Definition:
It is defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness and cough, that vary over time and in intensity, together with variable expiratory airflow limitation.
Symptoms:
Wheeze, shortness of breath, cough and/or chest tightness.
• Patients (especially adults) experience more than one of these types of symptoms.
• Symptoms are often worse at night or in the early morning.
• Symptoms vary over time and in intensity.
• Symptoms are triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter or irritants such as car exhaust fumes, smoke or strong smells.
Diagnostic criteria:
· History of wheeze, shortness of breath, chest tightness and cough
· Post bronchodilator responsiveness – Increase in FEV1 > 12% or > 200ml
Treatment:
· Using ICS-formoterol as the Reliever and Maintenance therapy:
Symptoms | Treatment |
Symptoms < 4-5 days a week | As needed low dose ICS-formoterol |
Symptoms most days or waking with asthma once a week or more | Low dose maintenance ICS- formoterol |
Daily symptoms or waking with asthma once a week or more and low lung function | Medium dose maintenance ICS- formoterol |
Severe asthma not controlled with ICS-formoterol | Add on LAMA High dose ICS-formoterol Refer to Pulmonologist for phenotypic assessment and biologic therapy |
RELIEVER: As needed low dose ICS-formoterol | |
· Alternative controller and reliever:
Symptoms | Treatment |
Symptoms < twice a month | Take ICS whenever SABA taken |
Symptoms > twice a month but < 4-5 days a week | Low dose maintenance ICS |
Symptoms most days or waking with asthma once a week or more | Low dose maintenance ICS-LABA |
Daily symptoms or waking with asthma once a week or more with low lung function | Medium low dose maintenance ICS- LABA |
Severe asthma | Add on LAMA High dose ICS-formoterol Refer to Pulmonologist for phenotypic assessment & biologic therapy |
RELIEVER: As needed SABA or as needed ICS-SABA | |
· Vaccination:
a) Influenza vaccination
· Non-pharmacological treatment:
a) Smoking cessation
b) Physical activity
c) Avoidance of occupational or domestic exposures to allergens or irritants
d) Avoidance of medications that may make asthma worse
e) Healthy diet
f) Avoidance of indoor/ outdoor allergens
g) Weight reduction
h) Breathing exercises
INDICATIONS FOR REFERRAL
· Difficulty confirming the diagnosis of asthma
· Persistent or severely uncontrolled asthma or frequent exacerbations
· Any risk factors for asthma-related death
· Evidence of or risk of significant treatment side-effects
ASTHMA EXACERBATIONS:
Episodes characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, i.e. they represent a change from the patient’s usual status that is sufficient to require a change in treatment
Management of exacerbations:
Classify exacerbation into:
Mild or moderate:
· Talk in phrases
· Prefers sitting to lying
· Respiratory rate increased
· Accessory muscles of respiration not in used
· PR: 100-120bpm
· SPO2: 90-95% at room air
Severe:
· Talks in words
· Sits hunched forward
· Agitated
· Respiratory rate > 30/min
· Accessory muscles of respiration in used
· Pulse rate > 120bpm
· SPO2< 90% at room air
Life threatening exacerbation:
· Drowsy
· Confused
· Silent chest
Treatment:
Mild/moderate exacerbation:
· SABA (Levosalbutamol) 4-10puffs stat and repeat every 20 minutes for 1 hour
· Prednisolone: 40-50mg
· O2 inhalation – target SPO2: 93 – 95%
· Review response at 1 hour:
a) If symptoms improve and SPO2 > 94% at room air – advice discharge with reliever medication and continue prednisolone for 5-7 days
b) If symptoms worsen – Add ipratropium bromide, O2 inhalation and systemic corticosteroids and refer to higher centre
Severe/ life threatening exacerbation:
· SABA + SAMA (Duolin, Salbair I, Combimist L)
· O2 inhalation
· Systemic corticosteroids
· Refer to Higher Centre
References
No references available