British Guideline on the Management of Asthma

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 ß2 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 patients 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