Maintenance plan for persistent asthma—adult (example)

Question 1

—adult (example)

Answer 1

Inhaled short acting B-agonist, prn

Inhaled steroid (dose according to severity) (can use a cromolyn if milder asthma)

If more severe with inadequate control, stepwise options to add:

• longer acting inhaled steroid bd (if using shorter acting steroid which should be ceased); SABA prn. for symptom relief
• long acting B-agonist separate or combined with above
• consider inhaled ipratropium
• consider leukotriene antagonist
• oral prednisolone prn

Question 2

For attack

Answer 2

High dose inhaled bronchodilators (spacer preferred);

<25 kg up to 6 puffs

25–35 kg 8 puffs

>35 kg 12 puffs

Question 3

Prophylactic agents

Answer 3

This term is reserved for those medications that are taken prior to known trigger factors, particularly exercise-induced asthma.

Question 4

Exercise-induced asthma

Answer 4

B-agonist inhaler (puffer);

• two puffs immediately before exercise last 1–2 h.
• LABAs are more effective.

Cromoglycate or nedocromil, two puffs (5–10 mins before)

Montelukast 10 mg (less in children ≥2 yrs) (o) daily 1–2 h before

Combination B-agonist + cromoglycate or nedocromil

Question 5

Thunderstorm asthma

Answer 5

Caused by high winds preceding a storm stirring up massive amounts of rye grass pollens which rupture, releasing allergens.

Those most vulnerable to asthma attack are those with a history of allergy and especially poorly controlled asthma.

At risk people should;

• stay inside with windows and doors closed
• take preventer medication
• follow action plans
• ensure ready supply of reliever drugs.

Rx is with salbutamol spray, followed by corticosteroids.