G IN A

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G INA
lobal itiative for sthma
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GINA Program Objectives

• Increase appreciation of asthma as a global
  public health problem
• Present key recommendations for diagnosis and
  management of asthma
• Provide strategies to adapt recommendations to
  varying health needs, services, and resources
• Identify areas for future investigation of
  particular significance to the global community

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Executive CommitteeChair Paul OByrne, MD
GINA Structure
Dissemination/Implementation Task Group Chair
Wan Tan, MD
Science Committee Chair Eric Bateman, MD
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GINA Executive Committee

• P. OByrne, Chair, Canada
• E. Bateman, S. Africa S. Pedersen, Denmark
• J. Bousquet, France R. Singh, India
• T. Clark, UK M. Soto-Quiroz, Costa Rica
• K. Ohta, Japan W. Tan, Canada
• P. Paggario, Italy

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GINA Science Committee

• E. Bateman, Chair, S. Africa
• P. Barnes, UK K. Ohta, Japan
• J. Bousquet, France S. Pedersen, Denmark
• J. Drazen, US E. Pizzichini, Brazil
• M. FitzGerald, Canada S. Sullivan, US
• P. Gibson, Australia S. Wenzel, US
• P. OByrne, Canada H. Zar, S. Africa

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Executive CommitteeChair Paul OByrne, MD
GINA Structure
Science Committee Chair Eric Bateman, MD
Dissemination/Implementation Task Group Chair
Wan Tan, MD
GINA ASSEMBLY
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GINA Assembly

• A network of individuals participating in the
  dissemination and implementation of asthma
  management programs at the local, national and
  regional level
• GINA Assembly members are invited to meet with
  the GINA Executive Committee during the ATS and
  ERS meetings

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Bangladesh
Saudi Arabia
Slovenia
Germany
Ireland
Yugoslavia
Australia
Croatia
Canada
Brazil
Austria
Taiwan ROC
United States
Portugal
Thailand
Malta
Greece
Moldova
Mexico
China
Syria
South Africa
United Kingdom
Hong Kong
New Zealand
Italy
Chile
Venezuela
Argentina
Israel
Lebanon
Pakistan
Japan
GINA Assembly
Korea
Poland
Netherlands
Switzerland
Georgia
Russia
Macedonia
France
Czech Republic
Denmark
Turkey
Slovakia
Belgium
Singapore
Spain
Colombia
Ukraine
Romania
India
Sweden
Vietnam
Kyrgyzstan
Albania
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GINA Documents

• Global Strategy for Asthma Management and
  Prevention (revised 2006)
• Pocket Guide Asthma Management and Prevention
  (revised 2006)
• Pocket Guide Asthma Management and Prevention in
  Children (revised 2006)
• Guide for asthma patients and families
• All materials are available on GINA web site
  www.ginasthma.org

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Global Strategy for Asthma Management and
Prevention

• Evidence-based
• Implementation oriented
• Diagnosis
• Management
• Prevention
• Outcomes can be evaluated

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Global Strategy for Asthma Management and
Prevention

• Evidence Category Sources of Evidence
• A Randomized clinical trials
• Rich body of data
• B Randomized clinical trials
• Limited body of data
•  
• C Non-randomized trials
• Observational studies
• D Panel judgment consensus

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Global Strategy for Asthma Management and
Prevention (2006)

• Definition and Overview
• Diagnosis and Classification
• Asthma Medications
• Asthma Management and Prevention Program
• Implementation of Asthma Guidelines in Health
  Systems

Revised 2006
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Definition of Asthma

• A chronic inflammatory disorder of the airways
• Many cells and cellular elements play a role
• Chronic inflammation is associated with airway
  hyperresponsiveness that leads to recurrent
  episodes of wheezing, breathlessness, chest
  tightness, and coughing
• Widespread, variable, and often reversible
  airflow limitation

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Asthma Inflammation Cells and Mediators
Source Peter J. Barnes, MD
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Mechanisms Asthma Inflammation
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Asthma Inflammation Cells and Mediators
Source Peter J. Barnes, MD
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Burden of Asthma

• Asthma is one of the most common chronic diseases
  worldwide with an estimated 300 million affected
  individuals
• Prevalence increasing in many countries,
  especially in children
• A major cause of school/work absence

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Burden of Asthma

• Health care expenditures very high
• Developed economies might expect to spend 1-2
  percent of total health care expenditures on
  asthma. Developing economies likely to face
  increased demand
• Poorly controlled asthma is expensive investment
  in prevention medication likely to yield cost
  savings in emergency care

