Based on Version 4 Dudley Asthma Treatment Guidelines May 2017 ASTHMA TREATMENT GUIDELINES SPACER DEVICES Spacer devices are recommended for use with Metered Dose Inhalers (MDI’s) in all age groups. CLEANING – Wash the spacer once a month using detergent, such as washing-up liquid. – Don’t scrub the inside of the spacer as this affects the way it works. – Leave it to air-dry as this helps to prevent the medicine sticking to the sides of the chamber and reduces the static. – Wipe the mouthpiece clean of detergent before using it again. Don’t worry if the spacer looks cloudy - that doesn’t mean its dirty. – The spacer should be replaced at least every year, especially if used daily, but some may need to be replaced sooner. – Ensure the inhaler is compatible with the spacer device Aerochamber Child Device with mask (Yellow) 1 - 5 years Volumatic 3+ years Aerochamber Plus (Blue) 5+ years Aerochamber Plus with mask (Blue) 5+ years Volumatic with Face Mask 0+ years ©2017 Produced by Dudley Respiratory Group Chairman Dr Mark Hopkin. www.dudleyrespiratorygroup.org ASTHMA TREATMENT GUIDELINES for all ages Version 2.4.2 June 2017 Based on Version 4 of Dudley Asthma Treatment Guidelines May 2017 • This has been produced, based on Dudley Asthma Guidelines V4 May 2017, BTS/SIGN 2016 • The purpose is to assist Health Care Professionals, who are managing patients with a Diagnosis of Asthma, to select an appropriate inhaler device. • There are many devices available, with different steroid potencies, which has caused much confusion. • The total daily steroid load equivalent to Beclometasone is highlighted in each box. Definition of Asthma Central to all definitions is the presence of symptoms (more than one of wheeze, breathlessness, chest tightness, cough) and of variable airflow obstruction. More recent descriptions of asthma in both children and adults have included airway hyper-responsiveness and airway inflammation as components of the disease. (BTS/SIGN 2016) BEST PRACTICE - Review patients regularly Considering Step Up & Down accordingly - A Spacer device is recommended when using a MDI (see back sheet) - Check Inhaler technique and compliance at each appointment and before starting any additional therapy - Use an in-check device to measure inspiratory effort - Consider total steroid load when reviewing patient - All patients should have a written Personal Asthma Action Plan (PAAP) - Reconsider the diagnosis in patients who continue to have symptoms - Follow up patients who have an asthma attack within 2 working days – see Acute Guidelines Asthma is not controlled at any step if using Short Acting B2 Agonists (SABAs) 3 times a week or more: having symptoms 3 times a week or more: waking at least once a week. A WELL CONTROLLED ASTHMATIC SHOULD NOT REQUIRE MORE THAN ONE TO TWO SABA INHALERS PER YEAR The aim of asthma management is control of the disease. Complete control of asthma is defined as: • No daytime symptoms • No asthma attacks • No night time awakening due to asthma • Normal lung function • No need for rescue medication • Minimal side effects from medication • No limitations on activity including exercise INHALED CORTICOSTEROIDS ARE THE CORNERSTONE OF TREATMENT IN ASTHMA Spacer devices should be replaced every 6-12 months. Aerochamber Infant Device with mask (Orange) 0-18 months In adults and adolescents over the age of 12 combined maintenance and reliever therapy can be considered for patients who have a history of asthma attacks, on medium dose ICS or ICS/LABA (800-1000mcgs BDP/day) - BTS/SIGN 2016. Version 2.4.2 June 2017 www.dudleyrespiratorygroup.org Spiriva Respimat 2.5 mcgs • Two inhalations once a day This is indicated as an add on brochodilator treatment in adult patients with asthma who are currently treated with a maintenance combination inhaler (ICS+LABA) at 800mcgs/day BDP equivalent and who experience one or more severe exacerbations in the previous year. LAMA - Long Acting Muscarinic Antagonist 18+ years 12+ years How to Use Symbicort SMART 18+ years How to use Fostair MART The use of separate reliever inhaler( SABA) is NOT required ADDITIONAL INFORMATION SUPPLEMENT • Symbicort SMART means patients use Symbicort as both their preventer and their reliever • The SMART dosing regimen applies to both the Symbicort 100/6 and 200/6 • Adult and adolescent patients (≥12 years) • Recommended maintenance dose is two inhalations per day • Patients should take one additional inhalation as needed in response to symptoms • A total daily dose of more than 8 inhalations is not normally needed: • No more than 6 inhalations on any single occasion • Patients using >8 inhalations daily should be strongly recommended to seek medical advice • Fostair MART means patients use Fostair as both their preventer and their reliever • The MART dosing regimen applies to the Fostair 100/6 Metered Dose Inhaler (MDI) • Adult patients (>18+ years) • Recommended maintenance dose is one inhalation twice a day patients should take one additional inhalation as needed in response to symptoms • A maximum of 8 inhalations per day (Maintenance & Reliever) • Patients requiring frequent use of rescue inhalations daily should be strongly recommended to seek medical advice. Their asthma should be reassessed and their maintenance therapy reconsidered New 2017