Chronic inflammatory disease of the airway pump system. Expose to an allergen, exercise, infection etc it becomes inflamed, mucous plugging so that narrowed
Not curable, can control very effectively
Needs long term treatments
First assess the severity intermittent, frequent (episodic ) and persistent-based on the history and lung functions
Select appropriate starting therapy and upgrade ( 1 month) and downgrade (6 months)
Reliever ( salbutamol, prevent ) to relieve symptoms and preventer ( steroid, montelukast ) to reduce inflammation symptom controller ( salmeterol formoterol ) for long term symptoms control or combined preparations
Make sure compliance and techniques
Target is < 2 /week daytime symptoms, < 2/week reliever use, no night time symptoms, not impact of activities
Can monitor PEFR values and diurnal variation < 10% or after 4 weeks preventer LFT > ? 20% improvement
Rule out risk factors GORD, OSA, T-sinusitis, atopy ( GOTA ) depression and treat
Avoid precipitants dust moist stress pets
Avoid 1ry or 2ry smoking
Occupational modifications
Immunization
AAP
Education for compliance
4 R- asthma educator, pharmacist
Review for up titrate or down
