Asthma is one of the most common chronic disease. In which the reversible airways obstruction and bronchospasm occur and may produce extra mucus. This can make breathing problem and trigger coughing.
This is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity and mortality in severe cases.
Diagnosis of Asthma
Comprehensive assessment of each patient should always be completed by primary care physician particularly during the first visit. The physicians are encouraged to use the initial assessment form which covers the essential aspects required to ascertain diagnosis of asthma, assess degree of asthma control, future risk for poor outcome, identifying trigger, and suggest alternative diagnosis.
For example the patient can be asked the following questions: “In the previous 4 weeks, have you had: 1) daytime asthma symptoms more than twice per week? 2) any nighttime awakenings due to asthma? 3) to use an asthma reliever for symptoms more than twice per week? 4) any activity limitations due to asthma?” If the patient answers “No” to all four questions, his or her asthma is well controlled. If the patient answers “Yes” to one or two of the questions, the asthma is partially controlled, but if the answer is “Yes” to three to four of the questions, the asthma is not well controlled.
Management Plan of Asthma
Once diagnosis and the degree of control are ascertained, management plan should be initiated and must aim at:
a. Control asthma symptoms by achieving Asthma Control Test (ACT) score ≥ 20.
b. Maintain normal daily and exercise activities on minimal medications.
c. Minimize or prevent ED visit.
The management plan should cover the following aspects:
a. Inform patient /parents about the diagnosis.
b. Education about asthma possible triggers.
c. Available options of medications.
d. Proper technique of using inhaler device.e. How can the patient/parent minimize exacerbations?
f. How do patient/parent deal with worsening symptoms (action plan)?
g. How would the patient/parent communicate with the treating physician?
h. How frequent is the patient going to be seen in the clinic?
Pharmacological Management of Asthma in Patient Aged 10 Years and Older
GINA recommends the following asthma-treatment steps:
Step 1: This step is advised for patients with mild asthma who have symptoms less than twice per month and no risk of exacerbations. As mentioned previously, based on new evidence, the 2019 GINA guidelines no longer recommend SABA use alone to treat asthma.
Step 2: The preferred controller regimen is as-needed low-dose ICS-formoterol or daily low-dose ICS plus as-needed SABA. The ICS-formoterol regimen avoids the need for daily ICS while providing similar benefits for exercise-induced bronchoconstriction as daily ICS with as-needed SABA.
Step 3: Preferred controller treatments include a low-dose ICS–long-acting beta2 agonist (LABA) plus as-needed SABA or low-dose ICS-formoterol for both maintenance and reliever therapy.
Step 4: The preferred controller treatment is low-dose ICS-formoterol as maintenance and reliever therapy or medium-dose ICS-LABA as maintenance plus as-needed SABA. Note that ICS-formoterol should not be combined with an ICS-LABA containing a different LABA.
Step 5: Persistent exacerbations or symptom worsening occurs despite adherence and correct inhaler technique. These patients are considered to have severe or difficult-to-treat asthma and should be referred to a pulmonologist.
Stepping up through the stages outlined above is appropriate when patients have persistently poor symptom control or exacerbations despite low-dose ICS treatment for 2 to 3 months. Stepping down is appropriate when the patient has good symptom control and stable lung function for at least 3 months.
- Ministry of Health, Saudi Arabia
- Global Initiative for Asthma