Asthma PDF
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Asthma CLINICIAN’S DESK REFERENCE Graham Douglas BSc (Hons) FRCPE Consultant Respiratory Physician, Aberdeen Royal Infirmary, UK Honorary Reader in Medicine, University of Aberdeen Co-chair BTS/SIGN British Guideline on the Management of Asthma Kurtis S Elward MD, MPH, FAAFP Associate Clinical Professor of Family Medicine, Virginia Commonwealth University Assistant Professor of Research in Family Medicine, University of Virginia Family Physician, Family Medicine of Albemarle, Charlottesville, Virginia MANSON PUBLISHING CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2010 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140529 International Standard Book Number-13: 978-1-84076-513-7 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Contributors 5 CHAPTER 4 Graeme Currie Preface 7 Inhaler devices 43 Introduction 43 CHAPTER 1 Graham Douglas and Kurtis S Elward Types of inhaler 43 The scale of the problem 9 Inhalers for adults 45 Inhalers for children (0–12 years) 46 Definition of asthma 9 Local effects 46 Assessing asthma epidemiology 9 How to use and maintain spacers 47 Worldwide distribution of asthma 10 Combination inhalers 48 Asthma in the USA and UK 11 Nebulizers 48 Ethnicity and social deprivation 12 Effect of gender and age 12 CHAPTER 5 Graham Douglas and Kurtis S Elward Increase in asthma prevalence 13 Long-term management of asthma Hospital admissions 15 in adults 49 Asthma mortality 17 Healthcare costs 19 Asthma control 49 Stepwise management 50 CHAPTER 2 Patrick Fitch Stepping down 57 Scientific principles of asthma 21 Control assessment 57 Anti-IgE monoclonal antibodytherapy 58 Pathology 21 Difficult asthma 59 Airway inflammation in asthma 22 Origins of atopy 24 CHAPTER 6 Graham Douglas Allergen exposure 25 Management of acute asthma in adults 61 Asthma triggers 25 Atopy 26 Introduction 61 Bronchial hyper-reactivity 26 Adverse psychosocial and behavioural factors 62 Genetics of asthma 27 Definition of acute asthma 62 Air pollution and smoking 27 How to recognize a severe attack 63 Hypotheses for the increased prevalence Investigations 64 of asthma 28 Management of severe acute asthma in adults 65 Natural history of asthma 29 Referral to intensive care 69 Monitoring 69 CHAPTER 3 Graeme Currie Hospital discharge 70 Making the diagnosis of asthma 31 Follow-up 70 Introduction 31 Symptoms 31 Signs 32 Objective measures in the diagnosis of asthma 32 Probability of asthma 33 Asthma subtypes 38 Associated syndromes 40 CHAPTER 7 Richard Brooker and Kurtis S Elward CHAPTER 11 Graham Douglas Management of childhood asthma 73 Asthma and the future 119 Chronic asthma in children 73 Inroduction 119 Long-term management of asthma in children 78 Preventing asthma 119 Stepping down therapy 82 Controlling asthma 120 Monitoring 82 Managing severe acute asthma 123 Acute asthma in children 83 Improved inhaled delivery systems 123 Treatment of acute asthma 85 Asthma genetics 123 Special considerations in children aged less than Bronchial thermoplasty 124 2 years 89 Further investigations/monitoring 90 CHAPTER 12 Graham Douglas Discharge from hospital 90 Clinical cases: diagnosis and management 125 CHAPTER 8 Graham Douglas Occupational asthma 91 Diagnostic problems Asthma in the under 5s 125 Introduction 91 Exercise-induced breathlessness in children 127 Who should be investigated for occupational Chronic cough 129 asthma? 91 Occupational asthma 131 Diagnosis of occupational asthma 92 Asthma vs COPD 133 Causes of occupational asthma 95 Management problems Management of occupational asthma 96 Asthma in pregnancy 135 Reactive airways dysfunction syndrome 96 Lobar collapse 137 Severe chronic asthma 139 CHAPTER 9 Monica Fletcher Asthma and surgery 141 Educating patients and clinicians 97 Asthma and back pain 143 Introduction 97 Patient education 97 Clinician resources 145 Sources of information 99 Patient resources 156 Asthma action plans 100 Frequently-asked questions 157 Patient-centred care 104 Glossary 163 Educating health professionals 104 Index 170 CHAPTER 10 Iain Small Abbreviations 176 Asthma in primary care 107 Introduction 107 Diagnosis 108 Long-term management of asthma 110 Management of acute exacerbations of asthma 112 Organization and delivery of care 116 Provision of asthma care and ‘quality outcomes’ 118 5 Contributors CHAPTERS 1,5,6,8,11,12 