol 2-4 puffs as need, no more than 12/day
With or without chronic symptoms(cough, sputum production)	Mild COPD (Stage 1)	Inhaled salbutamol 2-4 puffs as need, no more than 12/day
With or without chronic symptoms(cough, sputum production breathlessness)	Moderate COPD (Stage 2a & 2b)	# SR theophylline low dose # Inhaled ipratropium bromide 2-6 puff qid # Inhaled salbutamol 2-4 puffs as need, no more than 12/day
Severe COPD Severe symptoms, exercise limitation,+ right sided hert failure	Severe COPD (Stage 3)	# If responds to steroid trial inhaled beclomethasone 1000mcg/day # SR theophylline low dose # Inhaled ipratropium bromide 2-6 puff qid # Inhaled salbutamol 2-4 puffs as need, no more than 12/day

 

Optimal Treatment Regimen For Asthma

Episodes of Breathlessness	Classification	Treatment
Less than 1/week or after exercise/exposure	Intermittent Asthma (Step 1)	# Oral Salbutamol
1 more /week but less than 1/day	Mild Persistent Asthma (Step 2)	# SR theophylline low dose # Oral Salbutamol
Daily Night symptoms more than 1/week.	Moderate Persistent Asthma (Step 3)	# SR theophylline low dose # intermittent prednisolone inhaled # beclomethasone 2000 mcg per day for 2 weeks then 1000mcg per day
Continuous Frequent night symptoms Limits physical activity	Severe Persistent Asthma (Step 4)	# Prednisolone 0.5 mg/kg/day. Taper to lowest dose inhaled # SR theophylline low dose # beclomethasone 2000 mcg per day for 2 weeks then 1000mcg per day