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TABLE 39.1 Guidelines for the Treatment of Asthma

Step Status

Symptoms

Lung Function (FEV± or PEF)

Drug Therapy

Mild intermittent Mild persistent

Moderate persistent

Severe persistent stwice a week

> twice a week but < once a day Exacerbations may affect activity

Daily

Daily use of p2-agonists Exacerbations may affect activity Exacerbations a twice a week

Continual symptoms Limited physical activity Frequent exacerbations

>80% predicted

>80% predicted PEF variability 20-30%

60-80% predicted PEF variability > 30%

PEF variability > 30%

Short-acting inhaled ß2-agonists as needed Step 1 and ONE of the following:

Antiinflammatory therapy (low dose of inhaled corticos-teroid) Cromolyn or nedocromil Theophylline Leukotriene modulator Step 2 with medium dose of inhaled corticosteroid If needed, ADD a long-acting bronchodilator (inhaled sal-meterol, oral ß 2-agonist, or theophylline) Step 3 with high dose of inhaled corticosteroid and long-acting bronchodilator Oral corticosteroid long term (2 mg/kg/day, not to exceed 60 mg/day)

From U. S. Department of Health and Human Service, National Institutes of Health, National Heart, Lung and Blood Institute;July 1997. FEVj, forced expiratory volume in 1 second (values < 100% indicate increased airway obstruction);PEF, peak expiratory flow (greater variability indicates less control of disease).

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Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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