GINA by niusheng11

VIEWS: 661 PAGES: 92

									G lobal
INitiative for
A sthma
         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
             GINA Structure

           Executive Committee
           Chair: Paul O’Byrne, MD

       Science            Dissemination/Implementation
      Committee                   Task Group
Chair: Eric Bateman, MD       Chair: Wan Tan, MD
       GINA Executive Committee

          P. O’Byrne, 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
      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. O’Byrne, Canada      H. Zar, S. Africa
             GINA Structure

           Executive Committee
           Chair: Paul O’Byrne, MD

       Science            Dissemination/Implementation
      Committee                   Task Group
Chair: Eric Bateman, MD       Chair: Wan Tan, MD


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

        Romania Colombia      Ukraine      Singapore Spain
India
              Sweden      Albania     Kyrgyzstan Vietnam
         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
    Global Strategy for Asthma
    Management and Prevention


 Evidence-based
 Implementation oriented
    Diagnosis
    Management
    Prevention
 Outcomes can be evaluated
       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
     Global Strategy for Asthma
     Management and Prevention (2006)

                Definition and Overview
                Diagnosis and
                 Classification
                Asthma Medications

                Asthma Management and
                 Prevention Program
Revised 2006    Implementation of Asthma
                 Guidelines in Health
                 Systems
       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
Asthma Inflammation: Cells and Mediators




                             Source: Peter J. Barnes, MD
Mechanisms: Asthma Inflammation




                        Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators




                           Source: Peter J. Barnes, MD
       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
Asthma Prevalence and Mortality




                Source: Masoli M et al. Allergy 2004
Countries should enter their
own data on burden of
asthma.
      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
      Factors that Exacerbate Asthma

   Allergens
   Respiratory infections
   Exercise and hyperventilation
   Weather changes
   Sulfur dioxide
   Food, additives, drugs
       Factors that Influence Asthma
       Development and Expression

Host Factors            Environmental Factors
 Genetic                Indoor allergens

                         Outdoor allergens
 - Atopy
                         Occupational sensitizers
 - Airway
                         Tobacco smoke
  hyperresponsiveness
                         Air Pollution
 Gender
                         Respiratory Infections
 Obesity                Diet
      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
       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
          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
Measuring Variability of Peak
Expiratory Flow
Measuring Airway Responsiveness
           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
                    Levels of Asthma Control
                            Controlled            Partly controlled
  Characteristic                                                            Uncontrolled
                       (All of the following)   (Any present in any week)

                       None (2 or less /             More than
Daytime symptoms
                       week)                        twice / week
   Limitations of                                                            3 or more
                              None                        Any
     activities                                                              features of
     Nocturnal                                                               partly
    symptoms /                None                        Any                controlled
    awakening                                                                asthma
                                                                             present in
 Need for rescue /     None (2 or less /             More than
                                                                             any week
“reliever” treatment   week)                        twice / week
                                                < 80% predicted or
  Lung function
                            Normal               personal best (if
  (PEF or FEV1)
                                                known) on any day

   Exacerbation               None              One or more / year          1 in any week
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
Revised 2006



               5. Special Considerations
    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
      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
        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.
      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
    Asthma Management and Prevention Program
    Component 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
         Asthma Management and Prevention Program
         Component 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 patient’s
    family
      Asthma Management and Prevention Program
      Component 1: Develop
      Patient/Doctor Partnership

Key factors to facilitate communication:
 Friendly demeanor
 Interactive dialogue
 Encouragement and praise
 Provide appropriate information
 Feedback and review
        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 don’t 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.
           Asthma Management and Prevention Program
           Factors Involved in Non-Adherence


Medication Usage                 Non-Medication Factors
   Difficulties associated         Misunderstanding/lack of
    with inhalers                    information
   Complicated regimens            Fears about side-effects
   Fears about, or actual          Inappropriate expectations
    side effects
   Cost                            Underestimation of severity

   Distance to pharmacies          Attitudes toward ill health
                                    Cultural factors
                                    Poor communication
       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.
       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
      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
  Asthma Management and Prevention Program

  Component 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
    Asthma Management and Prevention Program

    Component 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
        Asthma Management and Prevention Program

        Component 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
        Asthma Management and Prevention Program

        Component 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
                       Levels of Asthma Control

  Characteristic         Controlled          Partly controlled         Uncontrolled
                                           (Any present in any week)

                       None (2 or less /        More than
Daytime symptoms
                       week)                   twice / week
   Limitations of                                                       3 or more
                            None                     Any
     activities                                                         features of
     Nocturnal                                                          partly
    symptoms /              None                     Any                controlled
    awakening                                                           asthma
                                                                        present in
 Need for rescue /     None (2 or less /        More than
                                                                        any week
“reliever” treatment   week)                   twice / week
                                           < 80% predicted or
  Lung function
                           Normal           personal best (if
  (PEF or FEV1)
                                           known) on any day

   Exacerbation             None           One or more / year          1 in any week
        Asthma Management and Prevention Program

        Component 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
       Component 4: Asthma Management and Prevention Program

