Special Operations Forces Medical Handbook

4-19

Plan:
Treatment:
Primary:

1. Initial therapy: Avoid exposure.


2. Corticosteroids: Prednisone, 2 mg/kg/day or 60 mg/m2/day po, or other comparable corticosteroid. Initial
   course of 1-2 weeks with progressive withdrawal of medication. If exposure cannot be discontinued,
   alternate day therapy may help, but may not prevent progression.


3. If symptoms have progressed to pneumonia, give antibiotics (Macrolide, Vibramycin) and bronchodilator
   (albuterol) as discussed in Pneumonia and Asthma Sections respectively.
   Primitive: Avoid allergen. Breath humidied air from steam kettle or shower.

Patient Education
General: Avoid the allergen. There is risk of irreversible lung damage with continued exposure. Note that
chronic exposure may lead to a loss of acute symptoms previously experienced on exposure, i.e., patient may
lose awareness of exposure-symptom relationship.
Activity: Restrict if symptoms worsen after exposure to antigen
Prevention: Use appropriate masks and lters when exposed to allergen. Keep ventilation systems clean
and well maintained.
No Improvement/Deterioration: Return for worsening symptoms or those that do not resolve after 3-4 days
of treatment.

Follow-up Actions
Return Evaluation: Symptoms that do not improve should be referred for specialty care and additional
special studies.
Evacuation/Consultation criteria: Evacuate patients who are not able to complete the mission, or whose
symptoms do not resolve. Consult internist or pulmonologist as needed.

Respiratory: Asthma

COL Warren Whitlock, MC, USA

Introduction: Asthma is usually an acute allergic response triggered by inhaled particles (dander, pollen,
mold, and dust), fumes, drugs or food. It is characterized by continuous or paroxysmal breathing, wheezing,
coughing or gasping caused by narrowed airways in the lungs. This narrowing is due to spasm of bronchial
smooth muscle, edema and inflammation of the bronchial mucosa, and production of mucus. Asthma can
occur at any age but develops most commonly in children, with 7-19% of children experiencing asthma at
some time. 50% of cases are children under age 10. Asthma attacks may have a slow onset or they may
occur suddenly, causing death in minutes. Some cases may become continuous (called status asthmaticus),
and can be fatal. Intermittent symptoms are usually brought on by exercise, cold air or respiratory tract
infections. Nocturnal asthma attacks occur in up to 50% of all asthmatics and may be the only symptoms
presented by the patient. Smoke, other inhaled pollutants, respiratory tract infections (especially viral), aspirin
use, tartrates, exercise, sinusitis, gastroesophageal reflux, and stress are aggravating factors.

Subjective: Symptoms
May be paroxysmal or constant: Coughing, labored breathing, wheezing, gasping, feeling of constriction in
the chest.
Focused History: Quantity: How many nights are you awakened by wheezing? (few times per week
indicates moderate disease; almost nightly indicates severe disease). How many days of work or school
have you missed in the last month because of asthma? (provides gauge to improvement and control)
Duration: Have you been admitted to the hospital for asthma? (Patients with histories of hospitalization tend
to progress very rapidly and should be treated aggressively and early.) Alleviating Factors: What typically
triggers an asthma attack? (Any recognized trigger should be diligently avoided.)