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  GINA  At-A-Glance AsthmaManagement Reference Updated 201 4 Please refer to the Global Strategy for Asthma Management and Prevention (updated 201 4   ) -  © Global Initiative for Asthma  DEFINITION & DIAGNOSIS OF ASTHMA  Asthma is a common and potentially serious chronic disease that can be effectively treated to control symptoms and minimize the risk of flare-ups (exacerbations). Asthma is usually characterized by chronic airway inflammation. The two key defining features of asthma are: ã  A history of variable respiratory symptoms such as wheezing, shortness of breath, chest tightness, cough ã  Variable expiratory airflow limitation. When making the diagnosis of asthma, document: ã   A typical pattern of symptoms , e.g. more than one type of respiratory symptom; often worse at night or early morning; varying over time and in intensity; triggered by colds, exercise, allergen exposure, laughter or smoke ã   Physical examination : often normal, but may show wheezing on auscultation, especially on forced expiration ã   Expiratory airflow limitation : confirm that when FEV 1  is reduced, FEV 1 /FVC ratio is reduced (this ratio is normally > 0.75–0.80 in healthy adults, and >0.90 in children) ã   Excessive variation in lung function : for example, o  Bronchodilator reversibility, i.e. FEV 1  increases by >12% and 200mL (in children, by >12% of predicted value) after inhaling a bronchodilator o   FEV 1  increases by >12% and 200mL (or PEF by >20% on same meter), after 4 weeks of anti-inflammatory treatment For abbreviations, see page 5. 2  ASSESSMENT OF ASTHMA Box 1. Assessing the two domains of asthma control A. Asthma symptom control in the last 4 weeks Daytime symptoms more than twice/week?  Yes   No    Any night waking due to asthma?  Yes   No   Reliever needed more than twice/week?  Yes   No    Any activity limitation due to asthma?  Yes   No    None of these = asthma symptoms well-controlled  1–2 of these = asthma symptoms partly-controlled  3–4 of these = asthma symptoms uncontrolled   2. Risk factors for poor asthma outcomes ã   For exacerbations : uncontrolled symptoms; no ICS, or poor adherence, or incorrect inhaler technique; excessive reliever use; low FEV 1  especially if <60% predicted; major psychological or socioeconomic problems; smoking; blood eosinophilia; pregnancy ã   For fixed airflow limitation : lack of ICS treatment; low initial FEV 1 ; smoking or occupational exposures; chronic mucus hypersecretion; blood eosinophilia ã   For medication side-effects : frequent oral steroids; long-term high dose ICS; use of P450 inhibitors; (local: high dose or potent ICS; incorrect inhaler technique) For every person with asthma, also check: ã  Inhaler technique, adherence, medication side-effects ã  Do they have a written asthma action plan (p.7)? 3  Consider stepping up if  : uncontrolled symptoms, exacerbations Consider stepping down if  : symptoms controlled for 3+ months a Box 2. Stepwise asthma management
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