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Asthma - Management
Management of controlled asthma
Children and adults with controlled symptoms on current treatment: How do I manage?
- Do NOT step down treatment for people who have ongoing symptoms or need inhaled short-acting beta2-agonists, and those who have had a recent exacerbation.
- If a person has controlled symptoms, consider the following approach to step-down treatment:
- Make sure the person feels that their asthma is controlled and that they are willing to try step-down treatment.
- Reduce the dose of inhaled corticosteroids slowly. The usual protocol is to decrease the dose by 25% to 50% per 3-month visit. Explain the potential for worsening symptoms and the increased risk of an exacerbation.
- Some children with milder asthma and a clear seasonal pattern to their symptoms may tolerate a more rapid dose reduction during their 'good' season.
- Review the person on a regular basis; promote lifestyle advice, assess for worsening symptoms, and consider increasing medication if the person's asthma deteriorates.
- If stepping down is not possible, and the person is stable on an inhaled corticosteroid and a long-acting beta2-agonist, consider prescribing a combination inhaler.
In depth
What follow up is needed in someone with asthma?
- Review a person with stable asthma at least once a year. More frequent follow up may be needed after the initial diagnosis, when there is a change to medication, or in people with severe asthma or recurrent exacerbations.
- Review asthma control:
- Ask about symptoms, during the day; difficulty sleeping; and the impact of asthma on such activities as exercise, work, or school in the past week or month.
- Assess lung function using spirometry or Peak Expiratory Flow.
- Ask about past exacerbations and their frequency, and whether oral corticosteroids or hospital admission was needed.
- Ask about possible trigger factors such as exercise, work, and allergens.
- Ask about other conditions, that are known to co-exist with asthma and aggravate symptoms e.g. allergic rhinitis, sleep apnoea, and gastro-oesophageal reflux disease.
- Look for signs of complications which may necessitate referral to a specialist.
- Review asthma medication:
- Ask about the use of reliever medication, any benefits seen with changes in medication, and compliance with treatment.
- Assess inhaler technique and check peak expiratory flow rate to compare with the previously recorded value.
- Review smoking habit. Encourage people with asthma or parents of children with asthma to stop smoking.
- Review self-management education and make any necessary changes to written action plans.
In depth
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