sign101

Revised
2011
Revised
2011
Revised
2011
Contents
1 introduction 1
1.1 The need for a guideline 1
1.2 Remit of the guideline 1
1.3 Statement of intent 2
2 diagnosis 4
2.1 Diagnosis in children 4
2.2 Other investigations 10
2.3 Summary 11
2.4 Diagnosis in adults 13
2.5 Further investigations that may be useful in patients with an intermediate probability of asthma 18
2.6 Monitoring asthma 20
3 non-pharmacological management 28
3.1 Primary prophylaxis 28
3.2 Secondary non-pharmacological prophylaxis 31
3.3 Other environmental factors 32
3.4 Dietary manipulation 33
3.5 Complementary and alternative medicine 35
3.6 Other complementary or alternative approaches 36
4 Pharmacological management 37
4.1 Step 1: mild intermittent asthma 38
4.2 Step 2: introduction of regular preventer therapy 38
4.3 Step 3: initial add-on therapy 42
4.4 Step 4: poor control on moderate dose of inhaled steroid + add-on therapy: addition of fourth drug 45
4.5 Step 5: continuous or frequent use of oral steroids 45
4.6 Stepping down 51
4.7 Specific management issues 51
5 inhaler devices 54
5.1 Technique and training 54
5.2 β 2 agonist delivery 54
5.3 Inhaled steroids for stable asthma 55
5.4 CFC propellant PMDi vs HFA propellant PMDI 55
5.5 Prescribing devices 56
5.6 Use and care of spacers 56
6 Management of acute asthma 57
6.1 Lessons from studies of asthma deaths and near-fatal asthma 57
6.2 Acute asthma in adults 59
6.3 Treatment of acute asthma in adults 62
6.4 Further investigation and monitoring 66
6.5 Asthma management protocols and proformas 66
Contents