Developed in Line with the British Guideline on the Management of Asthma (SIGN 141 October

Manchester Primary Care Guideline on the Management of Stable Asthma

Developed in line with the British Guideline on the Management of Asthma (SIGN 141 October 2014)1.

References:

BTS/SIGN Guideline on the Management of Asthma. (SIGN 141). October 2014
NICE. Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma. (TA10). August 2000
NICE. Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). (TA38) March 2002
NICE. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. (TA138) March 2008
NICE. Inhaled corticosteroids for the treatment of chronic asthma in children under 12 years. (TA131) March 2008
NPC MeReC Bulletin Vol 19 No.2. Current issues in the treatment of asthma. Sept 2008
Summary of Product Characteristics for Spiriva Respimat®. Accessed via October 2014
NICE. Omalizumab for treating severe persistent allergic asthma (review of technology appraisal guidance 133 and 201) April 2013
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2014. Available from:

Document written by:

Daniel Watts

(Final update in May 2015 by Jennifer Bartlett)

Medicines Management Team

South Manchester Clinical Commissioning Group

In consultation with local specialists

Appendices

Appendix 1- Adult asthma stepwise treatment ladder

(Refer to BTS/SIGN Asthma Guidelines for treatment ladders for children/adolescents)

Appendix 2

Strategy for stepping down treatment

Appendix 3

ACT (Asthma Control Test™) questions:

1) During the past 4 weeks, how often did your asthma prevent you from getting as much done at work/school/home?

All of the time = 1 / Most of the time = 2 / Some of the time = 3 / A little of the time = 4 / None of the time = 5
Score

2) During the past 4 weeks, how often have you had shortness of breath?

More than once a day = 1 / Once a day = 2 / 3-6 times a week = 3 / 1-2 times a week = 4 / Not at all = 5
Score

3) During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning?

4 or more times a week = 1 / 2-3 nights a week = 2 / Once a week = 3 / Once or twice = 4 / Not at all = 5
Score

4) During the past 4 weeks, how often have you used your reliever inhaler (usually blue)?

3 or more times a day = 1 / 1-2 times a day = 2 / 2-3 times a day = 3 / Once a week or less = 4 / Not at all = 5
Score

5) How would you rate your asthma control during the past 4 weeks?

Not controlled = 1 / Poorly controlled = 2 / Somewhat controlled = 3 / Well controlled = 4 / Completely controlled = 5
Score
TOTAL
Score = 25
Asthma appears to be under control during the last 4 weeks. / Score = 20 to 24
Asthma appears to be reasonably well controlled during the last 4 weeks but patient may need a review by Doctor/Nurse if they are symptomatic. / Score = below 20
Asthma does notappear to becontrolled during the past 4weeks.Patient should be reviewed by Doctor/Nurse.

®2002, by QualityMetric Incorporated. Asthma Control Test® is a Trademark of QualityMetric Incorporated

Appendix 4

Equivalent doses of inhaled steroids relative to Beclometasonediproponate (BDP)(BTS/SIGN 2014)

**Relvar® (launched 2014) is a combination inhaler containing fluticasone furoate which is approximately FIVE times more potent# than fluticasone propionate. (i.e. Relvar® 92/22 ONCE daily is approximately equal to Seretide 250/50 TWICE a day).

(#Relvar SPC via accessed October 2014)

DuorespSpiromax®(launched September 2014) is a combination inhaler with the same molecules as SymbicortTurbohaler®(budesonide/formoterol). It has equivalent potency but strengths are quoted as ‘delivered dose’ rather than ‘emitted dose’. Duoresp 160/4.5 and 320/9 are equivalent to Symbicort 200/6 and 400/12 respectively.