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Asthma management

The main goals of asthma management are to:1
  • Achieve and maintain control of symptoms
  • Maintain normal activity levels, including exercise
  • Maintain pulmonary function as close to normal as possible
  • Prevent asthma exacerbations
  • Avoid adverse effects with therapies
  • Prevent mortality 
These can be accomplished through patient education, environmental control and drug therapy. According to GINA strategy, asthma control can be achieved using appropriate pharmacotherapy and by appropriate adjustment of treatment (Figure 1).1

Physicians should routinely re-assess the degree of asthma control and, if necessary, adjust their treatment strategies (Figure 1). When asthma is under control, medication should be reduced to find the lowest level that maintains good or acceptable control. All asthma drugs should be used at the lowest possible dose and frequency to maintain acceptable control of asthma symptoms.

In treatment-naïve patients with persistent asthma, treatment should be started at step 2, or if very symptomatic (uncontrolled), at step 3 (Figure 1).1

Despite the inflammation and remodelling observed in the small airways of patients with asthma,2 current guidelines do not take into account the need to specifically treat this region of the lungs.

14 fig 1GINA treatment steps
Figure 1: GINA asthma management approach based on control1
Reproduced with permission from the Global Strategy for Asthma Management and Prevention 2012, © Global Initiative for Asthma (GINA) all rights reserved. 


References
  1. The Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention. Available from: http://www.ginasthma.org/. 2012
  2. Contoli M, Bousquet J, Fabbri LM, et al. The small airways and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy 2010;65:141-51.
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