A preteen girl stands in the middle of her local pharmacy and closes her eyes. She draws a tissue up to her mouth with both hands and coughs. Her unrecognizable brother stands at the pharmacy counter in the background to purchase cold medication for her.

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