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Asthma Prevalence and Mortality
Source Masoli M et al. Allergy 2004
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Countries should enter their own data on burden
of asthma.
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Risk Factors for Asthma

• Host factors predispose individuals to, or
  protect them from, developing asthma
• Environmental factors influence susceptibility
  to development of asthma in predisposed
  individuals, precipitate asthma exacerbations,
  and/or cause symptoms to persist

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Factors that Exacerbate Asthma

• Allergens
• Respiratory infections
• Exercise and hyperventilation
• Weather changes
• Sulfur dioxide
• Food, additives, drugs

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Factors that Influence Asthma Development and
Expression

• Host Factors
• Genetic
• - Atopy
• - Airway hyperresponsiveness
• Gender
• Obesity

• Environmental Factors
• Indoor allergens
• Outdoor allergens
• Occupational sensitizers
• Tobacco smoke
• Air Pollution
• Respiratory Infections
• Diet

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Is it Asthma?

• Recurrent episodes of wheezing
• Troublesome cough at night
• Cough or wheeze after exercise
• Cough, wheeze or chest tightness after exposure
  to airborne allergens or pollutants
• Colds go to the chest or take more than 10 days
  to clear

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Asthma Diagnosis

• History and patterns of symptoms
• Measurements of lung function
• - Spirometry
• - Peak expiratory flow
• Measurement of airway responsiveness
• Measurements of allergic status to identify risk
  factors
• Extra measures may be required to diagnose asthma
  in children 5 years and younger and the elderly

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Typical Spirometric (FEV1) Tracings
Volume
FEV1
Normal Subject
Asthmatic (After Bronchodilator)
Asthmatic (Before Bronchodilator)
1
2
3
4
5
Time (sec)
Note Each FEV1 curve represents the highest of
three repeat measurements
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Measuring Variability of Peak Expiratory Flow
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Measuring Airway Responsiveness
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Clinical Control of Asthma

• No (or minimal) daytime symptoms
• No limitations of activity
• No nocturnal symptoms
• No (or minimal) need for rescue medication
• Normal lung function
• No exacerbations
• _________
• Minimal twice or less per week

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Levels of Asthma Control
Characteristic Controlled (All of the following) Partly controlled(Any present in any week) Uncontrolled
Daytime symptoms None (2 or less / week) More than twice / week 3 or more features of partly controlled asthma present in any week
Limitations of activities None Any 3 or more features of partly controlled asthma present in any week
Nocturnal symptoms / awakening None Any 3 or more features of partly controlled asthma present in any week
Need for rescue / reliever treatment None (2 or less / week) More than twice / week 3 or more features of partly controlled asthma present in any week
Lung function (PEF or FEV1) Normal lt 80 predicted or personal best (if known) on any day 3 or more features of partly controlled asthma present in any week
Exacerbation None One or more / year 1 in any week One or more / year 1 in any week
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Asthma Management and Prevention Program Five
Components
1. Develop Patient/Doctor Partnership 2. Identify
and Reduce Exposure to Risk Factors 3. Assess,
Treat and Monitor Asthma 4. Manage Asthma
Exacerbations 5. Special Considerations
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Asthma Management and Prevention Program Five
Interrelated Components
1. Develop Patient/Doctor Partnership 2. Identify
and Reduce Exposure to Risk Factors 3.
Assess, Treat and Monitor Asthma 4. Manage Asthma
Exacerbations 5. Special Considerations
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Asthma Management and Prevention Program Goals of
Long-term Management

• Achieve and maintain control of symptoms
• Maintain normal activity levels, including
  exercise
• Maintain pulmonary function as close to normal
  levels as possible
• Prevent asthma exacerbations
• Avoid adverse effects from asthma medications
• Prevent asthma mortality

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.
Asthma Management and Prevention Program

• Asthma can be effectively controlled in most
  patients by intervening to suppress and reverse
  inflammation as well as treating
  bronchoconstriction and related symptoms
• Early intervention to stop exposure to the risk
  factors that sensitized the airway may help
  improve the control of asthma and reduce
  medication needs.

