1. ASTHMA
2010 NEW GINA
GUIDELINES
Dr.Pradeep.G.C

2. Managing Asthma:
Asthma Management Goals
 Achieve and maintain control of symptoms
 Maintain normal activity levels, including
exercise
 Maintain pulmonary function as close to
normal levels as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma
medications
 Prevent asthma mortality

3. Six-Part Asthma Management
Program
1. Educate patients to develop a partnership in
asthma management
2. Assess and monitor asthma severity with
symptom reports and measures of lung
function as much as possible
3. Avoid exposure to risk factors
4. Establish medication plans for chronic
management in children and adults
5. Establish individual plans for managing
exacerbations
6. Provide regular follow-up care

6. Classifying severity in children who are not currently
taking long-term control medication.

8. Classifying severity for patients who are not currently
taking long-term control medications.

9. Classifying severity in patients after asthma becomes
well controlled, by lowest level
of treatment required to maintain control

12. Peak flow meter
The peak expiratory flow (PEF), also called
peak expiratory flow rate (PEFR) is a
person's maximum speed of expiration,
Peak flow meter, a small, hand-held device
used to monitor a person's ability to breathe
out air.
It measures the airflow through the bronchi
and thus the degree of obstruction in the
airways.

13. An easy to remember approximation is: PEFR (L/min) = [Height (cm) - 80] x 5

14. Managing Asthma:
Peak Flow Chart
People with
moderate or
severe asthma
should take
readings:
– Every morning
– Every evening
– After an
exacerbation
– Before inhaling
certain
medications
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI

15. Spirometry
Spirometry (meaning the
measuring of breath)
Measurement of the
amount (volume) and/or
speed (flow) of air that can
be inhaled and exhaled.
Spirometry is an important
tool used for assessing
conditions such as asthma
cystic fibrosis & COPD.

16.  A volume-time curve, showing volume
(liters) along the Y-axis and time (seconds)
along the X-axis
 A flow-volume loop, which graphically
depicts the rate of airflow on the Y-axis and
the total volume inspired or expired on the
X-axis
 Procedure

17. Typical Spirometric (FEV1)
Tracings
Volume
FEV1
Normal Subject
Asthmatic (After Bronchodilator)
Asthmatic (Before Bronchodilator)
1 2 3 4 5
Time (sec)
Note: Each FEV1 curve represents the highest of three repeat measurements

22. Limitations of test
 Spirometry can only be used on children old enough to
comprehend and follow the instructions given (6 years old
or more), and only on patients who are able to understand
and follow instructions
 Many intermittent or mild asthmatics have normal
spirometry between acute exacerbation, limiting
spirometry's usefulness as a diagnostic.
 It is more useful as a monitoring tool.

23. STEPWISE APPROACH FOR MANAGING ASTHMA I N
CHI LDREN 0–4 Y EARS OF AGE

24. STEPWISE APPROACH FOR MANAGING ASTHMA I N
CHI L DREN 5–11 YEARS OF AGE

26. Tool Kit for Achieving
Management Goals
 Relievers
 Preventers
 Peak Flow meter
 Patient education

27. Inhalation devices you can use
Dry Powder Spacer
Inhaler Metered Dose
inhaler

28. Advantages of Spacer
 No co-ordination required
 No cold - freon effect
 Reduced oropharyngeal deposition
 Increased drug deposition in the
lungs

29. The Zerostat advantage
 Non - static spacer made up
of polyamide material
 Increased respirable fraction → Increased
deposition of drug in the airways
 Increased aerosol half - life → Plenty of time
for the patient to inhale after actuation of the
drug
 No valve → No dead space → Less wastage
of the drug
 Small, portable, easy to carry → Child
friendly

30. Rotahaler - The dry powder
advantage
 Overcomes hand-lung
Overcomes hand-lung
coordination problems that
are encountered with MDIs.
 Can be easily used by children, elderly
and arthritic patients.
 Can take multiple inhalations if the entire
drug has not been inhaled in one
inhalation.

35.  Call for first follow up at 1-2 weeks after initiating therapy and
subsequent follow up 2-8 weekly.
 Review regime prescribed and diary of events since the past
visit. Enquire specifically regarding bronchodilator usage,
school absenteeism, limitation of activity and sleep
disturbance.
 Assess if symptoms and signs of asthma are present at the
time of visit and monitor weight and height.
 Check for adverse effects (relevant especially, if on oral drugs
e.g. steroids, theophylline).
 Re-emphasize the need for continued compliance and clarify
any doubts regarding asthma and its management (page 7).
 Assess whether goals of treatment (page 6) have been
achieved.

44.  Immunosuppresive drugs - Methotrexate
and gold salts.
 Other modalities - Ketotifen
Yoga
Acupuncture

45. THANK YOU