Based on Version 3 Dudley Asthma Treatment Guidelines September 2016
ASTHMA TREATMENT GUIDELINES
SPACERDEVICES
Spacer devices are recommended for use with Metered Dose Inhalers (MDI’s) in all age groups.
Aerochamber Infant Device with mask (Orange)
CLEANING
– Wash the spacer once a month using detergent, such as washing-up liquid.
– Don’t scrub the inside of the spacer as this affects the way it works.
– Leave it to air-dry as this helps to prevent the medicine sticking to the sides of the chamber and reduces the static.
– Wipe the mouthpiece clean of detergent before using it again. Don’t worry if the spacer looks cloudy - that doesn’t mean its dirty.
– The spacer should be replaced at least every year, especially if used daily, but some may need to be replaced sooner.
– Ensure the inhaler is compatible with the spacer device
0-18 months
Aerochamber Child Device with mask (Yellow)
1 - 5 years
Volumatic
3+ years
Aerochamber Plus (Blue)
5+ years
Aerochamber Plus with mask (Blue)
5+ years
Volumatic with Face Mask
0+ years
Spacer devices should be replaced every 6-12 months.
©2016 Produced by Dudley Respiratory Group Chairman Dr Mark Hopkin. www.dudleyrespiratorygroup.org
ASTHMA TREATMENT GUIDELINES
forall ages
Version 1.24 October 2016 Based on V3 of Dudley Asthma Treatment Guidelines Sept 2016
This has been produced, based on Dudley Asthma Guidelines V9.0 September 2016, (link to fullguideline). BTS/SIGN 2016
The purpose is to assist Health Care Professionals, who are managing patients with a Diagnosisof Asthma, to select an appropriate inhaler device.
There are many devices available, with different steroid potencies, which has caused much confusion.
The total daily steroid load equivalent to Beclometasone is highlighted in each box.
Definition of Asthma
Central to all definitions is the presence of symptoms (more than one of wheeze, breathlessness, chest tightness, cough) and of variable airflow obstruction. More recent descriptions of asthma in both children and adults have included airway hyper-responsivenessand airway inflammation as components of the disease. (BTS/SIGN 2016)
BEST PRACTICE
- Review patients regularly Considering Step Up & Down accordingly- A Spacer device is recommended when using a MDI (see back sheet)- Check Inhaler technique and compliance at each appointment and before starting any additional therapy- Use an in-check device to measure inspiratory effort- Consider total steroid load when reviewing patient- All patients should have a written Personal Asthma Action Plan (PAAP)- Reconsider the diagnosis in patients who continue to have symptoms- Follow up patients who have an asthma attack within 2 working days – see Acute Guidelines
Asthma is not controlled at any step if using Short Acting B2 Agonists (SABAs)3 times a week or more: having symptoms 3 times a week or more: waking at least once a week.
A WELL CONTROLLED ASTHMATIC SHOULD NOT REQUIRE MORE THAN ONE TO TWO SABAINHALERS PER YEAR
The aim of asthma management is control of the disease. Complete control of asthma is defined as:
• No daytime symptoms • No limitations on activity including exercise• No night time awakening due to asthma • No asthma attacks• No need for rescue medication • Normal lung function
• Minimal side effects from medication
INHALED CORTICOSTEROIDS ARE THE CORNERSTONE OF TREATMENT IN ASTHMA
INITIAL ADD ON PREV
ENTER
ASTHMA TREATMENT
GU
IDEL
INES
REG
ULAR PREV
ENTER
*200mcgsICS + LABA
*400mcgsICS + LABA
Symbicort 100/6
Turbohaler
1 puff twice a day
Symbicort 100/6
