Achieving Guideline-DefinedProf. Dr. Tamsil Syafiuddin, Sp.P (K)Over-All Asthma Control

Definition of AsthmaA chronic inflammatory disorder of the airwaysMany cells and cellular elements play a roleChronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughingWidespread, variable, and often reversible airflow limitation

Source: Peter J. Barnes, MDAsthma Inflammation: Cells and Mediators

Mechanisms: Asthma Inflammation

Burden of AsthmaAsthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individualsPrevalence increasing in many countries, especially in childrenA major cause of school/work absence

Asthma Prevalence and MortalitySource: Masoli M et al. Allergy 2004

Lai, C K W et al. Thorax 2009;64:476-483* JAMA 2001;286:Figure 1 Prevalence of current wheeze according to the written questionnaire in the 13-14 year age group. See text for definition of current wheeze. The symbols indicate prevalence values of

Factors that Influence Asthma Development and ExpressionHost FactorsGenetic - Atopy - Airway hyperresponsiveness GenderObesityEnvironmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Diet

Asthma Control What is asthma control as defined in the guidelines? How can we achieve this? Is it possible to do this in a simple way?

Elements of control

Levels of Asthma Control(GINA 2008)

Overall Asthma ControlCurrent ControlFuture RiskSymptomsReliever Usedefined byachievingActivityLung FunctionachievingInstability / worseningExacerbationsdefined byLung function lossMedication adverse effect

SMARTA better option forAsthma Control?

SMART : Achieve Overall Asthma Control SMART treatment is the management of persistent asthma with only one inhaler Budesonide/Formoterol Turbuhaler

Patients take an adequate maintenance dose of Budesonide/Formoterol with additional inhalations as needed to improve control and provide immediate relief from symptoms

Patients do not need to have a separate as-needed inhaler

Overall Asthma Control is possible with SMART Whats the Evidence? Over 16,000 patients Multicenter Multinational Pediatrics Adolescents Adults Elderly

GINA 2008

Asthma Control