Combination BTS treatment steps Step 1 SABA short acting bronchodilators – Step 2 ICS 200-800mcg/day low dose steroids – Step 3 ICS + LABA high dose of steroids with long acting – Better continue – Bit better add LTRA – No better change high dose ICS LTRA or theophylline Step 4 ICS 2000mcg/day – LTRA + LABA + Theophylline Step 5 OCS oral cortisteroids – Some people with chronic condition do not take the inhalers at all. Primary prophylaxis – Allergen avoidance no evidence – Breast feeding should be encouraged – Modified Milk formula no benefit – Other diet studies ongoing – Microbiological exposure no evidence – Immunotherapy prevents development of asthma – Smoking parents should be encouraged to stop – Secondary prophylaxis developing further – Allergen avoidance Environmental Smoking should stop – Air pollution probably no firm evidence – – GORD should be treated, probably won’t help asthma – High altitude - beneficial effects no long term data Immunotherapy reduce asthma and symptoms, no comparison to other Rx – I = Ideas C= Concerns E= Expectations
Combination BTS treatment steps Step 1 – SABA short acting bronchodilators Step 2 – ICS 200-800mcg/day low dose steroids Step 3 – ICS + LABA high dose of steroids with long acting Better – continue Bit better – add LTRA No better change high dose ICS LTRA or theophylline Step 4 – ICS 2000mcg/day LTRA + LABA + Theophylline Step 5 – OCS oral cortisteroids Some people with chronic condition do not take the inhalers at all. Primary prophylaxis – Allergen avoidance – no evidence Breast feeding – should be encouraged Modified Milk formula – no benefit Other diet – studies ongoing Microbiological exposure – no evidence Immunotherapy – prevents development of asthma Smoking – parents should be encouraged to stop Secondary prophylaxis – developing further Allergen avoidance Environmental Smoking – should stop Air pollution – probably – no firm evidence GORD – should be treated, probably won’t help asthma High altitude - beneficial effects no long term data Immunotherapy – reduce asthma and symptoms, no comparison to other Rx I = Ideas C= Concerns E= Expectations
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