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British Guideline on the MAnAGeMent of AsthMA Patients should start treatment at the step most appropriate to the initial severity of their asthma. Check concordance and reconsider diagnosis if response to treatment is unexpectedly poor.MOVE UP TO IMPROVE CONTROL AS NEEDED 48 Figure 4: Summary of stepwise management in adults Use daily steroid tablet in lowest dose providing adequate control Maintain high dose inhaled steroid at 2000 mcg/day* Consider trials of: � increasing inhaled steroid up to 2000 mcg/day* � addition of a fourth drug e.g. leukotriene receptor antagonist, SR theophylline, β agonist tablet 2 MOVE DOWN TO FIND AND MAINTAIN LOWEST CONTROLLING STEP Consider other treatments to minimise the use of steroid tablets 1. 1. Add Add inhaled inhaled long-acting long-acting β agonist (LABA) 2 2. Assess control of asthma: � good response to LABA - continue LABA � benefit from LABA but control still inadequate - continue LABA and increase inhaled steroid dose to 800 mcg/day* (if not already on this dose) � no response to LABA - stop LABA and increase inhaled steroid to 800 mcg/ day.*If control still inadequate, institute trial of other therapies, leukotriene receptor antagonist or SR theophylline Add inhaled steroid 200-800 mcg/day* 400 mcg is an appropriate starting dose for many patients Refer patient for specialist care Inhaled short-acting β2 agonist as required Start at dose of inhaled steroid appropriate to severity of disease. STEP 5 Continuous or frequent use of oral steroids STEP 4 Persistent poor control 1. Add inhaled long-acting β Initial add-on therapy STEP 3 STEP 2 Regular preventer therapy STEP 1 * BDP or equivalent Mild intermittent asthma SYMPTOMS vs TREATMENT
MOVE UP TO IMPROVE CONTROL AS NEEDED Patients should start treatment at the step most appropriate to the initial severity of their asthma. Check concordance and reconsider diagnosis if response to treatment is unexpectedly poor. Figure 5: Summary of stepwise management in children aged 5-12 years Use daily steroid tablet in lowest dose providing adequate control Increase inhaled steroid up to 800 mcg/day* Maintain high dose inhaled steroid at 800 mcg/day* MOVE DOWN TO FIND AND MAINTAIN LOWEST CONTROLLING STEP Refer to respiratory paediatrician 1. 1. Add Add inhaled inhaled long-acting long-acting β2 β agonist (LABA) 2. Assess control of asthma: � good response to LABA - continue LABA � benefit from LABA but control still inadequate - continue LABA and increase inhaled steroid dose to 400 mcg/day* (if not already on this dose) � no response to LABA - stop LABA and increase inhaled steroid to 400 mcg/ day.*If control still inadequate, institute trial of other therapies, leukotriene receptor antagonist or SR theophylline Add inhaled steroid 200-400 mcg/day* (other preventer drug if inhaled steroid cannot be used) 200 mcg is an appropriate starting dose for many patients Inhaled short-acting β2 agonist as required Start at dose of inhaled steroid appropriate to severity of disease. STEP 5 Continuous or frequent use of oral steroids STEP 4 Persistent poor control 4 PhArMAColoGiCAl MAnAGeMent 1. Add inhaled long-acting STEP 3 β Initial add-on therapy STEP 2 Regular preventer therapy STEP 1 * BDP or equivalent Mild intermittent asthma SYMPTOMS vs TREATMENT 1 - 49 2 +
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101 British Guideline on the Manage
Page 3 and 4: British Thoracic Society Scottish I
Page 5 and 6: Revised 2011 Revised 2011 Revised 2
Page 7 and 8: 1 introduction 1.1 the need for A G
Page 9 and 10: 1.3.1 PATIENT vERSION Patient versi
Page 11 and 12: Table 1: Clinical features that inc
Page 13 and 14: Case detection studies have used sy
Page 15 and 16: 2.1.6 CHILDREN WITH AN INTERMEDIATE
Page 17 and 18: 2.3 suMMAry focus the initial asses
Page 19 and 20: 2.4 diAGnosis in Adults The diagnos
Page 21 and 22: 2.4.1 FURTHER INvESTIGATION OF PATI
Page 23 and 24: Table 6: Differential diagnosis of
Page 25 and 26: 2.5.1 TREATMENT TRIALS AND REvERSIB
Page 27 and 28: A small prospective observational s
Page 29 and 30: Table 8: Summary of tools that can
Page 31 and 32: Measurement Methodology Asthma Cont
Page 33 and 34: Measurement Methodology Eosinophil
Page 35 and 36: 3.1.2 FOOD ALLERGEN AvOIDANCE Sensi
Page 37 and 38: The limited data on antenatal or ea
Page 39 and 40: 3.3.2 AIR POLLUTION Challenge studi
Page 41 and 42: 3.5 CoMPleMentAry And AlternAtive M
Page 43 and 44: Revised 2011 4 Pharmacological mana
Page 45 and 46: Table 8b: Equivalent doses of inhal
Page 47 and 48: 4.2.3 SAFETy OF INHALED STEROIDS Th
Page 49 and 50: 4.3.2 ADD-ON THERAPy Options for ad
Page 51 and 52: 4.4 steP 4: Poor Control on ModerAt
Page 53: 4 PhArMAColoGiCAl MAnAGeMent Colchi
Page 57 and 58: 4.6 stePPinG doWn Stepping down the
Page 59 and 60: 4.7.5 ASPIRIN-INTOLERANT ASTHMA The
Page 61 and 62: 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
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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
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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
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Annex 6 Consider prednisolone 20 mg
Page 127 and 128:
Annex 8 Management of acute asthma
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Annex 10 PEF (l/min) EU Scale 680 6
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Annex 11 (contd) Annexes 125
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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
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456. McDowell KM, Chatburn RL, Myer
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562. McDonald JC, Keynes HL, Meredi
Page 145 and 146:
668. Enright PL, McClelland RL, New
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767. Berger W. Budesonide inhalatio
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862. Pedroletti C, Lundahl J, Alvin
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ISBN 978 1 905813 28 5 British Thor
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