QUICK REFERENCE FOR HEALTHCARE PROVIDERS in Adults[QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF ASTHMALN ADULTS + Asthma patients with the following conditions should be referred to specialists with experience in asthma management for further evaluation: diagnosis of asthma is not clear © _severelfe-threatening asthma exacerbations suspected occupational asthma 0 asthma in pregnancy poor response to asthma treatment asthma with multiple co-morbidities COMMON MEDICATIONS IN ASTHMA RELIEVER SABA ‘Salbutamol 100 ygldose inhaler (pMDI) 1-2 pals PRN (max puilsiday) i ‘CONTROLLER, Beclometasone dipropionate 60, 100 & 200 pgldose | ~ Exta-ine formulation: inhale (pM) 50-400 pg BD (max) ies Budesonide 100 & 200 pgldose nhaler pMDI) |» 100-800 9 BD (max) & Cilesonde 80& 160 pgldose inhaler (pMO) | + 160 u9 OD (max. 320 yg 80) Fucasone propionate 50 8125 ugitoseintler (MDD | = 100- 1000 ug BD (max) Maintenance therapy: Beclometasone cipropionete 100 ug &formoterl 6 | = 1-2 puis BD (max. 2 puis BD) bo inhaler (pM) tenance & reliever therapy: + 4 puff BD + Take additional 1 puff as needed + Total max, dose: 8 pufsiday ‘Waintenance therapy: + 1-2 puffs BD (max. 4 puffs BD) Budesonide 160 ug & formoterol 4.5 ig inhaler | Maintenance & reliever therapy: (Turbuhaler) + 1 puff BD (2 puffs BD may be used in | some patents) or 2 puffs OD | + Take addtional puff as needed + Total max. dose: 12 pufsiday Flotcasone propionale 125 pg & fomoterol 8 yg 4 inhaler (pM!) ICSILABA —[Fisicasone propionate 250 pg & formoterol 10 yg | * 2Pufs BO Combination | inhaler (pMDI) Fluticasone furoate 100 yg & vlanterol 25 pg inhaler (Ellipta®) Fiuicasone faroale 200 wp vianera)25 pgiahaer | ° ' PUfOD (Elipta®) ‘Salmeterol 25 1g & fluticasone propionate 125 yg | , inhaler (pMDI) puffs BD Saimeterol 60 ug & fuicasone propionate 250 ug inhaler (Accunaler®) Salmeterol 60 yg & fvicasone proponate 00 ug] ° | PUTED inhaler (Accuhaler®) TAMA Tiotropum 25 pg, solution for inhalation (Sof Mist | - 2 puffs OD Inhaler@/Respimat®) LTRA Montelukast 10 mg tablet + 10mg OD (in the evening) Theophyline | Theophyline SR 250 mg abet > 260mg BD + Suggested starting dose 250 mg OD Disclaimer: The information on common asthma medications inthis section only serves as a general guide and not all-inclusive. Doses may be different depending on formulation. SSABA=shortacing Br-agonisis, ICS=inhaled corticosteroids, LABA-Iong-acting @-agonists, ICS/LABA=combination medication in a single inhaler, LAMA=long-acting muscarinic antagonists, LTRA=leukotrene receptor antagonists, pMDi=pressurised metered-dose inhaler, PRN=when necessary, max=maximum, OD=nce daily, BD=wice dallyQUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF ASTHMA IN ADULTS ALGORITHM 1. STEPWISE TREATMENT LADDER IN STABLE ASTHMA STEP 3 ‘STEP 1 ‘STEP 2 Prefered Medium or Contraller Low dose | high dose Low does Ice, ICS/LABA ICS/LABA Refer for expert management Medium or |Add totropium high dose ICS omer | consider Ln oR | at High dose ICS ols hind ny Low dose ICS +LTRA cs theophylline ie oR us ee OR High dose ICS Low dose ICS | + theophyline" | + theophyline* etal Asneeded SABA As needed SABA orlow dose ICSILABA™™ ICS = inhaled corticosteroids, LABA = long-acting By-agonists, ICS/LABA = combination medication in a single inhaler, LTRA = leukotriene receptor antagonists, SABA = short-acting fb agonists, “theophylline= <250 mg daily "“Budesonidetformoterol or beciometasone formoterol Patients who are steroid-naive presenting at Step 3 and 4, should be initiated on low dose ICS BEFORE CONSIDERING STEP UP, CHECK INHALER TECHNIQUE AND TREATMENT ADHERENCE.OR HEALTHCARE PROVIDERS ALGORITHM 2. MANAGEMENT OF ACUTE ASTHMA IN PRIMARY CARE INTIAL ASSESSMENT 7 RRS CPR ote + Sp0z: Saturation <90% PEF <50% predicted clonal ery pre re ro CQUOK REFERENCE FER HEALTHCARE PROVOERS MANAGEMENT OF ATH ALGORITHM 3. MANAGEMENT OF ACUTE ASTHMA IN EMERGENCY DEPARTMENT INTIAL ASSESSMENT 7 Spela wos + Si fran + hala {Aces mules sed z LUFE-THREATENING FURTHER ASSESSMENT ¥ RR OM = hes x10y Rod FEATURES REFER FOR ADMISSION oodIc. ‘No spugr wheeze chest tightness or shortness of bee Green: Doing Wei! Sieer wl at nigtt AND a. fone up Bt neg Suet astra symptoms OR Sar ac some, bat nor ab usual aces OR oR Ln (50% HospitaliClinic: sin (80% 10 100% of personal best) ugh wnmeze “es! Yormess oF shonness of breath OR, WRITTEN ASTHMA ACTION PLAN Personal Best PEF:, Phone No. Limin Date of Plan: + Take these controller medications everyday: How Often = a SS | Pesesseeseseeeeeseesereeereneeey ath and sop up reaver medication for 1 hour: How Much. How Ofer Every 20 minutes sa Ifyour symptoms persis after 1 hour: ‘Stan prednisolone (f availabe) tablets daly for 5 éays (maximum dose 50 mgicay) Continue using your raiever medication and go to the nearest hospital or clinic Use spacer when possisie + Continue using your reliever mesication: [Reliever Medication [How Much [Wow Often crease cereale epee Star prednisolone NOW (i have not started): maximum dose 50 mg/day «Go to the nearest hospital or clinic IMMEDIATELY/atal 999 /OHLTW3H HOd 3ONSE3 SUIOAONA 3. ‘SLYIOWIN WHALSY 40 INIGOVNYHN