Guidelines for asthma

management
Which are the various guidelines
on asthma management?
GINA (Global INitiative for Asthma
Management)
BTS (British Thoracic Society)
NAEPP (National Asthma Education
and Prevention Program)
CTS (Canadian Thoracic Society)
CLASSIFICATION OF ASTHMA

Based on severity
(Old GINAGuidelines)

Based on Control achieved
(New GINA Guidelines)
OLD Classification of Severity-GINA
Classify Severity Symptoms
Nocturnal
Symptoms
Lung Function
STEP
1

Intermittent
Asymptomatic and
normal PEF between
attacks
< 2 times a month
> 80% predicted

Variability < 20%
STEP
2

Mild
Persistent
< 1 time a week > 2 times a month
> 80% predicted

Variability 20 30%
STEP
3

Moderate
Persistent
> 1 time a week but
< 1 time a day
> 1 time week

60 - 80% predicted

Variability > 30%
STEP
4

Severe
Persistent
Daily Attacks
Continuous Limited
physical activity
Frequent
< 60% predicted

Variability > 30%
: Controller
Daily inhaled
corticosteroid
Daily long-acting
inhaled
2
-agonist
Controller :
None

When asthma is
controlled,
reduce therapy

Monitor
Controller:
Daily inhaled
corticosteroid
Daily long acting
inhaled
2
-agonist
plus (if needed)

-Theophylline-SR
-Anti-Leukotriene
-Long-acting oral

2
- agonist
-Oral corticosteroid
: Controller
Daily inhaled
corticosteroid

Outcome: Asthma Control
Outcome: Best Possible
Results
OLD GUIDELINES FOR ASTHMA TREATMENT
Reliever: Rapid-acting inhaled
2
-agonist SOS
Alternative controller and reliever medications may be considered
New GINA guidelines
Focus on Asthma Control rather than severity
Global Initiative for Asthma (GINA) 2006
Characteristic Controlled
(All of the
following)
Partly Controlled
(Any measure
present in any
week)
Uncontrolled
Daytime symptoms None (twice or
less/week)
More than
twice/week




Three or more
features of partly
controlled asthma
present in any
week
Limitations of activities None Any
Nocturnal
symptoms/awakening
None Any
Need for
reliever/rescue
treatment
None (twice or
less/week)
More than
twice/week
Lung function
(PEF or FEV
1
)
Normal < 80% predicted or
personal best (if
known)
Exacerbations None One or more/year One in any week
MANAGEMENT APPROACH BASED ON CONTROL
Level of control Treatment Action
Controlled Reduce Maintain and find lowest
controlling step
Partly controlled Consider stepping up to gain
control
Uncontrolled Increase Step up until controlled
Exacerbation Treat as exacerbation