History & exam
Key factors
- presence of risk factors
- recent upper respiratory tract infection
- dyspnoea
- cough
- expiratory wheezes
- nasal polyposis
History & exam details
Diagnostic tests
1st tests to order
- FEV1/FVC ratio
- FEV1
- peak expiratory flow rate (PEFR)
- CXR
- FBC
Tests to consider
- bronchial challenge test
- serum IgE
- skin prick allergy testing
Emerging tests
- exhaled nitric oxide (eNO)
- sputum eosinophilia
Diagnostic tests details
Treatment details
Acute
step 1: mild intermittent and exercise-induced asthma
- short-acting beta agonist (SABA) as needed
step 2: mild persistent
- low-dose inhaled corticosteroid (ICS)
- short-acting beta agonist (SABA) as needed
- leukotriene-receptor antagonist (LTRA) or sodium cromoglicate or nedocromil or theophylline
- short-acting beta agonist (SABA) as needed
step 3: moderate persistent
- low-dose inhaled corticosteroid (ICS)
- long-acting beta agonist (LABA)
- short-acting beta agonist (SABA) as needed
- medium-dose inhaled corticosteroid (ICS)
- short-acting beta agonist (SABA) as needed
- low-dose inhaled corticosteroid (ICS) + leukotriene-receptor antagonist (LTRA) or theophylline or zileuton
- short-acting beta agonist (SABA) as needed
step 4: severe persistent
- medium-dose inhaled corticosteroid (ICS)
- long-acting beta agonist (LABA) or tiotropium
- short-acting beta agonist (SABA) as needed
- medium-dose inhaled corticosteroid (ICS) + leukotriene-receptor antagonist (LTRA) or theophylline or zileuton
- short-acting beta agonist (SABA) as needed
step 5: severe persistent, inadequate response to medium-dose inhaled corticosteroids (ICS) + adjunctive medications
- high-dose inhaled corticosteroid (ICS)
- long-acting beta agonist (LABA) or tiotropium
- immunomodulator
- short-acting beta agonist (SABA) as needed
step 6: severe persistent, inadequate response to high-dose inhaled corticosteroids (ICS) + adjunctive medications
- oral corticosteroid
- high-dose inhaled corticosteroid (ICS)
- long-acting beta agonist (LABA) or tiotropium
- immunomodulator
- short-acting beta agonist (SABA) as needed
Ongoing
all patients
- patient education and environmental control
-
known single allergen
- allergen immunotherapy
Treatment details
Last updated: Jan 23, 2013
