Asthma Treatment In Adults And Children Above 12

Question 1

Because of the new guidelines

Answer 1

Some asthma patients are not on AIR or mart therapy and need to be switched over to this as part of their next review

Question 2

Newly diagnosed patients in people aged 12 and over

Answer 2

1) Offer low dose ICS/Formoterol combination inhaler to be taken as needed (AIR therapy)

As needed ICS/LABA = AIR THERAPY

Question 3

Step 1 - As needed AIR therapy

Answer 3

Anti inflammatory reliever therapy as needed for quick relief of symptoms

A COMBINATION of an inhaled budesonide and formoterol (ICS/LABA)

Symbicort turbohaler,fostair NEXThaler,DuoRESP,WockAIR,Spiromax

Question 4

STEP 2- Low dose ICS/LABA (MART)

Answer 4

Start taking daily in addition to as needed

ICS -inhaled corticosteroid
LABA -Long acting beta agonist

Question 5

Examples of step 2

Answer 5

Anti inflammatory to maintain asthma control and for quick relief of symptoms

Eg. Fostair - beclometasone (ICS) 100MCG AND FORMOTEROL LABA

MART = take ONE puff twice daily and as needed. Max 8 puffs a day

Question 6

Skip straight to step2?

Answer 6

If the patient is highly symptomatic ie. Poor Asthma control test score or has been hospitalised due to exacerbations, it may be appropriate to put them straight onto step 2

Question 7

Step 3

Answer 7

Moderate dose ICS/LABA(MART)

Increase from low to moderate dose ICS

Question 8

Step 3: Moderate dose ICS/LABA (MART)

Answer 8

Anti inflammatory to maintain asthma control and for quick relief of symptoms

Fostair (beclometasone and formoterol)

Mart = take TWO puffs twice daily and as needed

Question 9

What to do if not controlled on step 3

Answer 9

If neither feNO or Eosinophils are raised

If either of these are raised, refer to a specialist in asthma care

Question 10

Step 4: Treatment in step 3, add in LTRA or LAMA

Answer 10

It really does ultimately depend on the patient

But,

LTRA:Better for patients with exercise induced asthma

LAMA: Better at improving lung function

So, if patient does not have exercise induced asthma, consider adding a LAMA

Question 11

Step 4a (if exercise induced asthma) consider LTRA + continue treatment in step 3

Answer 11

Leukotrine receptor antagonist = montelukast 10mg once in the evening

Do this as a trial for 8-12 weeks unless there are side effects

At the end of the trial - if asthma is controlled,continue the treatment

If control has been improved but is still inadequate,continue the treatment and start a trial of LAMA

Question 12

STEP 4b) if not exercise induced asthma, then consider LAMA + Continue treatment in step 3

Answer 12

LAMA=Long acting Muscarinic antagonist like Spiriva soft mist is licensed for asthma

This is a trial for 8-12 weeks unless there are side effects

If asthma is controlled,continue the treatment

If control has improved but is still inadequate,continue LAMA but also trial LTRA (montelukast)

Question 14

Step 5 Refer:

Answer 14

Medium dose ICS/LABA as Mart
+
LTRA (Montelukast)
+
LAMA

And the asthma is still not controlled = Respiratory consultant