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Asthma Management and Prevention Program

• Although there is no cure for asthma, appropriate
  management that includes a partnership between
  the physician and the patient/family most often
  results in the achievement of control

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Asthma Management and Prevention
ProgramComponent 1 Develop Patient/Doctor
Partnership

• Guidelines on asthma management should be
  available but adapted and adopted for local use
  by local asthma planning teams
• Clear communication between health care
  professionals and asthma patients is key to
  enhancing compliance

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Asthma Management and Prevention
ProgramComponent 1 Develop Patient/Doctor
Partnership

• Educate continually
• Include the family
• Provide information about asthma
• Provide training on self-management skills
• Emphasize a partnership among health care
  providers, the patient, and the patients family

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Asthma Management and Prevention
ProgramComponent 1 Develop Patient/Doctor
Partnership

• Key factors to facilitate communication
• Friendly demeanor
• Interactive dialogue
• Encouragement and praise
• Provide appropriate information
• Feedback and review

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Example Of Contents Of An Action Plan To Maintain Asthma Control
Your Regular Treatment 1. Each day take ___________________________ 2. Before exercise, take _____________________ WHEN TO INCREASE TREATMENT Assess your level of Asthma Control In the past week have you had Daytime asthma symptoms more than 2 times ? No Yes Activity or exercise limited by asthma? No Yes Waking at night because of asthma? No Yes The need to use your rescue medication more than 2 times? No Yes If you are monitoring peak flow, peak flow less than________? No Yes If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to step up your treatment. HOW TO INCREASE TREATMENT STEP-UP your treatment as follows and assess improvement every day ____________________________________________ Write in next treatment step here Maintain this treatment for _____________ days specify number WHEN TO CALL THE DOCTOR/CLINIC. Call your doctor/clinic _______________ provide phone numbers If you dont respond in _________ days specify number ______________________________ optional lines for additional instruction EMERGENCY/SEVERE LOSS OF CONTROL ?If you have severe shortness of breath, and can only speak in short sentences, ?If you are having a severe attack of asthma and are frightened, ?If you need your reliever medication more than every 4 hours and are not improving. 1. Take 2 to 4 puffs ___________ reliever medication 2. Take ____mg of ____________ oral glucocorticosteroid 3. Seek medical help Go to _____________________ Address___________________ Phone _______________________ 4. Continue to use your _________reliever medication until you are able to get medical help.
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Asthma Management and Prevention ProgramFactors
Involved in Non-Adherence

• Medication Usage
• Difficulties associated with inhalers
• Complicated regimens
• Fears about, or actual side effects
• Cost
• Distance to pharmacies

• Non-Medication Factors
• Misunderstanding/lack of information
• Fears about side-effects
• Inappropriate expectations
• Underestimation of severity
• Attitudes toward ill health
• Cultural factors
• Poor communication

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Asthma Management and Prevention
Program Component 2 Identify and Reduce
Exposure to Risk Factors

• Measures to prevent the development of asthma,
  and asthma exacerbations by avoiding or reducing
  exposure to risk factors should be implemented
  wherever possible.
• Asthma exacerbations may be caused by a variety
  of risk factors allergens, viral infections,
  pollutants and drugs.
• Reducing exposure to some categories of risk
  factors improves the control of asthma and
  reduces medications needs.

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Asthma Management and Prevention
Program Component 2 Identify and Reduce
Exposure to Risk Factors

• Reduce exposure to indoor allergens
• Avoid tobacco smoke
• Avoid vehicle emission
• Identify irritants in the workplace
• Explore role of infections on asthma development,
  especially in children and young infants

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Asthma Management and Prevention
Program Influenza Vaccination

• Influenza vaccination should be provided to
  patients with asthma when vaccination of the
  general population is advised
• However, routine influenza vaccination of
  children and adults with asthma does not appear
  to protect them from asthma exacerbations or
  improve asthma control

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma

• The goal of asthma treatment, to achieve and
  maintain clinical control, can be achieved in a
  majority of patients with a pharmacologic
  intervention strategy developed in partnership
  between the patient/family and the health care
  professional

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma

• Depending on level of asthma control, the patient
  is assigned to one of five treatment steps
• Treatment is adjusted in a continuous cycle
  driven by changes in asthma control status. The
  cycle involves
• - Assessing Asthma Control
• - Treating to Achieve Control
• - Monitoring to Maintain Control

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma

• A stepwise approach to pharmacological therapy is
  recommended
• The aim is to accomplish the goals of therapy
  with the least possible medication
• Although in many countries traditional methods of
  healing are used, their efficacy has not yet been
  established and their use can therefore not be
  recommended

