Overview of asthma management in adults and adolescents

Overall goals for the Australian population:

• to minimise asthma deaths
• to minimise ED visits for asthma
• to minimise the burden of disease due to asthma.

Overall goals for individual patients:

• to minimise symptoms and disruption to exercise, sleep, and daily activities
• to minimise exacerbations requiring urgent care and systemic corticosteroids
• to achieve and maintain healthy lung function
• to minimise adverse effects of asthma treatment
• to achieve the patient’s goals for their health.

Asthma management in adults is based on:

• confirming the diagnosis
• assessing symptom control and risk factors repeatedly over time
• identifying management goals in collaboration with the patient
• choosing treatment according to symptom control, risk factors and patient preference
• providing information, skills and tools for self-management, including:
  – training in correct inhaler technique
  – information and support to maximise adherence to prescribed medicines
  – an individualised written asthma action plan
  – information about avoiding triggers, where appropriate
• reviewing and adjusting treatment periodically
• managing exacerbations when they occur
• managing comorbid conditions that affect asthma or contribute to respiratory symptoms
• providing advice about smoking, healthy eating, physical activity, healthy weight and immunisation.

Asthma treatment in adults and adolescents is based on inhaled medication:

1. ICS to reduce airway inflammation and prevent exacerbations (with other inhaled medicines, as indicated)

2. rapid-acting bronchodilators to manage symptoms.

Both these functions can be performed by a single inhaler, or the patient can have a separate inhaler for each function.

ICSs can be administered in either of two ways:

• (recommended approach) via an inhaler containing a combination of ICS and formoterol, taken as needed to relieve symptoms, with or without daily maintenance doses.
• (alternative approach) via an inhaler containing ICS alone, or ICS in combination with a LABA, taken as daily maintenance treatment (with a separate as-needed SABA inhaler for symptom relief).

Rapid-acting bronchodilators for relief of symptoms can be administered in either of two ways:

• (standard approach) using an inhaler containing a combination of ICS and formoterol
• (alternative approach) using an inhaler containing a SABA.