Non-acute Asthma in Adults; therapy

Question 1

Stepwise anti-inflammatory reliever (AIR) therapy

Answer 1

Use a Budesonide (inhaled corticosteroid ) + Formoterol ( long-acting beta2-adrenergic agonist - LABA) via dry powder inhaler product licensed for as-needed symptom relief as part of an AIR plan:

. Budesonide 200 microgram + formoterol 6 microgram (use first line)

. Budesonide 100 microgram + formoterol 6 microgram (consider in a patient at increased risk of steroid side-effects)

Question 2

Use stepwise dosage strategy

Answer 2

. For mild, intermittent asthma, start at step 1.

. For asthma that is poorly controlled, start at step 2.

. If asthma control remains poor, review treatment and consider stepping up.
-Ensure easy access to medications
-Check inhaler use and technique
-Provide extra services, reviews, and support and consider outreach
services
-Manage co-morbidities and confounding factors
-Consider alternate diagnoses

. Step down when patient is at low risk of flare-ups and has sustained good control to for at least 3 months.

. Adjust to discover and maintain the lowest required step

Question 3

Table dosages are based on a budesonide 200 microgram + formoterol 6 microgram AIR inhaler.

Answer 3

1) Maintenance:

Step 1; None
Step 2; 1 actuation BD or 2 actuations BD
Step 3; 2 actuations BD

2) Symptom relief: for all;

1 actuation prn (max 8 to 12 daily)

Question 4

Provide a personalised AIR asthma action plan:

Answer 4

. My Asthma App
. Printable AIR Asthma Action Plan
. Interactive AIR Asthma Action Plan
. For detailed information, see NZ Adolescent & Adult Asthma Guidelines: Anti-Inflammatory Reliever (AIR) Therapy (page 8).

Question 5

Traditional ICS and SABA therapy

Answer 5

1. Prescribe initial medications:

• An inhaled corticosteroid (ICS) for daily maintenance;
  Inhaled corticosteroid standard daily doses
  .Budesonide 400 microgram
  .Fluticasone proprionate 200 to 250 microgram
  .Fluticasone furoate 100 microgram
  .Beclomethasone diproprionate 400 to 500 microgram
  .Beclomethasone diproprionate extrafine 200 microgram
• A short-acting bronchodilator (SABA) for symptom relief as necessary

2. Use stepwise dosage strategy:
   * Describe the cycle of continual repeated review and adjustment.
   * For asthma that is poorly controlled, start at step 2.
   * If asthma control remains poor, review treatment and consider stepping up.
   * Step down when patient is at low risk of flare ups and has sustained good control to for at least 3 months.
   * Adjust to discover and maintain the lowest required step.
3. Provide a personalised action plan:
   . My Asthma App
   . Printable 4 Stage Asthma Action Plan (standard-dose ICS)
   . Interactive 4 Stage Asthma Action Plan (standard-dose ICS)
   . Printable 3 Stage Asthma Action Plan (high-dose ICS)
   . Interactive 3 Stage Asthma Action Plan (high-dose ICS)

Question 6

Use stepwise dosage strategy

Answer 6

1) Maintenance:
Step 1; Standard dose ICS
Step 2; Standard dose ICS plus LABA
Step 3; High dose ICS plus LABA

2) Symptom relief; for all steps:
SABA 1 to 2 puffs via spacer prn.
Repeat every few minutes as necessary.