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma

• The choice of treatment should be guided by
• Level of asthma control
• Current treatment
• Pharmacological properties and availability
  of the various forms of asthma treatment
• Economic considerations
• Cultural preferences and differing health care
• systems need to be considered

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Levels of Asthma Control
Characteristic Controlled Partly controlled(Any present in any week) Uncontrolled
Daytime symptoms None (2 or less / week) More than twice / week 3 or more features of partly controlled asthma present in any week
Limitations of activities None Any 3 or more features of partly controlled asthma present in any week
Nocturnal symptoms / awakening None Any 3 or more features of partly controlled asthma present in any week
Need for rescue / reliever treatment None (2 or less / week) More than twice / week 3 or more features of partly controlled asthma present in any week
Lung function (PEF or FEV1) Normal lt 80 predicted or personal best (if known) on any day 3 or more features of partly controlled asthma present in any week
Exacerbation None One or more / year 1 in any week One or more / year 1 in any week
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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma

• The choice of treatment should be guided by
• Level of asthma control
• Current treatment
• Pharmacological properties and availability
  of the various forms of asthma treatment
• Economic considerations
• Cultural preferences and differing health care
• systems need to be considered

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Component 4 Asthma Management and Prevention
Program Controller Medications

• Inhaled glucocorticosteroids
• Leukotriene modifiers
• Long-acting inhaled ß2-agonists
• Systemic glucocorticosteroids
• Theophylline
• Cromones
• Long-acting oral ß2-agonists
• Anti-IgE
• Systemic glucocorticosteroids

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Estimate Comparative Daily Dosages for Inhaled
Glucocorticosteroids by Age
Drug Low Daily
Dose (?g) Medium Daily Dose (?g) High
Daily Dose (?g)
gt 5 y Age lt 5 y gt 5 y Age
lt 5 y gt 5 y Age lt 5 y
Beclomethasone 200-500 100-200 gt500-1000 gt200-400 gt1000 gt400
Budesonide 200-600 100-200 600-1000 gt200-400 gt1000 gt400
Budesonide-Neb Inhalation Suspension 250-500 gt500-1000 gt1000
Ciclesonide 80 160 80-160 gt160-320 gt160-320 gt320-1280 gt320
Flunisolide 500-1000 500-750 gt1000-2000 gt750-1250 gt2000 gt1250
Fluticasone 100-250 100-200 gt250-500 gt200-500 gt500 gt500
Mometasone furoate 200-400 100-200 gt 400-800 gt200-400 gt800-1200 gt400
Triamcinolone acetonide 400-1000 400-800 gt1000-2000 gt800-1200 gt2000 gt1200
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Component 4 Asthma Management and Prevention
Program Reliever Medications

• Rapid-acting inhaled ß2-agonists
• Systemic glucocorticosteroids
• Anticholinergics
• Theophylline
• Short-acting oral ß2-agonists

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Component 4 Asthma Management and Prevention
Program Allergen-specific Immunotherapy

• Greatest benefit of specific immunotherapy using
  allergen extracts has been obtained in the
  treatment of allergic rhinitis
• The role of specific immunotherapy in asthma is
  limited
• Specific immunotherapy should be considered only
  after strict environmental avoidance and
  pharmacologic intervention, including inhaled
  glucocorticosteroids, have failed to control
  asthma
• Perform only by trained physician

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Treating to Achieve Asthma Control

• Step 1 As-needed reliever medication
• Patients with occasional daytime symptoms of
  short duration
• A rapid-acting inhaled ß2-agonist is the
  recommended reliever treatment (Evidence A)
• When symptoms are more frequent, and/or worsen
  periodically, patients require regular controller
  treatment (step 2 or higher)

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Treating to Achieve Asthma Control

• Step 2 Reliever medication plus a single
  controller
• A low-dose inhaled glucocorticosteroid is
  recommended as the initial controller treatment
  for patients of all ages (Evidence A)
• Alternative controller medications include
  leukotriene modifiers (Evidence A) appropriate
  for patients unable/unwilling to use inhaled
  glucocorticosteroids

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Treating to Achieve Asthma Control

• Step 3 Reliever medication plus one or two
  controllers
• For adults and adolescents, combine a low-dose
  inhaled glucocorticosteroid with an inhaled
  long-acting ß2-agonist either in a combination
  inhaler device or as separate components
  (Evidence A)
• Inhaled long-acting ß2-agonist must not be used
  as monotherapy
• For children, increase to a medium-dose inhaled
  glucocorticosteroid (Evidence A)

