Guideline for the management of chronic asthma in adults--2000 update. South African Pulmonology Society Adult Asthma Working Group.
OBJECTIVE
To make recommendations for the cost-effective management of asthma incorporating recent advances in the understanding and treatment of asthma since the last guideline statement in 1992. The guideline is applicable to adults and children over 12 years of age.


METHODS
Asthma should be graded according to standard severity criteria. The principle of 'hit early, hit hard' with corticosteroids to achieve rapid control is encouraged; thereafter treatment should be tailed down to the lowest dose of corticosteroids that maintains the aims of asthma treatment.


RESULTS
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 best possible) lung function; (iv) reduction of the risk of severe attacks; and (v) optimisation of treatment with minimal side-effects.


METHODS
Based on a selective review of randomised, controlled studies to support an evidence-based approach to treatment.


RESULTS
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 perspective together with a strategy to minimise these effects.


CONCLUSIONS
Asthma should be managed with inhaled corticosteroids as the most important anti-inflammatory treatment, except in the case of mild intermittent asthma which may be treated with beta 2 agonists on a pro re nata (prn) basis. It is preferable to add long-acting beta 2 agonists to low-dose inhaled corticosteroids before increasing corticosteroids. Leukotriene receptor antagonists are currently recommended for use in combination with 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 encouraged.


RESULTS
Endorsed by the South African Pulmonology Society, the Allergy Society of South Africa and the South African Medical Association. The guideline is compatible with those of other international societies.
Lalloo
U G
UG
Department of Medicine, University of Natal, Durban. LALLOO@MED.UND.AC.ZA
Bateman
E D
ED
Feldman
C
C
Bardin
P G
PG
Plit
M
M
Irusen
E M
EM
O'Brien
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D018680:Cholinergic Antagonists / Q000008:administration & dosage; D002908:Chronic Disease; D000075202:Contraindications; D003937:Diagnosis, Differential; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage; D010353:Patient Education as Topic; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013806:Theophylline / Q000008:administration & dosage
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D018680:Cholinergic Antagonists; D020024:Leukotriene Antagonists; D013806:Theophylline