23 The recommendations for asthma management Revised 2006Develop Patient/Doctor PartnershipIdentify and Reduce Exposure to Risk FactorsAssess, Treat, and Monitor AsthmaManage Asthma ExacerbationsSpecial Considerations
24 GINA 2006 Assessing asthma control Treating to achieve asthma control Day symptomsNight symptomsRelieverPEFRExacerbationLimitation of activityAssessing asthma controlControlledPartly controlledUncontrolledTreating to achieve asthma controlB2-agonist prnICSICS (low dose) + LABAICS (high dose) + LABAICS (high dose) + LABA + prednisoloneMonitoring to maintain control
25 Health Information Division, Bureau of Health Policy and Planing Asthma admission in Thailand (excluding Bangkok)Health Information Division, Bureau of Health Policy and Planing
26 Survey of asthma control in Thailand KhonkaenBangkokSurvey of asthma control in ThailandChiangmaiWatchara BoonsawatPoonkasem CharoenphanSumalee KaitboonsriVilaivan WiriyachaiyoChaicharn PothiratSomkiat WongtimNikom ThanomsiengSongkhlaRespirology (2004)
27 GINA Goal: No Emergency visits Asthma morbidity in the past year
37 Six-Part Asthma Management Program It’s not easy1. Educate Patients2. Assess and Monitor Severity3. Avoid Exposure to Risk Factors4. Establish Medication Plans for Chronic Management: Adults and Children5. Establish Plans for Managing Exacerbations6. Provide Regular Follow-up Care
39 Easy asthma clinic: กลยุทธ์ Make the treatment of asthma as easy as possibleRun by GP in general hospitals throughout the countryEmphasize the role of pharmacist and nurse in asthma managementOrganize the system
45 Conclusions Concept in asthma treatment is changing Old GINA guidelines using asthma severity to guide treatment.New GINA2006 using asthma control to guide treatment. No more severity.Easy Asthma Clinic is the easy way to implement guidelines
47 Simplified asthma treatment Total controlAsthma PatientNo day symptomsNo night symptomsNo rescue medicationNo ER visitPEFR >80%Assess ControlICS 500ug/d+Other controllerTreatmentICS 500ug/d
48 Levels of Asthma Control CharacteristicControlled(All of the following)Partly Controlled(Any measure present in any week)UncontrolledDaytime symptomsNone (twice or less/week)More than twice/weekThree or more featuresof partly controlledasthma presentLimitations of activitiesNoneAnyNocturnal symptoms/awakeningNeed for reliever/rescue treatmentLung function (PEF or FEV1)‡Normal< 80% predicted or personal best (if known)ExacerbationsOne or more/year*One in any week†* Any exacerbation should prompt review of maintenance treatment to ensure that it is adequate.† By definition, an exacerbation in any week makes that an uncontrolled asthma week.‡ Lung function is not a reliable test for children 5 years and younger.
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