British Guideline on the Management of Asthma

BTS/SIGN Guidance May 2008 (revised July 2009)

Patient groups Children < 5 years 5-12 years Adults General Pregnancy Occupational

Diagnosis Clinical features Increase/Decrease probability of Asthma Stratify probability Low Intermediate High

Management Non-pharmacological Pharmacological

Children < 5 years Step 1: Short acting Beta agonist Step 2: Steroid ( mcg/day) or Leukotriene receptor antagonist Step 3: Steroid or LRA Step 4: Refer to paeds

Children 5-12 years Step 1: Short acting beta agonist Step 2: Regular inhaled steroid Step 3: LABA +/- increased steroid or Leukotriene Receptor Antagonist or Theophylline SR Step 4: Increase steroid to 800mcg/day Step 5: Oral steroid / Refer

Adults Step 1: Short acting beta agonist Step 2: Inhaled steroid Step 3: LABA +/- increased steroid or Leukotriene Receptor Antagonist or Theophylline SR Step 4: Increased inhaled steroid Consider trial of other drug Step 5: Oral steroid / Refer

Acute asthma Sats, PEFR, HR, RR, speech, chest examination, accessory muscles Severe Life threatening

Severity Moderate PEFR > 50-75% No features severe Acute severe PEFR 33-50% RR ≥ 25, (adult), >40 (2-5 yrs), >30 (>5yrs) HR ≥ 110 (adult), >140 (2-5 yrs), >125 (>5 yrs) Unable complete sentences/feed Life threatening PEFR < 33% Silent chest, Sats < 92%, exhaustion Arrhythmia, cyanosis

Management Oxygen Inhaled beta agonist Oral steroid < 2 years : 10mg for 3 days minimum 2-5 years : 20mg for 3 days minimum >5 years: 30-40mg for 3 days minimum Adults: 40-50mg for 5 days minimum ?Ipratropium bromide

Who to admit - children Severe or life threatening ASAP Moderate No improvement after MDI

Who to admit - Adults Life threatening ASAP Severe Treat and see

Pregnancy Close monitoring Medication as normal Same when breastfeeding (encourage) Acute: same but fetal monitoring also Rare during labour

Occupational asthma Serial PEFR recordings Early referral

Fin