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2. Respiratory diseases
Treatment
O nly patients w ith persistent asth m a need long - term treatm ent. T h e m ainstay of
treatm ent is inh aled corticosteroid s. T reatm ent is started at th e step m ost appropriate to
initial sev erity th en, re-ev aluated and ad justed accord ing to clinical response. I t aim s to
abolish sym ptom s w ith th e low est possible d ose of inh aled corticosteroid s. A n 2
interv ening sev ere exacerbation or loss of control necessitates reassessm ent to re-
ev aluate treatm ent.
L ong -term treatm ent d oes not m ean treatm ent for life. A sth m a attacks m ay occur
ov er
m onth s or years, w ith interv ening asym ptom atic interv als w h en long -term treatm ent
is
not required .
Long-term treatment of asthma according to severity
Categories Treatment
Intermittent asthma N o long term treatm ent
– Interm ittent sym ptom s (< once/ w eek) Inh aled salbutamol w h en sym ptom atic
– N ig h t tim e sym ptom s < tw ice/ m onth
– N orm al ph ysical activ ity
Mild persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– Sym ptom s > once/ w eek, but < once/ d ay +
– N ig h t tim e sym ptom s > tw ice/ m onth Inh aled salbutamol w h en sym ptom atic
– Sym ptom s m ay affect activ ity
Moderate persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– D aily sym ptom s +
– Sym ptom s affect activ ity Inh aled salbutamol (1 puff 4 tim es/ d ay)
– N ig h t tim e sym ptom s > once/ w eek
– D aily use of salbutam ol
Severe persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– D aily sym ptom s +
– F requent nig h t tim e sym ptom s Inh aled salbutamol (1 -2 puff/ s 4 to 6
tim es/ d ay)
– P h ysical activ ity lim ited by sym ptom s
Inh aled corticosteroid treatm ent: beclometasone d ose v aries accord ing to th e sev erity of
asth m a. F ind th e m inim um d ose necessary to both control th e sym ptom s and av oid
local and system ic ad v erse effects:
C h ild ren: 5 0 to 1 0 0 m icrog ram s tw ice d aily d epend ing on th e sev erity. I ncrease to
2 0 0 m icrog ram s tw ice d aily if th e sym ptom s are not controlled . I n patients w ith
sev ere
ch ronic asth m a th e d osag e m ay be as h ig h as 8 0 0 m icrog ram s/ d ay.
A d ults: start w ith 2 5 0 to 5 0 0 m icrog ram s tw ice d aily d epend ing on to th e sev erity.
If a
total d osag e of 1 0 0 0 m icrog ram s/ d ay (in 2 to 4 d iv id ed d oses) is ineffectiv e, th e
d osag e
m ay be increased to 1 5 0 0 m icrog ram s/ d ay, but th e benefits are lim ited .
T h e num ber of puffs of beclom etasone d epend s on its concentration in th e
inh aled aerosol: 5 0 , 1 0 0 or 2 5 0 m icrog ram s/ puff. T o av oid d osing errors, use
only inh alers of 5 0 or 1 0 0 m icrog ram s/ puff for ch ild ren. R eserv e inh alers of
2 5 0 m icrog ram s/ puff for ad ults.
Treatment
O nly patients w ith persistent asth m a need long - term treatm ent. T h e m ainstay of
treatm ent is inh aled corticosteroid s. T reatm ent is started at th e step m ost appropriate to
initial sev erity th en, re-ev aluated and ad justed accord ing to clinical response. I t aim s to
abolish sym ptom s w ith th e low est possible d ose of inh aled corticosteroid s. A n 2
interv ening sev ere exacerbation or loss of control necessitates reassessm ent to re-
ev aluate treatm ent.
L ong -term treatm ent d oes not m ean treatm ent for life. A sth m a attacks m ay occur
ov er
m onth s or years, w ith interv ening asym ptom atic interv als w h en long -term treatm ent
is
not required .
Long-term treatment of asthma according to severity
Categories Treatment
Intermittent asthma N o long term treatm ent
– Interm ittent sym ptom s (< once/ w eek) Inh aled salbutamol w h en sym ptom atic
– N ig h t tim e sym ptom s < tw ice/ m onth
– N orm al ph ysical activ ity
Mild persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– Sym ptom s > once/ w eek, but < once/ d ay +
– N ig h t tim e sym ptom s > tw ice/ m onth Inh aled salbutamol w h en sym ptom atic
– Sym ptom s m ay affect activ ity
Moderate persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– D aily sym ptom s +
– Sym ptom s affect activ ity Inh aled salbutamol (1 puff 4 tim es/ d ay)
– N ig h t tim e sym ptom s > once/ w eek
– D aily use of salbutam ol
Severe persistent asthma C ontinuous treatm ent w ith inh aledb eclometasone
– D aily sym ptom s +
– F requent nig h t tim e sym ptom s Inh aled salbutamol (1 -2 puff/ s 4 to 6
tim es/ d ay)
– P h ysical activ ity lim ited by sym ptom s
Inh aled corticosteroid treatm ent: beclometasone d ose v aries accord ing to th e sev erity of
asth m a. F ind th e m inim um d ose necessary to both control th e sym ptom s and av oid
local and system ic ad v erse effects:
C h ild ren: 5 0 to 1 0 0 m icrog ram s tw ice d aily d epend ing on th e sev erity. I ncrease to
2 0 0 m icrog ram s tw ice d aily if th e sym ptom s are not controlled . I n patients w ith
sev ere
ch ronic asth m a th e d osag e m ay be as h ig h as 8 0 0 m icrog ram s/ d ay.
A d ults: start w ith 2 5 0 to 5 0 0 m icrog ram s tw ice d aily d epend ing on to th e sev erity.
If a
total d osag e of 1 0 0 0 m icrog ram s/ d ay (in 2 to 4 d iv id ed d oses) is ineffectiv e, th e
d osag e
m ay be increased to 1 5 0 0 m icrog ram s/ d ay, but th e benefits are lim ited .
T h e num ber of puffs of beclom etasone d epend s on its concentration in th e
inh aled aerosol: 5 0 , 1 0 0 or 2 5 0 m icrog ram s/ puff. T o av oid d osing errors, use
only inh alers of 5 0 or 1 0 0 m icrog ram s/ puff for ch ild ren. R eserv e inh alers of
2 5 0 m icrog ram s/ puff for ad ults.
