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Chronic Asthma (Drug Ladder (3 LABA: salmeterol 50ug bd (If control is…
Chronic Asthma
Drug Ladder
3 LABA: salmeterol 50ug bd
Good response: continue
Benefit but control still poor: ↑ steroid to 400ug bd
No benefit: discontinue + ↑ steroid to 400ug bd
If control is still poor consider
4
Trials of
↑ inhaled steroid to up to 1000ug bd
Leukotriene receptor antagonist
Esp. if exercise- or NSAID-induced asthma
MR Theophylline
MR β agonist PO
2 Low-dose inhaled steroid: beclometasone 100-400ug bd
200ug bd is good starting dose for most
5
Oral steroids: e.g. prednisolone 5-10mg od
Use lowest dose necessary for symptom control
Maintain high-dose inhaled steroid
Refer to asthma clinic
1 SABA PRN
If use >1/d or nocte symptoms
General Measures: TAME
Technique for inhaler use
Avoidance: allergens, smoke (ing), dust
Monitor: Peak flow diary (2x/d)
Written instruction based on peak flow
Educate
Liaise c¯ specialist nurse
Need for Rx compliance
Emergency action plan