The Modern Management of Asthma (page 2 of 6)
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British guidelines on the management of asthma
The first British guidelines on asthma management in adults were published in the British Medical Journal (BMJ) in 1990. Since 1999, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guideline Network (SIGN) have collaborated to produce guidelines on the management of asthma that are available on the BTS and SIGN websites. These guidelines use rigorous evidence-based methodology covering all aspects of asthma care and contain graded recommendations supported by evidence tables. These BTS/SIGN guidelines are now updated with new recommendations every year. They are becoming increasingly recognised across the world and are accepted for use in Finland, Germany, Australia and New Zealand. They advise a step-wise approach to drug therapy.
Step One: Mild intermittent asthma
All patients should be prescribed an inhaled short-acting beta-agonist (e.g. Salbutamol) for symptomatic relief delivered by an inhaler they can use effectively.
Inhalers
Inhalers deliver bronchodilator or anti-inflammatory therapy to the airways. The most common device is a pressurised metered dose inhaler (pMDI), but up to 50% of patients are unable to use this correctly. Even with good inhaler technique, only 10% of the pMDI drug dose reaches the lungs. This can be improved with the addition of a spacer, which reduces the problem of co-ordination involved in activating the device and inhalation. Dry powder devices such as the Accuhaler and Turbohaler have become very popular, but they are more expensive and are no more effective than a pMDI and spacer.
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