TABLE 39.1 Guidelines for the Treatment of Asthma
Lung Function (FEV± or PEF)
Mild intermittent Mild persistent
Severe persistent stwice a week
> twice a week but < once a day Exacerbations may affect activity
Daily use of p2-agonists Exacerbations may affect activity Exacerbations a twice a week
Continual symptoms Limited physical activity Frequent exacerbations
>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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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.