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Sample Topic: Asthma

The summary contains the key recommendations for managing an individual in the specific clinical situation described by the scenario.

These are not referenced but link to the relevant section of the topic so that the reasoning for the recommendations and the evidence on which they are based is easily accessed.

Asthma : Last revised in December 2013


Summary

  • Asthma is a chronic inflammatory condition of the airways.
    • The airways are hyper-responsive and constrict easily in response to a wide range of stimuli. This may result in coughing, wheezing, chest tightness, and shortness of breath.
    • Narrowing of the airways is usually reversible (either spontaneously or with medication), leading to intermittent symptoms, but in some people with chronic asthma, the inflammation may lead to irreversible airflow obstruction.
  • Asthma is a common condition. A report by Asthma UK states that 5.2 million people in the UK have asthma.
  • The probability of someone having asthma is increased if they have:
    • Wheeze, breathlessness, chest tightness, and cough, particularly if symptoms are worse at night and in the early morning; occur in response to exercise, allergen exposure, and cold air; occur after taking aspirin or beta-blockers; occur even when the person has not got a cold.
    • History of atopic disorder.
    • Family history of asthma and/or atopic disorder.
    • Widespread wheeze (bilateral, predominantly expiratory).
    • Prolonged expiration.
    • Increased respiratory rate.
  • Spirometry should be performed on all adults to assess for the presence, severity, and reversibility of airway obstruction. Spirometry is recommended for children where the diagnosis of asthma is uncertain — if they are able to perform the test (usually older than 5 years).
  • For people with an intermediate or high probability of asthma, a trial of treatment to confirm the diagnosis should be considered. For people with a low probability of asthma, an alternative diagnosis should be considered.
  • A stepped approach to the management of chronic asthma is recommended. For people over the age of 5 years of age:
    • Step 1: occasional relief bronchodilator — an inhaled short-acting beta2 agonist as required.
    • Step 2: regular inhaled preventer therapy — an inhaled corticosteroid or, if an inhaled corticosteroid is not tolerated, a leukotriene receptor antagonist or cromone.
    • Step 3: inhaled corticosteroid and long-acting inhaled beta2 agonist. If symptom control is inadequate with a long-acting inhaled beta2 agonist, consider an alternative add-on treatment, such as a leukotriene receptor antagonist or modified-release theophylline before moving to step 4.
    • Step 4: high-dose inhaled corticosteroid and regular bronchodilator.
    • Step 5: regular corticosteroid tablets and referral to a specialist in respiratory medicine.
  • For children under 5 years, a stepped approach is also recommended.
    • Step 1: occasional relief bronchodilator — an inhaled short-acting beta2 agonist as required.
    • Step 2: regular preventer therapy — an inhaled corticosteroid or, if an inhaled corticosteroid is not tolerated, a leukotriene receptor antagonist (children 2–5 years).
    • Step 3: if younger than 2 years, referral to a respiratory paediatrician. For children aged 2–5 years, add a leukotriene receptor antagonist.
      Step 4: referral to a respiratory paediatrician.
  • Acute exacerbations of asthma are generally managed with a short course of oral prednisolone and a short-acting beta2-agonist. Hospital admission is necessary for people with life threatening asthma or severe asthma that does not adequately respond to initial treatment.

Video content relating to this topic

5-year-old with respiratory distress
5-year-old with respiratory distress.
4-year-old with moderate respiratory distress
4-year-old with moderate respiratory distress
16-year-old with wheezing and cough
16-year-old with wheezing and cough
5-year-old with mild respiratory distress
5-year-old with mild respiratory distress
2-year-old with cough and difficulty breathing
2-year-old with cough and difficulty breathing
10-year-old with asthma presents with acute respiratory distress
10-year-old with asthma presents with acute respiratory distress