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Asthma - Management
What advice should I give to people using inhaled corticosteroids?
- Advise people that smoking can reduce the effectiveness of inhaled corticosteroids (ICS) [SIGN and BTS, 2009].
- Advise people to rinse their mouth with water (or clean children's teeth) after inhalation of a dose of ICS to reduce the risk of oral candidiasis [BNF 53, 2007].
- Advise on general measures to counteract osteoporosis (such as regular exercise, smoking cessation, and adequate calcium intake) in people using high doses of ICS for prolonged periods.
- Advise parents to immediately report non-specific symptoms, such as anorexia, abdominal pain, weight loss, tiredness, headache, nausea, vomiting, decreased consciousness, hypoglycaemia, and seizures, in children using high doses of ICS (400 micrograms or more per day of beclometasone).
- Consider use of a steroid treatment card:
- People using prolonged high doses (off-label high doses, or maximum doses in conjunction with oral corticosteroids) of ICS should be given a steroid treatment card which gives guidance on minimizing risk and provides details of prescriber, drug, dosage, and duration of treatment [CHM, 2006].
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