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Asthma - Management
Managing adults with suspected asthma

How should I manage adults with a low probability of asthma?

  • Consider an alternative diagnosis, or refer to secondary care for further investigations.

In depth

How should I manage adults with a high probability of asthma?

  • Start a trial of asthma treatment for 2–3 months. The choice of treatment depends on the severity and frequency of symptoms.
  • If response is good, continue treatment.
  • If response is poor:
    • Assess compliance and inhaler technique.
    • Consider checking airway reversibility (in addition to spirometry at the initial diagnosis), or refer to secondary care for additional tests.

In depth

How should I manage adults with an intermediate probability of asthma?

  • If the person has an intermediate probability of asthma, consider performing a reversibility test (in addition to spirometry at the initial diagnosis) and/or a trial of treatment for 2–3 months:
    • If a trial of treatment is offered, the choice of treatment depends on the severity and frequency of symptoms.
    • If a reversibility test shows significant reversibility (a greater than 400 mL improvement in forced expiratory volume in 1  second [FEV1]), start a trial of asthma treatment.
    • If a reversibility test shows no reversibility (less than 400 mL improvement in FEV1), consider referring to secondary care for additional tests.
    • If a trial of asthma treatment has been started and:
      • Response is good, continue treatment.
      • Response is poor, check for reversibility. If there is insignificant reversibility, consider referral to secondary care for additional tests. If there is significant reversibility, assess compliance and inhaler technique.

In depth

How should I start treatment for asthma?

  • Explain that lifestyle changes and medication are meant to control asthma symptoms and prevent an exacerbation.
  • Explain the difference between reliever and preventive therapy, and demonstrate how to use inhalers and spacer devices.
  • Prescribe an effective delivery system on the basis of convenience, cost, and suitability.
  • Prescribe a short-acting beta2-agonist for use as required to treat daytime symptoms (twice weekly or less often) of short duration (lasting only a few hours).
  • Prescribe a regular inhaled corticosteroid with the short-acting beta2-agonist if symptoms are at least three times weekly, or waking the person one night weekly.
  • Prescribe a peak flow meter; record the person's best peak expiratory flow rate reading; and advise regular monitoring, especially during an exacerbation, worsening symptoms, or a medication change.
  • Provide education about asthma, such as how to monitor symptoms and recognize an exacerbation.

In depth

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