Secondary prevention

All patients with a history of near-fatal asthma, past intubation or frequent intubations should carry a vial of injectable adrenaline to use if unresponsive to standard therapy and use either inhaled or nebulised short-acting beta agonists (SABA) on their way to the emergency department.

Patients with known allergic asthma should avoid precipitants.

All smokers should be encouraged to quit and overweight patients should be encouraged to lose weight.

For patients with exercise-induced bronchospasm, a SABA used shortly before exercise (or as close to exercise as possible) maybe helpful for 2 to 3 hours. Long-acting beta agonists (LABA) can be protective up to 12 hours. When LABAs are administered on a daily basis, however, there is some shortening of the duration of protection, even in patients using inhaled corticosteroids. Frequent and chronic use of LABAs for exercise-induced bronchospasm should be discouraged. Such use may disguise poorly controlled persistent asthma. [1] [85] There is some evidence to suggest that fish oil supplementation may be beneficial in exercise induced bronchoconstriction, but not in regular management of asthma. [86]

Annual influenza vaccination is recommended for people with severe persistent asthma (including those who require frequent hospitalisation), Despite previous concerns that influenza vaccine might precipitate asthma attacks, current evidence suggests that there is a very low risk of an asthma. Although recommended in guidelines, influenza vaccination has not been shown to protect against asthma exacerbations.