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.