Risk factors for uncontrolled asthma - Dr. Sheetu Singh

1
Risk factors for uncontrolled asthma

• Excessive SABA use
• Obesity
• Rhinitis
• GERD
• Pregnancy
• Smoking
• Psychological issues
• FEV1lt60
• High blood eosinophils
• High FeNO
• Ever intubated
• Admission for exacerbation in past 12m

2
Review TAD TOS

• Technique inhaler
• Adherence
• Diagnosis Confirm asthma diagnosis check for
  co-morbids (Obesity, GERD, Sinusitis, OSA)
• Triggers smoke, dust, climate, damp, smell,
  pollen, anxiety-depression, medicines, URTI
• Optimize treatment
• Spirometry

3
Review TAD TOS

• Technique inhaler
• Adherence
• Diagnosis confirm Asthma diagnosis and check for
  co-morbids (Obesity, GERD, Sinusitis, OSA)
• Triggers smoke, dust, climate, damp, smell,
  pollen, anxiety-depression, medicines, URTI
• Optimize treatment
• Spirometry

X
X
4

• The odds ratios for the risk of asthma with
  traffic pollution 6-7 yr children1.4 to 1.6
• 13-14 yr 1.2 to 1.5

5
Mrs Sheela, 42 yr Uncontrolled Asthma

• Formoterol Budesonide 400 Twice a day
• Tiotropium once a day
• Salbutamol RC as needed
• Tab Cetrizine as needed
• Avoid pollution
• Check inhaler technique next time
• Serum IgE
• For 2 months Dr
  Sheetu Singh

No improvement in asthma at end of 2 m
6
Terminology

• Uncontrolled asthma
• Frequent symptoms and/or flare-ups
  (exacerbations)
• Many of these patients may potentially have mild
  asthma, i.e. their asthma could be
  well-controlled with low dose ICS, if taken
  regularly
• Difficult-to-treat asthma
• Asthma uncontrolled despite prescribing high dose
  preventer treatment
• Contributory factors may include incorrect
  diagnosis, incorrect inhaler technique, poor
  adherence, comorbidities
• Severe asthma
• Asthma that is uncontrolled despite maximal
  optimised therapy and treatment of contributory
  factors, or that worsens when high dose treatment
  is decreased