Adult and child over 5 years
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Child under 5 years
|
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Step 1: occasional
relief broncodilator
Inhaled
short-acting beta2 agonist as required (up to once daily)
Note:Move to step 2 if needed more than twice a week, or if
night-time symptoms more than once a week, or if exacerbation in the last 2
years requiring systemic corticosteroid or nebulised bronchodilator.
|
Step 1: occasional relief bronchodilator
Short-acting beta2 agonist as required (not
more than once daily)
Note
Preferably by inhalation (less effective and more
side-effects when given by mouth)
Move to step 2 if needed more than twice a week, or if
night-time symptoms more than once a week, or if exacerbation in the last 2
years
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Step 2: regular preventer therapy
Inhaled short-acting beta2 agonist as
required
plus
Either regular standard-dose inhaled corticosteroid
Or (if inhaled corticosteroid cannot be used) leukotriene receptor antagonist |
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Step 3: inhaled
corticosteroid + long-acting inhaled beta2 agonist
Inhaled short-acting beta2 agonist as required
plus
Regular standard-dose inhaled corticosteroid
plus
Regular inhaled long-acting beta2 agonist
(salmeterol or formoterol)
If asthma not controlled
Increase dose of inhaled corticosteroid to upper end of standard dose range
and
Either stop long-acting beta2 agonist if of no
benefit
Or continue long-acting beta2 agonist if of some benefit
If asthma still not controlled and long-acting beta2
agonist stopped, add one of
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Step 4: high-dose inhaled corticosteroid + regular bronchodilators
Inhaled
short-acting beta2 agonist as required
with
Regular
high-dose inhaled corticosteroid
plus
Inhaled
long-acting beta2 agonist
plus
In
adults 6-week sequential therapeutic trial of one or more of
·
Leukotriene
receptor antagonist
·
Modified-release
oral theophylline
·
Modified-release
oral beta2 agonist
Step 5: regular corticosteroid tablets
Inhaled short-acting beta2 agonist as required
with
Regular high-dose inhaled corticosteroid
and
One or more long-acting bronchodilators (see step 4)
plus
Regular prednisolone tablets (as single
daily dose)
Note:In addition to regular prednisolone, continue high-dose
inhaled corticosteroid (in exceptional cases may exceed licensed doses);
these patients should normally be referred to an asthma clinic.
|
Standard-dose inhaled
corticosteroids (given through a metered-dose inhaler and in children a
large-volume spacer):
Beclometasone
dipropionate or budesonide 100–400 micrograms twice
daily; child under 12 years 100–200 micrograms twice daily
Fluticasone
propionate 50–200 micrograms twice
daily; child 4–12 years 50–100 micrograms twice daily
Mometasone
furoate (given through a dry-powder
inhaler) 200 micrograms twice daily, Alternatives to inhaled
corticosteroid are leukotriene receptor antagonists, theophylline, inhaled
cromoglicate, or inhaled nedocromil. High-dose inhaled corticosteroids (given
through a metered-dose inhaler and a large-volume spacer):
Beclometasone
dipropionate or budesonide
0.4–1 mg twice daily; child 5–12 years 200–400 micrograms twice
daily
Fluticasone
propionate 200–500 micrograms twice
daily; child 5–12 years 100–200 micrograms twice daily.
Mometasone
furoate (given through a dry powder
inhaler) 200–400 micrograms twice daily.
Note. Doses of inhaled corticosteroids here are for
CFC-containing metered-dose inhalers; dose adjustments may be required for
other inhaler devices.
Failure to achieve control with
these doses is unusual.Lung-function measurements cannot be used to guide
management in those under 5 years
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Friday, August 8, 2014
Management of chronic asthma in childrens
Labels:
asthma in childrens,
asthma treatments
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