British Guideline on the Management of Asthma BTS/SIGN British Guideline on the Management of Asthma, May 2008

1. British Guideline on the Management of Asthma BTS/SIGN British Guideline on the Management of Asthma, May 2008 • Introduction • Diagnosis • Non-pharmacological management • Pharmacological management • Inhaler devices • Management of acute asthma • Special situations • Organisation and delivery of care, and audit • Patient education and self-management • Development of the guideline

2. Asthma controlBTS/SIGN British Guideline on the Management of Asthma, May 2008 • Aim is for asthma control: • no daytime symptoms • no night time awakening due to asthma • no need for rescue medication • no exacerbations • no limitations on activity including exercise • normal lung function • Before moving up to the next step: • Check compliance • Check inhaler technique • Eliminate trigger factors At any stage, step down therapy once asthma is controlled

3. Measuring clinical outcomesBTS/SIGN British Guideline on the Management of Asthma, May 2008 Ask the patient three key questions: In the last week (or month): have you had difficulty sleeping because of your asthma symptoms (including cough)? have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)? has your asthma interfered with your usual activities (e.g. housework, work/school etc.)?

4. Stepwise management of asthma in adultsBTS/SIGN British Guideline on the Management of Asthma, May 2008

5. Stepwise management of asthma in adultsBTS/SIGN British Guideline on the Management of Asthma, May 2008

6. Step 2: Regular preventer therapy BTS/SIGN British Guideline on the Management of Asthma, May 2008 Inhaled steroids are the most effective preventer drug for adults and children for achieving overall treatment goals

7. Stepwise management of asthma in adults BTS/SIGN British Guideline on the Management of Asthma, May 2008

8. Current advice from the CHMwww.mhra.gov.uk December 2006, updated February 2007 In the management of chronic asthma, formoterol and salmeterol should: be added only if regular use of standard-dose ICS has failed to control asthma adequately not be initiated in patients with rapidly deteriorating asthma be introduced at a low dose and the effect properly monitored before considering dose increase be discontinued in the absence of benefit be reviewed as appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved Patients should report any deterioration in symptoms following initiation of treatment with a LABA

9. So where does Symbicort SMART® fit in the management of asthma? BTS/SIGN British Guideline on the Management of Asthma, May 2008 • In adult patients at step 3, who are poorly controlled: • The use of budesonide/formoterol in a single inhaler (Symbicort SMART®) as rescue medication instead of a short-acting β2 agonist, in addition to its regular use as a controller treatment, has been shown to be an effective treatment option • Before instituting this management, careful patient education is required

10. Stepwise management of asthma in adultsBTS/SIGN British Guideline on the Management of Asthma, May 2008

11. Stepwise management of asthma in adultsBTS/SIGN British Guideline on the Management of Asthma, May 2008

12. Asthma – treatment summary • BTS/SIGN guidance is the basis for treatment • Use the RCP three questions to help assess control, not (just) PEFR and FEV1 • Start at step appropriate for patient’s asthma, and step down when control achieved and patient is stable • Safety issues and concerns regarding high-dose inhaled steroids and long-acting beta2-agonists