Asthma Management

Bronchial asthma is chronic condition
Aim of treatment is to obtain sustained complete control
Control means
- no symptoms during the day
- No nocturnal symptoms
- No limitation of activities
- Lung function test normal
- No exacerbation
Patient should be encouraged to manage their own disease.
- How?
  - By monitoring PEF (Peak Expiratory Flow) at home to guide their management
  - Avoid aggravating factors like avoid pet animal exposure, dust mite exposure by replacing carpets, eliminate cockroaches, stop smoking, avoid medicine which precipitate

Peak Flow Meter

Occasional use of inhaled short acting ẞ2 adrenoreceptor agonist - Broncho dilator eg ventolin - Beta-adrenergic agonists
For whom?
- For patients with mild intermittent asthma symptoms less than once a week.

Introduction of regular prevention therapy
Regular therapy with inhaled corticosteroids (ICS) such as beclometasone in addition to inhaled ẞ2 agonist is taken on required basis
For whom?
- Patients who have mild persistent asthma

If patient remains poorly controlled on regular ICS (inhaled Corticosteroid), then add inhaled long acting ẞ2 agonist (LABA) salmeterol, still not controlled add oral salbutamol

If still poor control, give high dose inhaled corticosteroid plus inhaled long acting ẞ2 agonist, plus add oral therapy with leukotrine receptor antagonist e.g. [montelukast](Leukotriene inhibitors) (Singulair) or add theophylline.

Add predinisolone 40 mg daily to step 4. OR I/V Corticosteroids may be required.

Unpredictable clinical course: one-third worsen, one-third remain stable and one-third improve.
Labour and delivery: 90% have no symptoms.
Safety data: good for B₂-agonists, inhaled steroids, theophyllines, oral prednisolone, and chromones.
Oral leukotriene receptor antagonists: no evidence that these harm the fetus and they should not be stopped in women who have previously demonstrated significant improvement in asthma control prior to pregnancy.
Steroids: women on maintenance prednisolone > 7.5 mg/day should receive hydrocortisone 100 mg 6-8-hourly during labour.
Prostaglandin F2x: may induce bronchospasm and should be used with extreme caution.
Breastfeeding: use medications as normal.
Uncontrolled asthma represents the greatest danger to the fetus: Associated with maternal (hyperemesis, hypertension, pre-eclampsia, vaginal haemorrhage, complicated labour) and fetal (intrauterine growth restriction and low birth weight, preterm birth, increased perinatal mortality, neonatal hypoxia) complications.