Things to note:
- Patient education including cessation of smoking advice.
- Reduce exposition to triggers, e.g. Pollens, grasses, pets, smoke, smoke, etc.
- The use of preparations of the same pharmacological classification in combination is dangerous and must be avoided.
- Nocturnal cough and wheeze symptoms and the regular need for bronchodilators tend to indicate poor asthma control. Consider treatment adjustment and Referral by specialists.
Correct inhalation technique should be demonstrated and checked regularly by placebo inhalers, as most asthmatic patients do not use their inhalers properly.MAINTENANCE THERAPY
Inhaled corticosteroids (ICS), e.g:
ICS is the cornerstone of chronic asthma treatment:
* Beclomethasone, inhaled, 100 mcg 12 hour starting doses.
- Increase the daily dose by 100 mcg 12 hours a month until the best effect is achieved.
- Total maximum daily dose: 1 200 mcg.
- Reduce the daily dose by 100 mcg every month to a dose of 200 mcg 12 hours well after 6 months.
- Dose adjustments may be necessary at seasonal change.
As reliever / rescue therapy:
Debemos Beta 2-stimulants, e.g: Salbutamol, MDI, 200 mcg, 6 hours as needed.
Poor control, as demonstrated by the Excessive use of Beta 2 stimulants, must be reviewed.
If the response to sufficient steroids and salbutamol is insufficient:
* Release modified by theophylline, oral.
- Initial dose: 12 hours for 150-200 mg.
- Increase 12 hourly to 300 mg.
- Further increases in dose require monitoring of blood levels after adhesion has been considered.
If asthma is not well regulated:ADD
A short course of long- acting beta- agonist therapy e.g:
* Formoterol, inhaled, 12 mcg 12 hourly in patients who have followed the above regimen. Initiated specialist.
Efficacy assessment after three months.
Over- therapy failure: ADD
- Prednisone, oral, daily 5-10 mg.
Refer to the professional.
* Prednisone, oral, 30 mg daily for 10 days for short- term exacerbations in patients who do not respond to the above.
See a tertiary centre.Exercise-induced asthma
Recognized by symptoms that occur within 5- 7 minutes of starting the exercise and associated with a 15 percent reduction in FEV1 and may require the use of an inhaled Beta 2-stimulant within 15-20 minutes of starting. Normally, these patients do not require steroids.Intercurrent bacterial infections
Bacterial infections rarely occur in acute asthma exacerbations, and yellow sputum is usually associated with eosinophils. Antibiotics play no role in asthma management unless air space is consolidated on X- rays or fever > 38 FC.