Turbohaler
2 puffs twice a day
Flutiform
50/5
MDI
2 puffs twice a day
ADDITIONAL ADD ON THERAPIES
*200mcgs/dayICS
*400mcgs/dayICS
Clenil 50 M
DI
2 puffs twice a day
(Spacer recom
mended)
Pulm
icort 100
Turbohaler
1 puff twice a day
Clenil 100 M
DI
2 puffs twice a day
(Spacer Recommended)
Pulm
icort 200
Turbohaler
1 puff twice a day
Key fo
r asthma gu
idelines
< 5
years
5-11
years
12-17
years
18+
years
IMPROVE CONTROL AS NEEDED
REFER
Maintenance & Reliever Therapy
Symbicort 200/6
Turbohaler
Fostair 100/6
MDI
1-2 puffs twice a day plus 1 puff
as required (m
ax 12/day)
1 puff tw
ice a day plus 1 puff
as required (m
ax 8/day)
Flutiform
250/10 M
DI
2 puffs twice a day
Fostair 200/6 M
DI
2 puffs twice a day
Fostair 200/6 Nexthaler
2 puffs twice a day
SHORT ACTING B
2AGONIST (SABA)
Salbutamol 100 M
DI
2 puffs as required
Salamol 100 Easi-Breathe
MDI
2 puffs as required
Bricany
l 500 Turbohaler
1 puff as required
STOP
SABA
REFER
REFER
Consider
REFER
HIGH DOSE THERAPIES
Spiriva Respim
at 2.5mcgs
2 puffs once a day
Long Acting
Muscarinic
Antagonist - LAMA
MAINTAINLOWESTCONTROLLINGSTEP
Version 2 Oct 2016 ©2016 Produced by Dudley Respiratory Group Chairm
an Dr Mark Hopkin. Adapted from BTS/SIGN 2016 - 153
www.dudleyrespiratorygroup.org
LTRA**
(See below)
*Beclometasone (BDP) Equivalen
t Total D
aily Dose
*200
0mcgs/day
ICS + LABA
MART
SMART
BDP
ICS
Budesonide
ICS
Fluticasone
Propionate IC
SBD
PExtra fine: IC
SFormoterol
LABA
Salmeterol
LABA
Tiotropium
LAMA
Clenil
�
Pulm
icort
�
Symbicort
��
Flutiform
��
Fostair
��
Seretide
��
Spiriva
�
**LTRA (L
euko
trine Recep
tor Antago
nist)
ICS -Inhaled Corticosteroid
LABA -Long Acting Beta 2Agonist
MDI- Metered Dose Inhaler
DPI- Dry Powder Inhaler
Montelukast 4mg Chew
tab
or4mg Granules (do not mix with fluid
can be mixed with food)
Once a day at night
Montelukast 5mg Chew
tab
once a day at night
Montelukast 10mg Tablet
once a day at night
6 months
to
5 years
6-14 years
15+ years
11
LAMA
10
1110
73
2
61
*400mcgs/dayICS
Clenil 100 M
DI
2 puffs twice a day
(Spacer Recommended)
Pulm
icort 200
Turbohaler
1 puff twice a day
4*800mcgsICS Clenil 200 M
DI
2 puffs twice a day
Pulm
icort 400 Turbohaler
1 puff twice a day
8
increase IC
S to
400mcgs/day
before adding in LABA
6+
*800mcgsICS + LABA
*1000mcgsICS + LABA
Symbicort 200/6
Turbohaler
2 puffs twice a day
Flutiform
125/5
MDI
2 puffs twice a day
Fostair 100/6
MDI
2 puffs twice a day
Fostair 100/6
Nexhaler
2 puffs twice a day
99
*400mcgsICS + LABA
Symbicort 100/6
Turbohaler***
2 puffs twice a day
Seretide 50
MDI
2 puffs twice a day
(Spacer Recommended)
5
6+
ALW
AYS
• Prescribe by
brand
• Check inhaler technique
• Check Compliance
• Is it Asthma?
• Use a spacer with M
DI
5 yrs
6-11 yrs
who can
not
use Turbohaler
(DPI)
OR
Clenil 100 M
DI
2 puffs twice a day
(Spacer Recommended)
OR
Asthma is not
controlled at any
step if:
•using SABA 3
times a
week
or more.
• having symptoms
3 times a week
or more.
• waking at least
once a week.
LTRA**
LTRA**
LTRA**
*200mcgs/day
ICS+LABA
In a
combination
inhaler
2
*400mcgs/day
3 ICS
GOOD RESPONSE - continue
IF BEN
EFIT from LABA but
control still inadequate then...
increase ICS in a
Combination Inhaler (ICS+LABA)
IF CONTROL STILL INADEQ
UATE
then trial
LTRA**
48
*400mcgs/day
ICS
10LA
MA
*800mcgs/day
ICS 9
*800 *1000
mcgs/day
ICS+LABA
REFER
*200mcgs/day
ICS1
*400mcgs/day
ICS6
*400mcgs/day
ICS+LABA
In a
combination
inhaler
7
NO RESPONSE
from LABA
STOP and INCREA
SE ICS
*400
mcgs/day
ICS+LABA
5
*2000mcgsICS + LABA
Based on V3 of Dudley Asthma Treatm
ent Guidelines Sept 2016