Based on Version 3 Dudley Asthma Treatment Guidelines ...€¦ · - Follow up patients who have an...

2
Based on Version 3 Dudley Asthma Treatment Guidelines September 2016 ASTHMA TREATMENT GUIDELINES SPACER DEVICES 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 for all 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 full guideline). BTS/SIGN 2016 The purpose is to assist Health Care Professionals, who are managing patients with a Diagnosis of 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-responsiveness and 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 SABA INHALERS 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

Transcript of Based on Version 3 Dudley Asthma Treatment Guidelines ...€¦ · - Follow up patients who have an...

Page 1: Based on Version 3 Dudley Asthma Treatment Guidelines ...€¦ · - Follow up patients who have an asthma attack within 2 working days – see Acute Guidelines Asthma is not controlled

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

Page 2: Based on Version 3 Dudley Asthma Treatment Guidelines ...€¦ · - Follow up patients who have an asthma attack within 2 working days – see Acute Guidelines Asthma is not controlled

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