Moderate persistent asthma is characterized by daily symptoms over a prolonged. period or by nocturnal asthma more than once a week.
Patients with moderate persistent asthma require controller medication every day to achieve and maintain control of their asthma.
The dose of inhaled corticosteroids should be decided by your doctor. A spacer device along with the inhaler is recommended in order to reduce oropharyngeal (back of the throat) side-effects and systemic absorption.
In addition to the inhaled corticosteroids, theophylline may also be considered, particularly to control nocturnal symptoms.
Inhaled bronchodilators should be available for use as needed, to relieve symptoms, but should not be taken more than 3 to 4 times a day. Long-acting inhaled bronchodilators may be prescribed sometimes to achieve maximum control at night.
A patient is considered to be suffering from mild persistent asthma if he or she has been experiencing mild persistent exacerbations at least once a week over the past 3 months and, at times, these exacerbations affect his or her sleep and activity levels. Such a form of asthma is said to be present also if the patient experiences nocturnal symptoms more than twice a month.
Patients with mild persistent asthma require controller medication every day to achieve and maintain control of their condition. The primary therapy for this type of asthma is the regular use of anti-inflammatory medication on a daily basis.
Relievers should be available for use as needed to ease symptoms, but should not be taken more than three to four times a day.
If symptoms persist despite the initial dose of inhaled corticosteroids, and the health care professional is satisfied that the patient is using the medications correctly, the dosage of such corticosteroids may be increased.
A patient is considered to have intermittent asthma if he or she experiences exacerbations (i.e, attacks of cough, wheezing, or dyspnoea) less than once a week over a period of at least 3 months and the exacerbations are brief, generally lasting only a few hours to a few days. Also, nocturnal asthma symptoms do not occur more than two times a month. In between exacerbations, the patient becomes asymptomatic and experiences normal lung functions.
The intermittent asthma category includes the following:
(1) those patients who become allergic when exposed to an allergen (e.g., dog, pollen) which is responsible for causing asthma symptoms (such patients could otherwise be completely symptom-free and could possess normal lung functions when not exposed to the allergen); (2) those patients who may contract exercise-induced asthma, especially when the weather turns bad; and (3) infants and children who occasionally wheeze when their respiratory tracts are infected with viruses.
Intermittent asthma should not be considered trivial. The severity of the asthma exacerbation varies from one patient to another and from one period to another and may prove life-threatening, although very rarely.
For intermittent asthma, it is recommended that long- term treatment using a controller medication should not be started. Rather, the exacerbations should be treated, depending on their severity.
The course of treatment includes taking appropriate medication prior to exercise (e.g., inhaling of salbutamol or sodium cromoglycate) or prior to exposure to an allergen (e.g., sodium cromoglycate). The medications used for treating the exacerbations include an inhaled bronchodilator taken as needed to relieve the asthma symptoms. Occasionally, more severe or prolonged exacerbations may require a short course of oral corticosteroids. The doctor would, obviously, be the best judge.
If medication is required more than once a week over a 3-month period, the patient should be moved to the next step of care.