CHAPTERS 3,4 Graham Douglas, BSc (Hons), FRCPE Graeme Currie, FRCPE Consultant Physician, Respiratory Unit, Consultant Physician, Respiratory Unit, Aberdeen Royal Infirmary, UK Aberdeen Royal Infirmary, UK Honorary Reader in Medicine, University of Aberdeen CHAPTER 7 Co-Chair of the BTS/SIGN British Guideline on the Management of Asthma Richard Brooker, FRCPE Consultant Paediatrician, CHAPTERS 1,5,7 Royal Aberdeen Hospital for Sick Children, UK Kurtis S Elward, MD, MPH, FAAFP Associate Clinical Professor of Family Medicine, CHAPTER 9 Virginia Commonwealth University Assistant Professor of Research in Family Medicine, Monica Fletcher, MSc, BSc (Hons), PGCE, RN, University of Virginia RSCN, HV dip Family Physician, Family Medicine of Albemarle, Chief Executive, Education for Health, Charlottesville, Virginia Warwick, UK andNational Respiratory Training Center, CHAPTER 2 Suffolk, Virginia, USA Patrick Fitch, FRCPE CHAPTER 10 Consultant Physician, Respiratory Unit, Aberdeen Royal Infirmary, UK Iain Small, FRCGP General Practitioner, Health Centre, Peterhead, UK Chair, UK General Practice Airways Group Acknowledgements We wish to thank Jackie Fiddes for her tireless We are very grateful to the following for permission to attention to detail in dealing with the figures and IT reproduce or adapt their figures, or use their data: support, Kim Clark, Senior Pharmacist, for help with the drug tables, and Ayala Kingsley, Project American Lung Association; Asthma, UK; British Manager/Designer, for putting the book together. Thoracic Society (BTS); Centers for Disease Control (CDC); European White Lung Book; Global Initiative for Asthma (GINA); ISAAC Steering Committee; Lung & Asthma Information Agency (LAIA); National Osteoporosis Society; National Respiratory Training Centre (NRTC); Prescriber; Richard J. G. Rycroft, MD; Scottish Intercollegiate Guideline Network (SIGN) This page intentionally left blank 7 Preface ASTHMAISONEOFTHEMOSTIMPORTANTchronic disorders in the developed world. Evidence from around the world shows that the prevalence of asthma has increased considerably since 1975, and it now affects around 5% of the world population (about 300 million individuals). In Europe and North America, asthma is among the most common chronic diseases affecting all age groups, with up to 11% of the population being diagnosed as having asthma at some time in their lives. Understanding of the basic mechanisms involved in the pathogenesis of asthma has improved dramatically over the past 20 years. Asthma is not a single disease but a spectrum of disorders characterized by airway obstruction, that varies spontaneously and with treatment. Along with this increase in basic scientific knowledge, randomized clinical trials have produced evidence to guide clinicians in how to manage patients with asthma. Evidence-based guidelines produced across the world have led to more uniform and improved care for all patients. Clinician’s’Desk Reference: Asthmahas been written for healthcare professionals, whether doctors, nurses, physiotherapists, or others caring for patients with asthma, in primary care and in hospital. The contributors are clinicians actively working in primary and secondary care, who are all experts in the management of asthma. Current evidence-based guidelines from North America and Europe have been used and the text is illustrated with a large number of diagrams and clinical photographs. The book covers epidemiology, pathology and diagnosis, highlights the underdiagnosis of occupational asthma, and emphasizes the importance of effective patient education, particularly asthma action plans. There are chapters on the treatment and management of adult and childhood asthma, and one on future possible developments in our understanding and treatment of this disease.The final chapter features ten patient profiles of common diagnostic and management problems, with the clinical problem on the first page and the suggested solution overleaf. Lastly, there are appendices containing useful resources for both patients and physicians. This book is unique in bringing together guidance and practice from both Europe and North America. We hope it will be of value to all those involved in caring for patients with asthma. GRAHAMDOUGLAS KURTISS ELWARD This page intentionally left blank
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