CRISBERT I. CUALTEROS, M.D. - Global Initiative For Asthma Guideline 2009
   
DR. CRISBERT I. CUALTEROS
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  Clinical Practice Guidelines

CRISBERT I. CUALTEROS, M.D. Family and Medicine

 

 

 

GINA ASTHMA GUIDELINES:

 

 

 

 

 

WHAT DETERMINES DISEASE CLASSIFICATION IN GINA 2002 ?

Worst feature determines the severity classification

Useful when decisions are being made about management at the initial assessment of a patient

ASTHMA SEVERITY

(GINA 2002)

Involves both the severity of the underlying disease and its responsiveness to treatment.

May change over months or years

VALUE OF GINA 2002 GUIDELINES

Cross sectional means of characterizing patients with asthma who are not on inhaled corticosteroids treatment

No maintenance

Newly diagnosed

No previous consult

No longer recommended as basis for ongoing treatment

ASTHMA CONTROL

(GINA 2006)

Refers to control of the clinical symptoms of the disease

Treatment is aimed at controlling the clinical features of disease

 

 

Classify Asthma Based on Severity:

 

 

 

 

 

 

 

 

Inhaled

 

 

β2β2β2

 

What is the role of Salbutamol – Ipratropium

in acute asthmatic attacks?

INTERMITTENT

- no added benefit over Salbutamol alone if attack is mild

However, any moderate to severe attack of asthma regardless of severity classification can benefit from the combination.

Medicines in Childhood Asthma

 

 

 

 

Inhaled Corticosteroids

Most effective long-term control for persistent asthma

Small risk for adverse events at recommended dosage

Benefits of daily use

Reduction of

asthma symptoms

frequency of exacerbations

airway inflammation

airway responsiveness

asthma mortality

Improvement of

lung function

quality of life

Inhaled Corticosteroids Adverse Events

Small risk for adverse events at recommended doses

Reduce potential for adverse events by:

Using spacer

Rinsing mouth

 

 

IGCS and controllers other the LABA

 

 

 

 

 

 

 

"

ADD-ON" Treatment Option

LEUKOTRIENE MODIFIER
Children Younger than 5 Years

Provide clinical benefit at all levels of severity (but less than ICS)

Partial protection against exercise-induced bronchoconstriction within hours after administration

Add on in children where asthma is insufficiently controlled by low dose of ICS

 

Provide clinical benefit at all levels of severity (but less than ICS)

Partial protection against exercise-induced bronchoconstriction within hours after administration

Add on in children where asthma is insufficiently controlled by low dose of ICS

Reduce viral induced asthma exacerbation

Montelukast+Budesonide vs. Double Dose of Budesonide

Montelukast vs. Corticosteroid based on Quality of Life

 

Salamat!

, reduce dose of IGCS by 50% until low dose of IGCS is reached, then may stop combination treatment (Evidence D)

Controller treatment may be stopped

if the patient’s asthma remains controlled on the lowest dose of controller and no recurrence of symptoms for ONE YEAR (Evidence D)
-AGONIST and INHALED ANTICHOLINERGIC is RECOMMENDED

 

COMBINATION of INHALED
-agonists is minimal, incomplete or poor …

 

However, once response to the initial

-agonists are the mainstay of therapy in acute asthma.
   

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