       Controller Medications

   Inhaled glucocorticosteroids
   Leukotriene modifiers
   Long-acting inhaled β2-agonists
   Systemic glucocorticosteroids
   Theophylline
   Cromones
   Long-acting oral β2-agonists
   Anti-IgE
   Systemic glucocorticosteroids
              Estimate Comparative Daily Dosages for
              Inhaled Glucocorticosteroids by Age

     Drug                 Low Daily Dose (g)    Medium Daily Dose (g)    High Daily Dose (g)
                           > 5 y Age < 5 y          > 5 y Age < 5 y         > 5 y Age < 5 y
Beclomethasone             200-500     100-200   >500-1000      >200-400    >1000       >400


Budesonide                 200-600     100-200    600-1000      >200-400   >1000        >400


Budesonide-Neb                         250-500                 >500-1000               >1000
Inhalation Suspension

Ciclesonide                 80 – 160   80-160    >160-320     >160-320     >320-1280    >320


Flunisolide                500-1000    500-750   >1000-2000    >750-1250    >2000      >1250

Fluticasone                100-250     100-200    >250-500      >200-500    >500         >500

Mometasone furoate         200-400     100-200   > 400-800     >200-400    >800-1200     >400


Triamcinolone acetonide    400-1000    400-800   >1000-2000    >800-1200   >2000        >1200
  Component 4: Asthma Management and Prevention Program

  Reliever Medications

 Rapid-acting inhaled β2-agonists
 Systemic glucocorticosteroids
 Anticholinergics
 Theophylline
 Short-acting oral β2-agonists
        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
                              REDUCE
 LEVEL OF CONTROL                            TREATMENT OF ACTION

                                             maintain and find lowest
        controlled
                                                 controlling step
                                             consider stepping up to
   partly controlled                              gain control




                              INCREASE
       uncontrolled                           step up until controlled

       exacerbation                            treat as exacerbation




REDUCE                                                           INCREASE
                         TREATMENT STEPS
  STEP          STEP           STEP                   STEP         STEP
   1                 2                   3             4               5
        Treating to Achieve Asthma Control

    Step 1 – As-needed reliever medication
 Patients with occasional daytime symptoms of
  short duration
 A rapid-acting inhaled β2-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)
       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
       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 β2-agonist either in a combination inhaler
  device or as separate components (Evidence A)
 Inhaled long-acting β2-agonist must not be used
  as monotherapy
 For children, increase to a medium-dose inhaled
  glucocorticosteroid (Evidence A)
        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)
       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
        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 β2-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 β2-agonist (Evidence B)
        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)
      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
       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)
       Treating to Maintain Asthma Control

Stepping down treatment when asthma is controlled
 When controlled on combination inhaled
  glucocorticosteroids and long-acting
  inhaled β2-agonist, reduce dose of inhaled
  glucocorticosteroid by 50% while
  continuing the long-acting β2-agonist
  (Evidence B)
 If control is maintained, reduce to low-
  dose inhaled glucocorticosteroids and
  stop long-acting β2-agonist (Evidence D)
       Treating to Maintain Asthma Control

Stepping up treatment in response to loss of control
 Rapid-onset, short-acting or long-
  acting inhaled β2-agonist
  bronchodilators provide temporary
  relief.
 Need for repeated dosing over more
  than one/two days signals need for
  possible increase in controller therapy
       Treating to Maintain Asthma Control

Stepping up treatment in response to loss of control
 Use of a combination rapid and long-acting
  inhaled β2-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)
  Asthma Management and Prevention Program
  Component 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.
  Asthma Management and Prevention Program
  Component 3: Assess, Treat and Monitor
  Asthma – Children 5 Years and Younger


Many asthma medications (e.g.
glucocorticosteroids, β2- agonists,
theophylline) are metabolized faster in
children than in adults, and younger
children tend to metabolize medications
faster than older children
     Asthma Management and Prevention Program
     Component 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
    Asthma Management and Prevention Program
    Component 3: Assess, Treat and Monitor
    Asthma – Children 5 Years and Younger


 Rapid-acting inhaled β2-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
     Asthma Management and Prevention Program
     Component 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
     Asthma Management and Prevention Program
     Component 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
     Asthma Management and Prevention Program
     Component 4: Manage Asthma
     Exacerbations

Primary therapies for exacerbations:
• Repetitive administration of rapid-acting inhaled
  β2-agonist
• Early introduction of systemic
  glucocorticosteroids
• Oxygen supplementation
Closely monitor response to treatment with serial
measures of lung function
 Asthma Management and Prevention Program
 Special 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
         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
        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
http://www.ginasthma.org
Alternate Slides for
Asthma Treatment
                     Levels of Asthma Control
Characteristic               Controlled                  Partly Controlled             Uncontrolled
                             (All of the                 (Any measure
                             following)                  present in any week)
Daytime symptoms             None (twice or less/week)   More than twice/week

Limitations of               None                        Any
activities
                                                                                       Three or more
Nocturnal                    None                        Any                           features of
symptoms/awakening                                                                     partly controlled
                                                                                       asthma present
Need for reliever/           None (twice or less/week)   More than twice/week
                                                                                       in any week
rescue treatment

Lung function (PEF or        Normal                      < 80% predicted or
FEV1)                                                    personal best (if known)

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.
Asthma Control: Treatment Steps
    Children Older than Five Years, Adolescents, Adults
        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 don’t 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.

								
To top