MANAGEMENT OF ASTHMA
MANAGEMENT OF ASTHMA
Drug treatment is not the only treatment of asthma. A holistic approach is required for optimal management of asthma and consists of:
• Drug treatment
• Allergen avoidance
• Family education
• Awareness of psychological factors. The aims of treatment in the control of asthma are:
• Minimally (ideally no) chronic symptoms, including nocturnal symptoms
• Minimal (infrequent) episodes of exacerbation
• No emergency visit
• Minimal need for ß2-agonist
• No limitation of activities including exercise
• PEF variability less than 20%
• Near normal PEF
• Minimal or no adverse effects from medicine.
Stepwise Approach to Drugs
Before altering a treatment it should be ensured that the treatment is being taken in an effective manner
Step 1: Occasional use of relief bronchodilators (intermittent and infrequent episodic asthma and exercise-induced asthma). Short acting ß2-bronchodilator (SABA) for relief of symptoms.
Step 2: Regular inhaled preventive therapy (frequent episodic and mild persistent asthma):
• Short acting ß2-bronchodilator as required + regular lowdose inhaled steroids (200–400 µg/day of BPD and Bud or 100–200 µg/day of FP) + antileukotriene can be considered.
Step 3: Add on therapy (Poorly controlled on conventional dose of ICS):
• Inhaled long acting ß2-bronchodilator + low-dose inhaled steroids, or
• If no benefit with LABA® ? stop LABA and increase ICS to upper limit of standard dose range
• Consider to add leukotriene receptor antagonist (LTRA) or slow release theophylline.
Step 4: Persistent poor control:
• High-dose of inhaled steroids (up to 800 µg/day of BPD or Bud or 400 µg/day of FP) + continue long acting bronchodilator + SABA as required (during exacerbation)
• Consider to add LTRA or slow release theophylline.
Step 5: Continuous or frequent use of oral steroid:
• Use daily steroid tablet in low dose
• Maintain high dose inhaled steroid at 800 µg/day of Bud or BPD 400 µg/day of FP
• Refer to respiratory specialist.
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