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Mechanisms Underlying the

Definition of Asthma

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GINA 2015 – changes to Steps 4 and 5

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*For children 6-11 years, theophylline is not recommended, and preferred Step 3 is medium dose ICS

**For patients prescribed BDP/formoterol or BUD/formoterol maintenance and reliever therapy

# Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations;

it is not indicated in children


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HOW TO ASSESS ASTHMA CONTROL

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The control-based asthma management cycle

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Choosing between controller options –individual patient decisions

Decisions for individual patients

Use shared decision-making with the patient/parent/carer to discuss the following:

1. Preferred treatment for symptom control and for risk reduction2. Patient characteristics (phenotype)

• Does the patient have any known predictors of risk or response?

(e.g. smoker, history of exacerbations, blood eosinophilia)

3. Patient preference

• What are the patient’s goals and concerns for their asthma?

4. Practical issues• Inhaler technique - can the patient use the device correctly after trainin

• Adherence: how often is the patient likely to take the medication?

• Cost: can the patient afford the medication?

GINA 2014, Box 3-3 (2/2) Provided by H Reddel

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Asthma Management นพ.อดิศร