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British Guideline on the MAnAGeMent of AsthMA 108 Dr Ben Green, SpR in Respiratory Medicine, Bournemouth Dr Sarah Haney Consultant in respiratory medicine, Northumbria Healthcare NHS trust Dr Andrew Smith Consultant in Respiratory Medicine, Wishaw General Hospital NON-PHARMACOLOGICAL MANAGEMENT Dr Paul Cullinan Reader in Occupational and Environmental Lung Disease, (Co-chair) Royal Brompton Hospital, London Professor John Warner Professor of Paediatrics and Head of Department, (Co-chair) Imperial College, London Dr David Bellamy General Practitioner, Bournemouth and Pool Primary Care Trust Dr Graham Devereux Consultant in Thoracic Medicine, Aberdeen Royal Infirmary Dr David Reilly Lead Consultant Physician, Glasgow Homoeopathic Hospital Dr Janet Rimmer Respiratory Physician, Darlinghurst, New South Wales, Australia Dr Lyn Smurthwaite Research Development Manager, Asthma UK, London Mrs Deryn Thompson Nursing Tutor, Division of Health Sciences, University of South Australia PHARMACOLOGICAL MANAGEMENT Professor Neil Barnes Consultant Respiratory Physician, (Co-chair) Barts and The London NHS Trust Professor Mike Shields (Co-chair) Professor of Child Health, Queen’s University, Belfast Dr Anne Boyter Senior Lecturer, Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow Dr Steve Cunningham Consultant Paediatrician, Royal Hospital for Sick Children, Edinburgh Ms Grainne d’Ancona Lead Pharmacist for Medicine, Guys and St Thomas’ Hospital, London Dr John Henderson Consultant in Paediatric Respiratory Medicine, Bristol Royal Hospital for Children Dr Catherine McDougall Paediatric Respiratory Trainee, Royal Hospital for Sick Children, Edinburgh Dr Mike McKean Consultant in Respiratory Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne Ms Linda Pearce Respiratory Nurse Consultant, West Suffolk Hospital Dr Savitha Pushparajah General Practitioner, London Dr Mike Smith Consultant Paediatrician, Craigavon Area Group Hospital, Northern Ireland Dr Alison Whittaker Consultant Physician, Newport Chest Clinic, Gwent
INHALER DEvICES Dr John White (Chair) Consultant Respiratory Physician, York District Hospital Dr Chris Cates Senior Research Fellow, St George’s, University of London Professor Henry Chrystyn Head of Pharmacy, University of Huddersfield Ms Monica Fletcher Chief Executive, Education for Health, Warwick Sr Karen Heslop Respiratory Nurse Specialist, Royal Victoria Infirmary, Newcastle upon Tyne Dr Alex Horsley Specialist Registrar, Western General Hospital, Edinburgh MANAGEMENT OF ACUTE ASTHMA Dr Gary Connett (Co-chair) Consultant Paediatrician, Southampton General Hospital Professor Colin Robertson Consultant in Emergency Medicine, (Co-chair) Edinburgh Royal Infirmary Dr Richard Chavasse Consultant in Respiratory Paediatrics, St Helier Hospital, Surrey Dr Graham Douglas Consultant Respiratory Physician, Aberdeen Royal Infirmary Dr Mike Greenstone Consultant Physician, Castle Hill Hospital, East Yorkshire Dr Nick Innes Consultant in Respiratory and General Medicine, The Ipswich Hospital Dr Mark Levy General Practitioner, The Kenton Bridge Medical Centre, Middlesex Dr Rob Niven Senior Lecturer in Respiratory Medicine, Whythenshawe Hospital, Manchester Dr Ronan O’Driscoll Respiratory Physician, Hope Hospital, Salford Dr Ed Paterson Specialist Registrar in Respiratory Medicine, Aberdeen Royal Infirmary Dr Colin Powell Consultant Paediatrician, University Hospital of Wales, Cardiff Dr Lindsay Reid Specialist Registrar in Emergency Medicine, Edinburgh Royal Infirmary Dr Peter Weller Consultant Paediatrician (Respiratory Medicine), Birmingham Children’s Hospital DELIvERy/ ORGANISATION OF CARE 11 develoPMent of the Guideline Professor Chris Griffiths Professor of Primary Care, Institute of Health Science (Chair) Education, London Ms Monica Fletcher Chief Executive, Education for Health, Warwick Professor David Price GPIAG Professor of Primary Care Respiratory Medicine, Foresterhill Health Centre, Aberdeen Dr Richard Russell Consultant Physician, Heatherwood and Wexham Park Hospitals, Berkshire 109
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101 British Guideline on the Manage
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British Thoracic Society Scottish I
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Revised 2011 Revised 2011 Revised 2
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1 introduction 1.1 the need for A G
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1.3.1 PATIENT vERSION Patient versi
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Table 1: Clinical features that inc
