Chapter

Pharmacological management

Graeme P. Currie

in Asthma

Second edition

Published on behalf of Oxford University Press

Published in print August 2012 | ISBN: 9780199638918
Published online September 2012 | e-ISBN: 9780191740893 | DOI: http://dx.doi.org/10.1093/med/9780199638918.003.0004

Series: Oxford Respiratory Medicine Library

Pharmacological management

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• UK guidelines advocate five steps in the pharmacological management of asthma in adults • The overall aims are to establish early control, maintain control and step down treatment following 3–6 months of clinical stability • Prior to escalating treatment, patients should have good concordance, have a satisfactory inhaler technique, and not be exposed to trigger factors wherever possible • SABAs should be used on an ‘as required’ basis in most asthmatics (step 1). • Regular low to moderate doses of ICSs are required (step 2): • When SABAs are used > several times per week • When symptoms are present > twice per week • When patients wake overnight due to asthma • Following a recent exacerbation • In patients with persistent symptoms, frequent reliever use and exacerbations despite an adequate dose of ICS, a long-acting β2-agonist (LABA) should be added (step 3) • Further options include the addition of a LTRA, theophylline or a higher ICS dose (step 4) • In a minority of persistent asthmatics receiving step 4 treatment, regular use of low dose oral steroid should be considered (step 5).

Chapter.  4122 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology ; Clinical Pharmacology and Therapeutics

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