Guideline for the management of chronic asthma in adults - 2000 update

Objective. To make recommendations for the cost-effective management of ast hma incorporating recent advances in the understanding and treatment of ast hma since the last guideline statement in 1992. The guideline is applicable to adults and children over 12 years of age. Options. Asthma should be graded according to standard severity criteria. T he principle of 'hit early, hit hard' with corticosteroids to achieve rapid control is encouraged; thereafter treatment should be tailed down to the l owest dose of corticosteroids that maintains the aims of asthma treatment. Outcomes. The aims of asthma management should be achieved; these include: (i) avoidance of causative and trigger factors; (ii) abolition of symptoms and ability to lead a normal lifestyle; (iii) restoration of normal (or bes t possible) lung function; (iv) reduction of the risk of severe attacks; an d (v) optimisation of treatment with minimal side-effects. Evidence. Based on a selective review of randomised, controled studies to s upport an evidence-based approach to treatment. Benefits, harms and costs. Appropriate management of asthma should lead to a reduction in morbidity and mortality of asthma and a consequent reduction in cost of asthma care. Side-effects of corticosteroids are placed in pers pective together with a strategy to minimise these effects. Recommendations. Asthma should be managed with inhaled corticosteroids as t he most important anti-inflammatory treatment, except in the case of mild i ntermittent asthma which may be treated with beta(2) agonists on a pro re n ata (pm) basis. It is preferable to add long-acting beta(2) agonists to low -dose inhaled corticosteroids before increasing corticosteroids. Leukotrien e receptor antagonists are currently recommended for use in combination wit h inhaled corticosteroids pending further data on their long-term benefits. Differentiation of asthma from chronic obstructive pulmonary disease (COPD ) is important. Early referral to a pulmonologist in difficult cases is enc ouraged. Validation. Endorsed by the South African Pulmonology Society, the Allergy Society of South Africa and the South African Medical Association. The guid eline is compatible with those of other international societies. Financial sponsor. Sponsored by an educational grant from the National Asth ma Education Programme, the official asthma education ann of the South Afri can Pulmonology Society.