Asthma Management Handbook

Definitions of special terms

Asthma

A chronic lung disease, which can be controlled but not cured.

Untreated asthma is usually characterised by chronic inflammation involving many cells and cellular elements, which is associated with airway hyperresponsiveness and intermittent airway narrowing due to any (or a combination) of bronchoconstriction, congestion or oedema of bronchial mucosa, and mucus.

Asthma probably represents a spectrum of conditions with different pathophysiological mechanisms.

In clinical practice, asthma is defined by the presence of both excessive variation in lung function and variable respiratory symptoms, such as wheeze, shortness of breath, cough and chest tightness.

Complementary and alternative therapies

The range of medical and healthcare practices and products that are not generally considered part of conventional medicine provided by doctors and allied health professionals in Australia. These include ‘natural’ products, ‘mind-and-body’ therapies, dietary supplements or restrictions, and physical therapies.

Control

Asthma control refers to the overall degree to which the impact of asthma, and the risks due to the underlying disease and its treatment, have been reduced or managed for the person.

Assessment of asthma control involves (both of):

  • assessment of recent asthma symptom control (e.g. good, partial or poor), based on frequency of daytime asthma symptoms, night-time symptoms or symptoms on waking, reliever use in response to symptoms, and on limitation of activity, usually over the past 4 weeks
  • assessment of risk factors for future adverse events (e.g. flare-ups, life-threatening asthma, accelerated decline in lung function, or adverse effects of treatment).

Flare-up

Worsening of asthma control (increase in asthma symptoms)

Mild flare-up: Worsening of asthma control that is only just outside the normal range of variation for the individual (documented when patient is well)

Moderate flare-up: Worsening asthma that is troublesome or distressing to the patient and requires a change in treatment, but is not life-threatening and does not require hospitalisation

Severe flare-up: Event that requires urgent action by the patient (or carers) and health professionals to prevent a serious outcome such as hospitalisation or death from asthma

High-dose inhaled corticosteroids

See Inhaled corticosteroids doses (adults), Inhaled corticosteroid doses (children)

Inhaled corticosteroid doses (adults)

Low dose: 100–200 mcg beclometasone dipropionate per day or 200–400 mcg budesonide per day or 80–160 mcg ciclesonide per day or 100–200 mcg fluticasone propionate per day

Medium dose: 250–400 mcg beclometasone dipropionate per day or 500–800 mcg budesonide per day or 240–320 mcg ciclesonide per day or 100 mcg of fluticasone furoate* per day or 250–500 mcg fluticasone propionate per day

High dose: more than 400 mcg beclometasone dipropionate per day or more than 800 mcg budesonide per day or more than 320 mcg ciclesonide per day or 200 mcg of fluticasone furoate* per day or more than 500 mcg fluticasone propionate per day

*Fluticasone furoate is available only in combination with vilanterol (a long-acting beta2 agonist), and is not available as a low dose. It should only be prescribed as one inhalation once daily.

Table. Definitions of ICS dose levels in adults

Inhaled corticosteroid Daily dose (mcg)
Low Medium High
Beclometasone dipropionate † 100–200 250–400 >400
Budesonide 200–400 500–800 >800
Ciclesonide 80–160 240–320 >320
Fluticasone furoate* 100 200
Fluticasone propionate 100–200 250–500 >500

† Dose equivalents for Qvar (TGA-registered CFC-free formulation of beclometasone dipropionate).

*Fluticasone furoate is not available as a low dose. TGA-registered formulations of fluticasone furoate contain a medium or high dose of fluticasone furoate and should only be prescribed as one inhalation once daily.

Note: The potency of generic formulations may differ from that of original formulations. Check TGA-approved product information for details.

Sources

Respiratory Expert Group, Therapeutic Guidelines Limited. Therapeutic Guidelines: Respiratory, Version 4. Therapeutic Guidelines Limited, Melbourne, 2009.

GlaxoSmithKline Australia Pty Ltd. Product Information: Breo (fluticasone furoate; vilanterol) Ellipta. Therapeutic Goods Administration, Canberra, 2014. Available from: https://www.ebs.tga.gov.au/

GlaxoSmithKline Australia Pty Ltd. Product Information: Arnuity (fluticasone furoate) Ellipta. Therapeutic Goods Administration, Canberra, 2016. Available from: https://www.ebs.tga.gov.au/

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Inhaled corticosteroid doses (children)

Low dose: 100–200 mcg beclometasone dipropionate per day or 200–400 mcg budesonide per day or 80–160 mcg ciclesonide per day or 100–200 mcg fluticasone propionate  per day

High dose: more than 200 mcg beclometasone dipropionate per day or more than 400 mcg budesonide per day or more than 160 mcg ciclesonide per day or more than 200 mcg fluticasone propionate per day

Table. Definitions of ICS dose levels in children

Inhaled corticosteroid

Daily dose (mcg)

Low

High

Beclometasone dipropionate

100–200

>200 (up to 400)

Budesonide

200–400

>400 (up to 800)

Ciclesonide

80–160

>160 (up to 320)

Fluticasone propionate

100–200

>200 (up to 500)

† Dose equivalents for Qvar (TGA-registered CFC-free formulation of beclometasone dipropionate)

‡ Ciclesonide is registered by the TGA for use in children aged 6 and over

Source

van Asperen PP, Mellis CM, Sly PD, Robertson C. The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand, 2010. Available from: 
http://www.thoracic.org.au/clinical-documents/area?command=record&id=14

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Low-dose inhaled corticosteroids

See Inhaled corticosteroids doses (adults), Inhaled corticosteroid doses (children)

Medium-dose inhaled corticosteroids

See Inhaled corticosteroids doses (adults)

Variable airflow limitation

Variation in airflow beyond the range seen in healthy populations, measured by any of the following methods:

  • spirometry before 10–15 minutes after administration of bronchodilator in a single session
  • spirometry on separate visits
  • spirometry before and after exercise
  • spirometry before and after a treatment trial with an inhaled corticosteroid
  • peak expiratory flow measured twice daily
  • airway hyperresponsiveness testing (exercise challenge test or bronchial provocation test).

Variable airflow limitation is defined by specific criteria for each method.

Written asthma action plan

An individualised set of instructions for a person with asthma (or their carer) to follow as asthma symptoms change, and which is updated from time to time by their health professional.

Written asthma action plans include a list of the person’s usual asthma and allergy medicines and instructions on what to do when the person experiences asthma symptoms (e.g. how to change medication, when and how to start a course of oral corticosteroids, when and how to get medical care, and what to do in an asthma emergency). A range of templates is available from National Asthma Council Australia's asthma action plan library.