Clinical Pharmacy - Asthma

Therapy: For all asthmatics: Objective assessment of airway function. Patient education. Written action plan. Avoidance of precipitating factors (allergens, dust, fumes, aspirin, NSAIDs, beta-blockers, oesophageal reflux). Avoidance of active/passive smoking. Regular exercise desirable. Nasal steroids if rhinitis also present. Early, aggressive treatment of exacerbations. Mild, intermittent asthma: Beta-agonist bronchodilator inhaler as required (e.g. salbutamol, terbutaline). Montelukast as prevention Sodium cromoglycate for allergen, cold or exercise induced asthma pre-exposure. More frequent asthma: Inhaled corticosteroids on a regular basis (e.g. beclomethasone, budesonide) AND/OR sodium cromoglycate or nedocromil AND bronchodilator inhalers regularly (e.g. efomoterol, salmeterol) or as required (e.g. salbutamol, terbutaline). ADD ipratropium bromide spray. ADD higher doses of inhaled steroids. ADD zafirlukast or montelukast. ADD theophylline. Acute asthma: Beta-agonist bronchodilator by nebuliser frequently AND nebulised ipratropium bromide AND oral prednisone short-term. Usually continue inhaled steroids. Status asthmaticus: Hospitalisation. Oxygen AND aggressive beta-agonist bronchodilator inhalation AND nebulised ipratropium bromide. ADD methylprednisolone or hydrocortisone IV. ADD IV salbutamol or IV aminophylline. ADD mechanical ventilation. Prognosis: Rarely fatal; significant morbidity unless well controlled. Adequate prophylaxis should be aimed for, and is usually possible.

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