Asthma: epidemiology / pathology

2. Asthma: epidemiology / pathology

3. Anatomy

5. Part 4: Long-term Asthma Management Stepwise Approach to Asthma Therapy - Adults Outcome: BestPossible Results Outcome: Asthma Control • Controller: • Daily inhaled corticosteroid • Daily long –acting inhaled β2-agonist • plus (if needed) • When asthma is controlled, reduce therapy • Monitor • Controller: • Daily inhaled corticosteroid • Daily long-acting inhaled β2-agonist • Controller: • Daily inhaled corticosteroid Controller: None -Theophylline-SR -Leukotriene -Long-acting inhaled β2- agonist -Oral corticosteroid Reliever: Rapid-acting inhaled β2-agonist prn STEP 1: Intermittent STEP 2: Mild Persistent STEP 3: Moderate Persistent STEP 4: Severe Persistent STEP Down Alternative controller and reliever medications may be considered (see text).

6. Part 4: Long-term Asthma Management Pharmacologic Therapy Controller Medications: • Inhaled glucocorticosteroids • Systemic glucocorticosteroids • Cromones • Methylxanthines • Long-acting inhaled β2-agonists • Long-acting oral β2-agonists • Leukotriene modifiers

7. Part 4: Long-term Asthma ManagementPharmacologic Therapy Reliever Medications: • Rapid-acting inhaled β2-agonists • Systemic glucocorticosteroids • Anticholinergics • Methylxanthines • Short-acting oral β2-agonists

8. Six-Part Asthma Management Program 1.Educate Patients 2. Assess and Monitor Severity 3. Avoid Exposure to Risk Factors 4. Establish Medication Plans for Chronic Management: Adults and Children 5. Establish Plans for Managing Exacerbations 6. Provide Regular Follow-up Care

9. Asthma: diagnosis

10. Asthma: diagnosis

11. Asthma: epidemiology / pathology

12. Asthma: epidemiology / pathology

13. Asthma: diagnosis

14. Asthma: epidemiology / pathology

15. Asthma: diagnosis

16. Asthma: diagnosis

17. Asthma: epidemiology / pathology

18. Asthma: epidemiology / pathology

19. Recommended Asthma Medications Step 1: Adults Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

20. Recommended Asthma Medications Step 2: Adults Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

21. Recommended Asthma Medications Step 3: Adults Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

22. Recommended Asthma Medications Step 4: Adults Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

23. Recommended Asthma Medications Step 1: Children Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

24. Recommended Asthma Medications Step 2: Children Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

25. Recommended Asthma Medications Step 3: Children Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

26. Recommended Asthma Medications Step 4: Children Reliever Medication: Rapid-acting inhaled β2- agonist prn, not more than 3-4 times a day. Once control is achieved and maintained for at least 3 months, gradual reduction of therapy should be tried.

27. Stepwise Approach to Asthma Therapy: Adults Step 1: Intermittent Asthma Reliever Medications Daily Controller Medications Rapid-actinginhaled 2-agonist for symptoms (but < once a week) Rapid-actinginhaled 2-agonist, cromone, or leukotriene modifier before exercise or exposure to allergen None required • Continuously review medication technique, compliance and environmental control • Review treatment every three months. • Step up if control is not achieved; step down if control is sustained for at least 3 months • Preferred treatments are in bold print

28. Stepwise Approach to Asthma Therapy: AdultsStep 2: Mild Persistent Asthma Daily Controller Medications Reliever Medications Inhaled glucocorticosteroid • (< 500 μg BDP or equivalent) Other options (order by cost): • sustained-release theophylline, or • Cromone, or • leukotriene modifier Rapid-actinginhaled 2-agonist for symptoms (but < 3-4 times/day) Other options: • inhaled anticholinergic, or • short-acting oral 2-agonist, or • short-acting theophylline • Continuously review medication technique, compliance and environmental control. • Review treatment every three months • Step up if control is not achieved; Step down if control is sustained for at least 3 months • Preferred treatments are in bold print

29. Stepwise Approach to Asthma Therapy: Adults Step 3: Moderate Persistent Asthma Daily Controller Medications Reliever Medications Inhaled glucocorticosteroid, (200 – 1000 μg BDP or equivalent)plus long-acting inhaled β2agonist Other options (order by cost): • Inhaled glucocorticosteroid(500 – 1000 μg BDP equivalent)plus sustained-release theophylline, or • Inhaled glucocorticosteroid(500 – 1000 μg BDP equivalent) plus long-acting inhaled β2- agonist, or • inhaled glucocorticosteroid at higher doses (> 1000 μg BDP equivalent), or • Inhaled glucocorticosteroid(500 – 1000 μg BDP equivalent)plus leukotriene modifier Rapid-actinginhaled 2-agonist for symptoms (but < 3 - 4 times/day) Other options: • inhaled anticholinergic or • short-acting oral 2-agonist or • short-acting theophylline • Continuously review medication technique, compliance and environmental control. • Review treatment every three months. • Step up if control is not achieved; Step down if control is sustained for at least 3 months. • Preferred treatments are in bold print.

30. Stepwise Approach to Asthma Therapy: Adults Step 4: Severe Persistent Asthma Daily Controller Medications Reliever Medications Inhaled glucocorticosteroid, (> 1000 μg BDP or equivalent)plus long-acting inhaled β2agonist plus one or more of the following, if needed (order by cost): • sustained-release theophylline, or • leukotriene modifier or • oral glucocorticosteroid Rapid-actinginhaled 2-agonist for symptoms (but < 3-4 times/day) Other options: • inhaled anticholinergic or • short-acting oral 2-agonist or • short-acting theophylline • Continuously review medication technique, compliance and environmental control. • Review treatment every three months. • Step up if control is not achieved; Step down if control is sustained for at least 3 months. • Preferred treatments are in bold print.