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British Guideline on the MAnAGeMent of AsthMA Annex 9 122 Guidelines for the Identification, Management and Prevention of Occupational Asthma • www.bohrf.org.uk/content/asthma.htm © British Occupational Health Research Foundation, 6 St Andrews Place, Regents Park, London NW1 4LB 1. At least 1 in 10 cases of new or reappearance of childhood asthma in adult life are attributable to occupation. 2. Enquire of adult patients with rhinitis or asthma about their job and the materials with which they work. 3. Rhino-conjunctivitis may precede IgE-associated occupational asthma; the risk of developing asthma being highest in the year after the onset of rhinitis. 4. The prognosis of occupational asthma is improved by early identification and early avoidance of further exposure to its cause 5. Confirm a diagnosis supported by objective criteria and not on the basis of a compatible history alone because of the potential implications for employment. 6. Arrange for workers whom you suspect of having work-related asthma to perform serial peak flow measurements at least four times a day. Refer quickly to a chest physician or occupational physician 4,5 Arrange serial PEF measurements 6 Monitor for the development of asthma symptoms 3 Yes Has the patient developed asthma? Refer to an allergy specialist or occupational physician Possible work-related asthma Possible work-related rhinitis ASTHMA RHINITIS Yes No Do symptoms improve when away from work or deteriorate when at work? Non-occupational disease Continue treatment No Yes Has an occupational cause of symptoms been excluded? 1,2 • baking • pastry making • spray painting • laboratory animal work • healthcare • dentalcare • food processing • welding • soldering • metalwork • woodwork • chemical processing • textile, plastics and rubber manufacture • farming and other jobs with exposure to dusts and fumes High risk work 2 includes: WORK-RELATED ASTHMA AND RHINITIS: CASE FINDING AND MANAGEMENT IN PRIMARY CARE
Annex 10 PEF (l/min) EU Scale 680 660 640 620 600 580 560 540 520 500 480 460 440 420 400 380 360 340 320 300 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age (years) Height Men 190 cm (75 in) 183 cm (72 in) 175 cm (69 in) 167 cm (66 in) 160 cm (63 in) Height Women 183 cm (72 in) 175 cm (69 in) 167 cm (66 in) 160 cm (63 in) 152 cm (60 in) Adapted by Clement Clarke for use with EN13826 / EU scale peak flow meters from Nunn AJ Gregg I, Br Med J 1989:298;1068-70 Annexes 123
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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
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Revised 2009 6 Management of acute
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Patients with brittle or difficult
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Table 11: Initial assessment - the
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In acute asthma without life threat
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6.3.8 ANTIBIOTICS 6.3.9 HELIOx When
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6.6.2 PATIENT EDUCATION Following d
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6.7.2 PULSE OxIMETRy 6.7.3 PEF Accu
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Page 79 and 80: 6.9.3 Iv MAGNESIUM SULPHATE Intrave
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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
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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 and 114: Dr James Paton* Reader and Honorary
Page 115 and 116: INHALER DEvICES Dr John White (Chai
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: Annex 8 Management of acute asthma
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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