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Treating to Achieve Asthma Control

• Additional Step 3 Options for Adolescents and
  Adults
• Increase to medium-dose inhaled
  glucocorticosteroid (Evidence A)
• Low-dose inhaled glucocorticosteroid combined
  with leukotriene modifiers (Evidence A)
• Low-dose sustained-release theophylline (Evidence
  B)

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Treating to Achieve Asthma Control

• Step 4 Reliever medication plus two or more
  controllers
• Selection of treatment at Step 4 depends on prior
  selections at Steps 2 and 3
• Where possible, patients not controlled on Step 3
  treatments should be referred to a health
  professional with expertise in the management of
  asthma

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Treating to Achieve Asthma Control

• Step 4 Reliever medication plus two or more
  controllers
• Medium- or high-dose inhaled glucocorticosteroid
  combined with a long-acting inhaled ß2-agonist
  (Evidence A)
• Medium- or high-dose inhaled glucocorticosteroid
  combined with leukotriene modifiers (Evidence A)
• Low-dose sustained-release theophylline added to
  medium- or high-dose inhaled glucocorticosteroid
  combined with a long-acting inhaled ß2-agonist
  (Evidence B)

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Treating to Achieve Asthma Control

• Step 5 Reliever medication plus additional
  controller options
• Addition of oral glucocorticosteroids to other
  controller medications may be effective (Evidence
  D) but is associated with severe side effects
  (Evidence A)
• Addition of anti-IgE treatment to other
  controller medications improves control of
  allergic asthma when control has not been
  achieved on other medications (Evidence A)

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Treating to Maintain Asthma Control

• When control as been achieved, ongoing monitoring
  is essential to
• - maintain control
• - establish lowest step/dose treatment
• Asthma control should be monitored by the health
  care professional and by the patient

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Treating to Maintain Asthma Control
Stepping down treatment when asthma is controlled

• When controlled on medium- to high-dose inhaled
  glucocorticosteroids 50 dose reduction at 3
  month intervals (Evidence B)
• When controlled on low-dose inhaled
  glucocorticosteroids switch to once-daily
  dosing (Evidence A)

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Treating to Maintain Asthma Control
Stepping down treatment when asthma is controlled

• When controlled on combination inhaled
  glucocorticosteroids and long-acting inhaled
  ß2-agonist, reduce dose of inhaled
  glucocorticosteroid by 50 while continuing the
  long-acting ß2-agonist (Evidence B)
• If control is maintained, reduce to low-dose
  inhaled glucocorticosteroids and stop long-acting
  ß2-agonist (Evidence D)

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Treating to Maintain Asthma Control
Stepping up treatment in response to loss of
control

• Rapid-onset, short-acting or long-acting inhaled
  ß2-agonist bronchodilators provide temporary
  relief.
• Need for repeated dosing over more than one/two
  days signals need for possible increase in
  controller therapy

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Treating to Maintain Asthma Control
Stepping up treatment in response to loss of
control

• Use of a combination rapid and long-acting
  inhaled ß2-agonist (e.g., formoterol) and an
  inhaled glucocorticosteroid (e.g., budesonide) in
  a single inhaler both as a controller and
  reliever is effecting in maintaining a high level
  of asthma control and reduces exacerbations
  (Evidence A)
• Doubling the dose of inhaled glucocortico-steroids
  is not effective, and is not recommended
  (Evidence A)

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma Children 5 Years and Younger

• Childhood and adult asthma share the same
  underlying mechanisms. However, because of
  processes of growth and development, effects of
  asthma treatments in children differ from those
  in adults.

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma Children 5 Years and Younger

• Many asthma medications (e.g.
  glucocorticosteroids, ß2- agonists, theophylline)
  are metabolized faster in children than in
  adults, and younger children tend to metabolize
  medications faster than older children

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma Children 5 Years and Younger

• Long-term treatment with inhaled
  glucocorticosteroids has not been shown to be
  associated with any increase in osteoporosis or
  bone fracture
• Studies including a total of over 3,500 children
  treated for periods of 1 13 years have found no
  sustained adverse effect of inhaled
  glucocorticosteroids on growth

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Asthma Management and Prevention
ProgramComponent 3 Assess, Treat and Monitor
Asthma Children 5 Years and Younger

• Rapid-acting inhaled ß2-agonists are the most
  effective reliever therapy for children
• These medications are the most effective
  bronchodilators available and are the treatment
  of choice for acute asthma symptoms

