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for SPACER all ages DEVICES A SIMPLE GUIDE - Welcome - Dudley … · 2017-07-05 · ©2016 Produced...
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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 2.4.2 June 2017 Based on V3 of Dudley Asthma Treatment Guidelines Sept 2016 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 asthma attacks • No night time awakening due to asthma • Normal lung function • No need for rescue medication • Minimal side effects from medication • No limitations on activity including exercise INHALED CORTICOSTEROIDS ARE THE CORNERSTONE OF TREATMENT IN ASTHMA A SIMPLE GUIDE • 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.
Transcript of for SPACER all ages DEVICES A SIMPLE GUIDE - Welcome - Dudley … · 2017-07-05 · ©2016 Produced...
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 2.4.2 June 2017 Based on V3 of Dudley Asthma Treatment Guidelines Sept 2016
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 SABAINHALERS PER YEAR
The aim of asthma management is control of the disease. Complete control of asthma is defined as:
• No daytime symptoms • No asthma attacks• No night time awakening due to asthma • Normal lung function• No need for rescue medication • Minimal side effects from medication• No limitations on activity including exercise
INHALED CORTICOSTEROIDS ARE THE CORNERSTONE OF TREATMENT IN ASTHMA
A SIMPLE GUIDE• 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, withdifferent steroid potencies, which has caused much confusion.
• The total daily steroid load equivalent to Beclometasone is highlighted in each box.
ASTHMA
TREATMENT
GU
IDEL
INES
*Beclometasone (BDP) Equivalent Total Daily Dose
Based on V3 of Dudley Asthma Treatment Guidelines Sept 2016
A SIMPLE GUIDE
INITIAL ADD ON PREVENTER
REGULAR PREVENTER
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
Clenil 50 MDI
2 puffs twice a day
(Spacer recommended)
Pulmicort 100
Turbohaler
1 puff twice a day
Clenil 100 MDI
2 puffs twice a day
(Spacer Recommended)
Pulmicort 200
Turbohaler
1 puff twice a day
Key for asthma guidelines
< 5
years
5-11
years
12-17
years
18+
years
MOVE UP TO IMPROVE CONTROL AS NEEDED
REFER
Symbicort 100/6 & 200/6
Turbohaler
2 puffs daily plus 1 puff as
required (max 12/day)
Fostair 200/6 Nexthaler
2 puffs twice a day
SHORT ACTING B2AGONIST (SABA)
Salbutamol 100 MDI
2 puffs as required
Salamol 100 Easi-Breathe
MDI
2 puffs as required
Bricanyl 500 Turbohaler
1 puff as required
REFER
REFER
Consider
REFER
HIGH DOSE THERAPIES
MOVE DOWN AND MAINTAIN LOWEST CONTROLLING THERAPY
Version 2.4.2 June 2017 ©2016 Produced by Dudley Respiratory Group Chairman Dr Mark Hopkin. Adapted from BTS/SIGN 2016 - 153
www.dudleyrespiratorygroup.org
LTRA**
(See below)
*2000mcgs/day
ICS + LABA
SMART
BDP
ICS
Budesonide
ICS
Fluticasone
Propionate IC
SBDP
Extra fine: ICS
Formoterol
LABA
Salmeterol
LABA
Tiotropium
LAMA
Clenil
�
Pulmicort
�
Symbicort
��
Flutiform
��
Fostair
��
Seretide
��
Spiriva
�
**LTRA (Leukotrine Receptor Antagonist)
*BDP - Beclomethasone Dipropionate
ICS -Inhaled Corticosteroid
LABA -Long Acting Beta 2Agonist
MDI- Metered Dose Inhaler
DPI- Dry Powder Inhaler
Montelukast 4mg Chewtab
or4mg Granules (do not mix with fluid
can be mixed with food)
Once a day at night
Montelukast 5mg Chewtab
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
73
2
61
*400mcgs/dayICS
Clenil 100 MDI
2 puffs twice a day
(Spacer Recommended)
Pulmicort 200
Turbohaler
1 puff twice a day
4
Clenil 200 MDI
2 puffs twice a day
Pulmicort 400 Turbohaler
1 puff twice a day
8
increase ICS to
400mcgs/day
before adding in LABA
6+
Symbicort 100/6
Turbohaler***
2 puffs twice a day
Seretide 50
MDI
2 puffs twice a day
(Spacer Recommended)
5
6+
ALWAYS
• Prescribe by brand
• Check inhaler technique
• Check Compliance
• Is it Asthma?
• Use a spacer with MDI
5 yrs
6-11 yrs
who cannot
use Turbohaler
(DPI)
OR
Clenil 100 MDI
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 BENEFIT from LABA but
control still inadequate...
increase ICS in a
Combination Inhaler (ICS+LABA)
consider trial of
LTRA**
48
*400mcgs/day
ICS
10LAMA
*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 INCREASE ICS
*400
mcgs/day
ICS+LABA
5
See
separate
notes
Flutiform 125/5
MDI
2 puffs twice a day
9*1000mcgs
ICS + LABA
Flutiform 250/10 MDI
2 puffs twice a day
11*2000mcgs
ICS + LABA
Symbicort 200/6
Turbohaler
2 puffs twice a day
9*800mcgs
ICS + LABA
*200mcgs
ICS + LABA
Very Low dose ICS
Lowdose ICS
Mediumdose ICS
Highdose ICS
POTENCY KEY
*200mcgs/dayICS
*400mcgs/dayICS
*400mcgsICS + LABA
Maintenance & Reliever Therapy
*800mcgsICS
*400mcgsICS + LABA
either
or
< 12 years
12+ years
STOP
SABA
Spiriva Respimat 2.5mcgs
2 puffs once a day
Long Acting Muscarinic
Antagonist - LAMA
10
