Asthma – BTS guideline adults

Presentation with respiratory symptoms : wheeze , cough , breathlessness , chest tightness.Structured clinical assessment ( from history and examination of previous medical records )Look for recurrent episodes of symptoms symptom variability abscence of symptoms of alternative diagnosis recorded observation of wheeze personal history of atopy historical record of variable PEF or FEV1.

high probability asthma - code as suspected asthma-initiation of treatment -assess response objectively-good response -Asthma-Adjust maintenance dose Provide self-management advArrange on-going review

Intermediate probablity of asthma-Test for airway obstructionspirometry + bronchodilator reversibility-Options for investigations are :Test for variability reversibility PEF charting challenge tests.Test for eosinophilic inflammation or atopy FeNO blood eosinophils skin- prick test IgE-Suspected asthmaWatchful waiting ( if asymptomatic )ORCommence treatment and assessresponse objectively

Low probability of asthma-Investigate / treat for other more likely diagnosis-Other diagnosis confirmed.Evaluation ○ assess symptoms ,measure lung function , check inhaler technique and adherence○ adjust dose ○ update self management plan ○ move up or down as appropriate

Diagnosis and assessment-Consider monitored initiation of treatment with low-dose ICS

Asthma-diagnosed Regular preventer Low dose ICS.Initial add-on therapy-Add inhaled LABA to low-dose ICS ( normally as a combination therapy ) Additional add-on therapiesNo reponse to LABA → stop LABA and consider ↑ ed...