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Asthma Management and Prevention
ProgramComponent 4 Manage Asthma Exacerbations

• Exacerbations of asthma are episodes of
  progressive increase in shortness of breath,
  cough, wheezing, or chest tightness
• Exacerbations are characterized by decreases in
  expiratory airflow that can be quantified and
  monitored by measurement of lung function (FEV1
  or PEF)
• Severe exacerbations are potentially
  life-threatening and treatment requires close
  supervision

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Asthma Management and Prevention
ProgramComponent 4 Manage Asthma Exacerbations

• Treatment of exacerbations depends on
• The patient
• Experience of the health care professional
• Therapies that are the most effective for the
  particular patient
• Availability of medications
• Emergency facilities

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Asthma Management and Prevention
ProgramComponent 4 Manage Asthma Exacerbations

• Primary therapies for exacerbations
• Repetitive administration of rapid-acting inhaled
  ß2-agonist
• Early introduction of systemic glucocorticosteroid
  s
• Oxygen supplementation
• Closely monitor response to treatment with serial
• measures of lung function

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Asthma Management and Prevention ProgramSpecial
Considerations

• Special considerations are required to
• manage asthma in relation to
• Pregnancy
• Surgery
• Rhinitis, sinusitis, and nasal polyps
• Occupational asthma
• Respiratory infections
• Gastroesophageal reflux
• Aspirin-induced asthma
• Anaphylaxis and Asthma

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Asthma Management and Prevention Program Summary

• Asthma can be effectively controlled in most
  patients by intervening to suppress and reverse
  inflammation as well as treating
  bronchoconstriction and related symptoms
• Although there is no cure for asthma, appropriate
  management that includes a partnership between
  the physician and the patient/family most often
  results in the achievement of control

82
Asthma Management and Prevention Program Summary

• A stepwise approach to pharmacologic therapy is
  recommended. The aim is to accomplish the goals
  of therapy with the least possible medication
• The availability of varying forms of treatment,
  cultural preferences, and differing health care
  systems need to be considered

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http//www.ginasthma.org
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Alternate Slides for Asthma Treatment
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Levels of Asthma Control
Characteristic Controlled (All of the following) Partly Controlled (Any measure present in any week) Uncontrolled
Daytime symptoms None (twice or less/week) More than twice/week Three or more features of partly controlled asthma present in any week
Limitations of activities None Any Three or more features of partly controlled asthma present in any week
Nocturnal symptoms/awakening None Any Three or more features of partly controlled asthma present in any week
Need for reliever/ rescue treatment None (twice or less/week) More than twice/week Three or more features of partly controlled asthma present in any week
Lung function (PEF or FEV1) Normal lt 80 predicted or personal best (if known) Three or more features of partly controlled asthma present in any week
Exacerbations None One or more/year One in any week
Any exacerbation should prompt review of
maintenance treatment to ensure that it is
adequate. By definition, an exacerbation in any
week makes that an uncontrolled asthma week.
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Asthma Control Treatment Steps Children Older
than Five Years, Adolescents, Adults
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Example Of Contents Of An Action Plan To Maintain Asthma Control
Your Regular Treatment 1. Each day take ___________________________ 2. Before exercise, take _____________________ WHEN TO INCREASE TREATMENT Assess your level of Asthma Control In the past week have you had Daytime asthma symptoms more than 2 times ? No Yes Activity or exercise limited by asthma? No Yes Waking at night because of asthma? No Yes The need to use your rescue medication more than 2 times? No Yes If you are monitoring peak flow, peak flow less than________? No Yes If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to step up your treatment. HOW TO INCREASE TREATMENT STEP-UP your treatment as follows and assess improvement every day ____________________________________________ Write in next treatment step here Maintain this treatment for _____________ days specify number WHEN TO CALL THE DOCTOR/CLINIC. Call your doctor/clinic _______________ provide phone numbers If you dont respond in _________ days specify number ______________________________ optional lines for additional instruction EMERGENCY/SEVERE LOSS OF CONTROL ?If you have severe shortness of breath, and can only speak in short sentences, ?If you are having a severe attack of asthma and are frightened, ?If you need your reliever medication more than every 4 hours and are not improving. 1. Take 2 to 4 puffs ___________ reliever medication 2. Take ____mg of ____________ oral glucocorticosteroid 3. Seek medical help Go to _____________________ Address___________________ Phone _______________________ 4. Continue to use your _________reliever medication until you are able to get medical help.