Treatment of Asthma

Chronic inflammatory disorder in susceptible individuals - reversible either spontaneously / w/ treatment

Wheezing/coughing Chest tightening Breathlessness Childhood

Bronchospasm with wheezing

Further inflammation + airway obstruction Cough + Sputum production

Medical History Signs + symptoms Lung function tests - spirometry - PEF (peak expiratory flow)

Intermittent Reliever therapy 1) Regular preventer therapy (mild persistent asthma) 2) Initial-add on therapy (moderate persistent) 3) Additional add-on therapy 4) High dose therapy 5) Continuous/frequent use of oral steroids

All patients with symptomatic asthma use Reliever - short-acting Beta2 agonist e.g. salbutamol) when needed - consider stepping up if using 3 doses a week or more

Controllers - taken daily to keep asthma under control Relievers - used on a as-needed basis to reverse bronchoconstriction quickly

Confirmed diagnosis of asthma Need to be on a - Inhaled corticosteroid (controller) = low dose - Short-acting beta2 agonist (reliever)

Low dose inhaled corticosteroids + long-acting beta2 agonist (controller) - Adults/children>5years = LABA/leukotriene receptor antagonist - children<5years = LABAs not licensed, just add LTRA Short-acting beta2 agonist

Increased inhaled corticosteroid dose + LABA (controller) SABA (reliever)

LTRA Prolonged release theophylline LAMA (long-acting muscarinic antagonist) in adults

Increased inhaled corticosteroids up to high doses If ineffective, return to original dose + add on - LTRA - modified release theophylline - oral beta2 agonist - LAMA Refer children to respiratory consultant

Daily steroids (prednisolone) + inhaled corticosteroids + LABA (controller) SABA (reliever)

No daytime symptoms No night-time waking due to asthma No need for rescue meds No exacerbations No limitations on activity - including exercise Normal lung function Minimal side effects from medicines

Trial them on inhaled steroids for 6 weeks Asthma symptom questionnaire Assess response by spirometry/home peak expiratory flow - if response is good = confirm asthma diagnosis + personalised asthma action plan - if response is poor = check adherence + inhaler technique; + arrange further tests

Check adherence Check inhaler technique Eliminate trigger factors

Offer appropriate support to stop smoking Weight loss interventions Breathing exercise problems

Omalizumab - NICE approved • for adults, teens + children>6years • add-on to optimise standard therapy • prophylaxis of severe, persistent allergic asthma • dose/per body weight/ IgE level

Symptomatic asthma control Lung function assessed by spirometry/PEF Inhaler technique Adherence Bronchodilator reliance Asthma attacks, oral corticosteroid use + time off work since last assessment

Oxygen SABA Ipratropium bromide (bronchodilator) Corticosteroids Magnesium Aminophyline

Start treatment at home or in surgery (GP) + assess response Inhaled SABA using spacer/nebuliser Prednisolone 40-50mg for at least 5 days - if response is poor, send to hospital

Increasing symptoms Peak flow>50% predicted/best No features of acute severe asthma

Cannot complete sentences in 1 breath Respiration>25 breaths/min Pulse>110 beats/min