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Family Medicine: Asthma (GINA Guidelines 2012) FCH 250

Asthma (GINA Guidelines 2012) V. MANAGEMENT


Patient-doctor partnership
I. Key Points
Identify and reduce exposure to risk factors
II. Diagnosis
III. Classification
o Host factors- obesity (BMI>30)
IV. Treatment o Environmental- allergens: mites, furred animals, cockroaches,
V. Management pollen, fungi, molds, yeasts; viral infections, occupational
sensitizers, tobacco smoke, medications (aspirin/NSAIDs),
pollution, diet
Assess, treat, monitor asthma
I. KEY POINTS
o Current level of asthma control determines treatment. (Refer to
Appendix.)
Asthma is a chronic inflammatory disorder of the airways. o If symptom control is maintained for three months, a step-
o Airway hyperresponsiveness down of treatment can be made.
o Recurrent episodes of wheezing, breathlessness, chest o If asthma is only partly controlled, an increase in treatment
tightness, coughing Particularly at night or early morning should be made.
o Reversible airway obstruction (Refer to the Appendix for Management Approach Based on
o Risk of developing asthma host (genetic) and environmental Control).
factors Manage asthma exacerbations
o Determine severity. (Refer to the Appendix for the table.)
II. DIAGNOSIS o Treat to achieve rapid resolution.
Medical history - Episodes of breathlessness, wheezing, cough ! Oxygen- Oxygen saturation of 90% for
chest tightness adults and 95% for children should be
Physical examination- may be normal; wheezing on auscultation, achieved; administration by nasal
other signs- cyanosis, drowsiness, tachycardia, use of accessory cannulae or mask
muscles ! Rapid-acting inhaled Beta 2 agonists-
Tests for diagnosis and monitoring administered at regular intervals
o Spirometry- preferred method to assess airflow limitation; FEV1/ ! Epinephrine- subcutaneous or
FVC< 80% suggests airflow limitation; 60 mL/min or intramuscular injection of epinephrine for
improvement of 20% after bronchodilator use anaphylaxis and angioedema
o PEF charts for monitoring
o For diagnosis of those with normal lung function but with clinical END OF TRANSCRIPTION
signs and symptoms: methacholine/ histamine inhalation,
mannitol inhalation/ challenge. A fall of 20% in FEV1 vs.
concentration of the triggers is plotted
o Skin test for measuring allergic status

III. CLASSIFICATION
Levels of asthma control. Asthma is now classified according to
intensity of treatment needed to control symptoms. Refer to the
Appendix for levels of asthma control.

IV. TREATMENT
Controllers- daily, long-term basis to keep asthma control;
mainly anti-inflammatory. Includes inhaled/ systemic
glucocorticosteroids, leukotriene modifiers, long-acting Beta 2
agonists with inhaled glucocorticosteroids, sustained-release
theophyllines, cromones, anti-IgE
o Inhaled corticosteroids- most effective anti-inflammatory for long-
term asthma, also recommended for children of all ages with
asthma; side effects include oropharyngeal candidiasis,
dysphonia, adrenal suppression, easy bruisability, decreased
bone mineral density.
o Leukotriene modifiers- mild bronchodilator effect; used as add-
on treatment to decrease dose of glucocorticoids
o Long-acting inhaled bronchodilators- Long-acting beta 2 agonists
like formoterol and salmeterol not used as monotherapy; usually
combined with glucocorticosteroids; fewer systemic effects than
oral therapy
o Theophyllines- modest anti-inflammatory effect; side effects
arrhymias, seizures, nausea and vomiting (most common)
o Cromones- limited effects
o Systemic glucocorticosteroids- for severely uncontrolled asthma;
side effects include diabetes,arterial hypertension, HPA
suppression, osteoporosis, cataractacts
Relievers- as-needed basis for bronchoconstriction. Includes
rapid-acting inhaled Beta 2 agonists, short-acting oral Beta agonists,
anticholinergics, short-acting theophyllines
o Rapid-acting inhaled Beta 2 agonists- Only on as-need basis at
lowest dose and frequency most effective bronchodilators,
preferred treatment in children; side effects include skeletal
muscle tremors, headaches, palpitations, agitation
o Anticholinergics- ipratropium/oxitropium bromide, less effective
than rapid acting Beta 2 agonists
Family Medicine: Asthma (GINA Guidelines 2012) FCH 250
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APPENDIX

Levels of Asthma Control


! Family Medicine: Asthma (GINA Guidelines 2012) FCH 250

Management approach based on control