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Case detection studies have used sy
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2.1.6 CHILDREN WITH AN INTERMEDIATE
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2.3 suMMAry focus the initial asses
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2.4 diAGnosis in Adults The diagnos
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2.4.1 FURTHER INvESTIGATION OF PATI
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Table 6: Differential diagnosis of
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2.5.1 TREATMENT TRIALS AND REvERSIB
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A small prospective observational s
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Table 8: Summary of tools that can
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Measurement Methodology Asthma Cont
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Measurement Methodology Eosinophil
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3.1.2 FOOD ALLERGEN AvOIDANCE Sensi
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The limited data on antenatal or ea
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3.3.2 AIR POLLUTION Challenge studi
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3.5 CoMPleMentAry And AlternAtive M
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Revised 2011 4 Pharmacological mana
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Table 8b: Equivalent doses of inhal
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4.2.3 SAFETy OF INHALED STEROIDS Th
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4.3.2 ADD-ON THERAPy Options for ad
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4.4 steP 4: Poor Control on ModerAt
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4 PhArMAColoGiCAl MAnAGeMent Colchi
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MOVE UP TO IMPROVE CONTROL AS NEEDE
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4.6 stePPinG doWn Stepping down the
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4.7.5 ASPIRIN-INTOLERANT ASTHMA The
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5.3 inhAled steroids for stABle Ast
Page 63 and 64: Revised 2009 6 Management of acute
Page 65 and 66: Patients with brittle or difficult
Page 67 and 68: Table 11: Initial assessment - the
Page 69 and 70: In acute asthma without life threat
Page 71 and 72: 6.3.8 ANTIBIOTICS 6.3.9 HELIOx When
Page 73 and 74: 6.6.2 PATIENT EDUCATION Following d
Page 75 and 76: 6.7.2 PULSE OxIMETRy 6.7.3 PEF Accu
Page 77 and 78: Frequent doses up to every 20-30 mi
Page 79 and 80: 6.9.3 Iv MAGNESIUM SULPHATE Intrave
Page 81 and 82: New 2011 7 special situations 7.1 A
Page 83 and 84: Gender During adolescence there is
Page 85 and 86: Complementary and alternative medic
Page 87 and 88: Table 13: Recommendations for organ
Page 89 and 90: 7.2 diffiCult AsthMA 7.2.1 DEFINING
Page 91 and 92: Revised 2009 Controlled studies usi
Page 93 and 94: Continuous fetal monitoring should
Page 95 and 96: C use steroid tablets as normal whe
Page 97 and 98: 7.9.2 AT-RISK POPULATIONS Several h
Page 99 and 100: 7.9.6 SPECIFIC BRONCHIAL PROvOCATIO
Page 101 and 102: Asthma clinics in primary care may
Page 103 and 104: A 8.3 Audit discharge from hospital
Page 105 and 106: 9 Patient education and self manage
Page 107 and 108: 9.2.1 COMPLIANCE WITH MONITORING AN
Page 109 and 110: Table 15. Summary of the key compon
Page 111 and 112: 8. What role does patient preferenc
Page 113: Dr James Paton* Reader and Honorary
Page 117 and 118: 11.4 disseMinAtion GrouP Mrs Sheila
Page 119 and 120: Abbreviations ABG arterial blood ga
Page 121 and 122: Annex 2 Management of acute severe
Page 123 and 124: Annex 4 Features of acute severe as
Page 125 and 126: Annex 6 Consider prednisolone 20 mg
Page 127 and 128: Annex 8 Management of acute asthma
Page 129 and 130: Annex 10 PEF (l/min) EU Scale 680 6
Page 131 and 132: Annex 11 (contd) Annexes 125
Page 133 and 134: 56. Abu-Hasan M, Tannous B, Weinber
Page 135 and 136: 156. Lodrup Carlsen KC, Carlsen KH,
Page 137 and 138: 256. Malmstrom M, Ahlner J, Carlsso
Page 139 and 140: 352. Brocklebank D, Ram F, Wright J
Page 141 and 142: 456. McDowell KM, Chatburn RL, Myer
Page 143 and 144: 562. McDonald JC, Keynes HL, Meredi
Page 145 and 146: 668. Enright PL, McClelland RL, New
Page 147 and 148: 767. Berger W. Budesonide inhalatio
Page 149 and 150: 862. Pedroletti C, Lundahl J, Alvin
Page 151: ISBN 978 1 905813 28 5 British Thor
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