Management of asthma

Main aim of asthma management is to control the disease to avoid exacerbations and to reduce the risk of morbidity and mortality (1). Asthma control

• can be described as the extent to which the manifestations of asthma can be observed in the patient, or have been reduced or removed by treatment
• should include both symptom control and control of future risk of adverse outcomes. Both should be assessed during consultation

The British guideline on the management of asthma has defined complete control of asthma as:

• no daytime symptoms
• no night-time awakening due to asthma
• no need for rescue medication
• no exacerbations
• no limitations on activity including exercise
• normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best).
• minimal side effects from medication (2)

Take into account the possible reasons for uncontrolled asthma, before starting or adjusting medicines for asthma in adults, young people and children. These may include:

• alternative diagnoses
• lack of adherence
• suboptimal inhaler technique
• smoking (active or passive)
• occupational exposures
• psychosocial factors
• seasonal or environmental factors (3)
• environmental factors (for example, air pollution, indoor mould exposure)

In most patients asthma control can be achieved through both non-pharmacological (mainly avoidance of triggers) and pharmacological interventions (1)

If possible, check the fractional exhaled nitric oxide (FeNO) level when asthma is uncontrolled. If it is raised this may indicate poor adherence to treatment or the need for an increased dose of inhaled corticosteroid (ICS) (3).

Do not prescribe short-acting beta2 agonists to people of any age with asthma without a concomitant prescription of an ICS (3).

After starting or adjusting medicines for asthma, review the response to treatment in 8 to 12 weeks (3).

Reference:

1. Kim H, Mazza J. Asthma. Allergy Asthma Clin Immunol. 2011;7 Suppl 1:S2
2. British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2019. British Guideline on the Management of Asthma. A national clinical guideline.
3. NICE (November 2024). Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)