The Learning Medicine for Doctors

Asthma Guideline (အရင်က SABA နဲ့စတာ အခုဆို AIR therapy နဲ့ စတယ်) anti-inflammatory reliever (AIR) therapy - low dose inhaled CS/formoterol (LABA) therapy နဲ့ စပေးတာပြောင်းသွားတယ် Management of adult patients aged children aged ≥ 12 years with newly diagnosed asthma** Step 1 [NICE] - a low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler to be taken as needed for symptom relief - this is termed anti-inflammatory reliever (AIR) therapy - if the patient presents highly symptomatic (for example, regular nocturnal waking) or with a severe exacerbation: - start treatment with low-dose MART (maintenance and reliever therapy, see below) - treat the acute symptoms as appropriate (e.g. a course of oral corticosteroids may be indicated) Step 2 [NICE] - a low-dose MART - MART describes using an inhaled corticosteroid (ICS)/formoterol combination inhaler for daily maintenance therapy and the relief of symptoms as needed, i.e. regularly and as required Step 3 - a moderate-dose MART Step 4 - check the fractional exhaled nitric oxide (FeNO) level if available, and the blood eosinophil count [NICE] - if either of these is raised, refer to a specialist in asthma care - if neither FeNO nor eosinophil count is raised, consider a trial of either a leukotriene receptor antagonist (LTRA) or a long-acting muscarinic receptor antagonist (LAMA) used in addition to moderate-dose MART - if control has not improved, stop the LTRA or LAMA and start a trial of the alternative medicine (LTRA or LAMA) Step 5 - refer people to a specialist in asthma care when asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA ဘယ်လို step down လုပ်ရမလဲ we should consider stepping down treatment every 3 months or so. The guidelines don't advocate a strict move from say step 3 to step 2 but advise us to take into account duration of treatment, side-effects and patient preference. When reducing the dose of inhaled steroids the BTS advise us to do this by 25-50% at a time.