Scenario: Newly-diagnosed asthma | Management | Asthma | CKS | NICE

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• d/or PEF > 80% predicted or best). However, be aware that lung function measurements cannot be used reliably to guide asthma management in children under five years of age.

• Use an inhaled SABA three times a week or more, and/or Have asthma symptoms three times a week or more, and/or Are woken at night by asthma symptoms once weekly or more. In addition, an ICS should be considered for adults and children over the age of 5 years who have had an asthma attack requiring treatment with oral corticosteroids in the past two years

• CS should initially be used twice daily (except ciclesonide, which is used once daily). There is little evidence of benefit from ICS dosing more than twice daily.

• Consider offering a leukotriene receptor antagonist (LTRA) in addition to the low dose ICS. Review the response to treatment in 4 to 8 weeks. Note: An LTRA is an oral therapy, taken only at night which may potentially affect adherence to the inhaled ICS therapy.

• consider offering a long-acting beta-2 agonist (LABA) in combination with the ICS as an alternative.

• e. MART treatment consists of a single inhaler containing both ICS and a fast-acting LABA, which is used for both daily maintenance therapy and the relief of symptoms as required.

• f asthma is uncontrolled on a moderate maintenance ICS dose with a LABA (either as MART or a fixed-dose regimen), with or without an LTRA, consider a trial of an additional drug (for example, a muscarinic receptor antagonist or theophylline).

• Alternatively, a high maintenance dose of ICS may be appropriate.

• A specialist may also recommend continuous or frequent use of oral steroids (usually prednisolone) or additional steroid tablet-sparing treatments.

• In adults, a PMDI with or without a spacer is as effective as any other hand-held inhaler, but some people may prefer use of a DPI

• In children aged between 5 and 12 years, a PMDI with a spacer is recommended. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece.

• age, dexterity, coordination, and inspiratory flow.

• The medication (and dose) being prescribed — a spacer should be used by all people on high-dose inhaled corticosteroids, and by most elderly people using PMDIs.

• They are not interchangeable and must be compatible with the pMDI used.

• Tidal breathing can be used, as it is as effective as single breaths.

• Spacers should be washed monthly in detergent and allowed to dry in air.

• Plastic spacers should be replaced at least every 12 months, although some manufacturers advise changing at 6 months.

• The drug is administered by single-dose actuations from the pMDI into the spacer, with each actuation followed by inhalation. There should be minimal delay between inhaler actuation and inhalation, as the drug aerosol is very short-lived.