sign101

Revised
2011
4 Pharmacological management
The aim of asthma management is control of the disease. Complete control of asthma is defined as:
no daytime symptoms
no night-time awakening due to asthma
no need for rescue medication
no exacerbations
no limitations on activity including exercise
normal lung function (in practical terms FEv 1 and/or PEF>80% predicted or best).
minimal side effects from medication.
; Lung function measurements cannot be reliably used to guide asthma management in
children under five years of age.
In clinical practice patients may have different goals and may wish to balance the aims of
asthma management against the potential side effects or inconvenience of taking medication
necessary to achieve perfect control.
A stepwise approach aims to abolish symptoms as soon as possible and to optimise peak flow
by starting treatment at the level most likely to achieve this. Patients should start treatment at
the step most appropriate to the initial severity of their asthma. The aim is to achieve early
control and to maintain by stepping up treatment as necessary and stepping down when control
is good (see figures 4, 5 and 6 for summaries of stepwise management in adults and children).
; Before initiating a new drug therapy practitioners should check adherence with existing
therapies (see section 9.2), inhaler technique (see section 5) and eliminate trigger factors
(see section 3).
Until May 2009 all doses of inhaled steroids in this section were referenced against beclometasone
(BDP) given via CFC-MDIs (metered dose inhaler). As BDP CFC is now unavailable, the reference
inhaled steroid will be the BDP-HFA product, which is available at the same dosage as BDP-
CFC. Note that some BDP-HFA (hydrofluroalkane) products are more potent and all should be
prescribed by brand (see Table 8b). Adjustments to doses will have to be made for other inhaler
devices and other corticosteroid molecules (see section 4.2).
In this and the following section, each recommendation has been graded and the supporting
evidence assessed for adults and adolescents >12 years old, children 5-12 years, and children
under 5 years. The evidence is less clear in children under two and the threshold for seeking
an expert opinion should be lowest in these children.
1 2 3 1 Adults and adolescents aged over 12
2 Children aged 5-12 years
3 Children under 5 years
recommendation does not apply to this age group.
4 PhArMAColoGiCAl MAnAGeMent
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