Respiratory

Treatment of Chronic Asthma

See also the acute management of asthma.

Step 1

Salbutamol (short acting beta-2 agonist) inhaled 200 micrograms PRN

Step 2

Low dose inhaled steroids: 100-400 micrograms Beclometasone inhaled twice daily

Step 3

Salmeterol (long acting beta-2 agonistinhaled 50 micrograms (2 puffs) twice daily

Step 4

High dose inh steroids: Beclometasone 1000 micrograms (in divided doses). Or oral theophyline, or leukotriene receptor antagonist

Step 5

Regular prednisolone tablets. Initially 10-20mg (after breakfast). Maintenance 2.5-15 mg daily.

Adverse Effects

• Salbutamol: Tremor, tachycardia, headache
• Ipratropium: Antimuscarinic: dry mouth, nausea, constipation, headache
• Inhaled steroids: Adrenal suppression (patients should have a steroid card, may need corticosteroids during illness), growth retardation, glaucoma, oral hoarseness/candidiasis