|
SUMMARY OF PRACTICE POINTS
| LEVEL OF EVIDENCE |
|
Assess asthma control regularly
|
| Inappropriate dose increases of reliever or preventer should be avoided in young children with transient infant wheeze or intermittent viral-induced wheezing, because it is often not possible to eradicate this symptom completely using either SABA [I] or ICS [II] treatment. |
I & II |
| In children, attempts to completely eradicate cough by increasing asthma medication may result in over-treatment and increase the risk of adverse effects. |
III-2 |
| In the absence of other asthma symptoms, cough should not be used as a marker of asthma control. |
III-2 |
| Isolated persistent cough is rarely asthma. |
III-2 |
| In children, symptoms are as reliable as PEF for monitoring asthma control. |
II |
| In Aboriginal and Torres Strait Islander people with asthma and a past history of pneumonia, careful assessment is needed to rule out additional respiratory illness. |
IV |
|
Identify and avoid trigger factors
|
| Take a careful history to establish possible allergic triggers within the person's home or work environment. |
[√] |
| Consider skin prick tests or RAST to identify specific immunoglobulin (Ig)E antibodies to a suspected trigger. |
[√] |
| Reassure patients that food is not a common trigger of asthma. |
II |
| Warn patients who use complementary medicines that echinacea and royal jelly can precipitate life-threatening anaphylaxis in predisposed individuals with asthma. |
IV |
| A trial of acid suppression therapy may be worthwhile if GORD is suspected [√] . However, asthma control does not predictably improve if reflux is treated (I). |
[√] & I |
|
Prevent exacerbations
|
| In the absence of bacterial infection, antibiotics are not indicated during viral respiratory tract infections in people with asthma. |
I |
| Influenza vaccination is recommended in patients with severe persistent asthma (in addition to other indications). |
[√] |
| Influenza vaccination is very unlikely to cause asthma exacerbations. |
I |
| Pneumococcal vaccination is indicated in patients with asthma who also have chronic bronchitis, emphysema, or require long-term systemic corticosteroid use (in addition to other indications). |
[√] |
|
Provide asthma self-management education
|
| All adults with asthma should be offered self-management education that involves a written action plan, self-monitoring and regular medical review. This approach can improve asthma control. |
I |
| Asthma action plans enable patients to manage their asthma exacerbations appropriately (when provided with other self-management education). |
I |
| Provide active training in inhaler technique and reinforce regularly, to maximise correct use of inhalation devices. |
II |
| Provide confidential health care for adolescents, where appropriate. |
II |
|
Troubleshooting
|
| When asthma is inadequately controlled despite apparently appropriate treatment, increase medication doses only after careful reassessment of the diagnosis, triggers, inhaler technique and adherence. |
[√] |
| If possible, avoid the use of multiple types of inhalation devices to deliver asthma medications, because this increases risk of poor inhaler technique. |
III-2 |
|
Organising your practice for effective asthma management
|
| Appropriately trained nurses can effectively undertake a substantial proportion of tasks related to asthma management, including the asthma review. |
II |
| Proactive care in general practice, combined with an active recall system, increases the use of written asthma action plans, reduces airway hyperresponsiveness and decreases the rate of emergency visits for asthma in children. |
II |
| Assessment for exposure to environmental tobacco smoke should be undertaken and specific interventions considered where exposure is identified. |
IV |
Ongoing care 
