Asthma management- NICE guidance

[@radhwanabdulla6806]

Great thanks and appreciation Sir

[@practicalgp]

Thank you for your comment. I really appreciate your support 🙏

[@mehyarkhaled397]

Thank you!

[@practicalgp]

I am pleased that you found it helpful :)

[@syedwaqasshah5744]

Watch Allergic asthma lecture given by Dr. Najeeb kzbin.info/www/bejne/qGHOeJdna6tmpqs

[@TruthfulPromise]

useful. thanks

[@practicalgp]

Thank you for your support. I really appreciate it 🙏

[@jasniangel9155]

Thank u..very helpful..hows is this different from British thoracic society guidelines in childhood asthma

[@practicalgp]

Thank you for your comment. I really appreciate it. NICE are working with BTS/SIGN to produce UK-wide guidance that will update and replace the current NICE guideline. The methodology is also different. BTS/SIGN use literature appraisal and clinical studies whereas NICE combine critical appraisal with health economic modelling. The differences in the guidance are probably varied. I have not compared them both in detail but this article, although from 2017, will give you a flavour. One big difference is the use of SABA alone for some in the NICE guideline, whereas for BTS they go more for combination with ICS. blogs.bmj.com/thorax/files/2017/12/BTS-SIGN-and-NICE-Asthma-guidelines.pdf

[@jasniangel9155]

@@practicalgp truly enlightened.. Thank u.. U r a great doctor

[@practicalgp]

@@jasniangel9155 Thank you again for your kind words and support 🙏

[@ankineedukavuri8634]

Dear doctor sir l have heard your entire speach with atmost care and consuntration,l have under stood the points in your speech,l too is a asthma patient since 1987,l always feel nasal congestion phlegm,at present l am useing sero flo 250 mcg,before to seroflo 250 l have used Forocort 400mcg, even though threre phlegm and sore throat which one better for ASTHMA PATIENTS SOLMETROL OR FORMETROL plese advice l am a LIVER TRANSPLANT PATIENT SINCE 2017.

[@practicalgp]

Thank you for your comment. I am sorry that you are having these issues. I cannot give you medical advice, but I can give you general information about salmeterol and formoterol. Salmeterol and formoterol are both long-acting beta-agonist (LABA) bronchodilators used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). One is not better that the other. They have similar mechanisms of action and are intended for long-term treatment. However, there are some differences between the two: ⦁ Formoterol has a relatively rapid onset of action and a shorter duration compared to salmeterol. Formoterol starts working within a few minutes and can last up to 12 hours, while salmeterol takes longer to kick in and also has a duration of action of about 12 hours. ⦁ Salmeterol is typically administered either as a dry powder inhaler (DPI) or a metered-dose inhaler (MDI), while formoterol is mostly available as DPI . I think that you are taking Seroflo 250 in the MDI version The choice between salmeterol and formoterol may depend on individual factors, including previous response to the medications, the severity of the symptoms, and any side effects. Some patients may prefer the faster onset of formoterol, while others may find the inhaler device used for salmeterol more convenient. Both salmeterol and formoterol are combined with inhaled corticosteroids (ICS) in single inhalers to provide both long-acting bronchodilation and anti-inflammatory effects. The steroid element of the inhalers can increase the risk of thrush in the mouth and throat. This can give symptoms such as a sore throat and white plaques in your mouth. This risk may be greater in your case because of your history of liver transplant. DPIs have less risk of oral thrush than MDIs but they are not necessarily better. Using a spacer with the MDI can also reduce the risk of oral thrush. An MDI may be more suitable for you and if you are in doubt, you should consult your doctor about this. I wish you all the best

[@ankineedukavuri8634]

Dear most respected sir l am super satisfaction with your immediate response,l m a retired TEACHER, I TAUGHT physics and chemistry at high school level for about 20 years nd 15 years in elementary level,even though l am LIVER TRANSPLANT I am stable with the help greate HEPTOLOGIST DR DHERMESH KAPOOR OF HYDERABD.. OF INDIA. NOW l am useing dry powder of solmetrol 250mcg two times a day it costly one,, any how your advice gave me more nd more satisfaction.

[@practicalgp]

Thank you 🙏

[@oumaymen6773]

The ultimate treatment for asthma is found in food. This is based on personal experience. God completely cured me of it five years ago and I threw away all medications and sprays.

[@mohammediraheem3073]

What is MART???

[@practicalgp]

Thank you for your question. Maintenance and Reliever Therapy, or MART, is just one inhaler to use as a preventer and a reliever. A MART inhaler is a combination inhaler that contains a steroid and a long acting bronchodilator that can also work quickly as reliever inhaler (short-acting), usually formoterol . Please note that not all inhalers with formoterol are licensed for MART though. I hope that this makes it clearer.

[@islamagha1852]

@@practicalgpif MART is used for maintenance and reliever why SABA is still added to this step. My understanding that MART is used twice daily for prevention and up to extra 8 times for relief. Is this right?

[@practicalgp]

@@islamagha1852 You’re right. The maximum number of inhalations per day depends on the inhaler, but for many MART inhalers like those containing budesonide/formoterol, the total daily dose (maintenance plus reliever) is limited to 8 -12 inhalations per day (12 with medical supervision as per the BNF) NICE recommends including a SABA, like salbutamol, as a potential reliever option alongside MART for a variety of reasons, like acting as an additional reliever option, given that some people may prefer to use a separate, reliever in an acute situation and having a familiar option gives patients confidence. Sometimes it can also be a backup for poor control especially if they are overusing the MART inhaler (beyond the recommended limit), which could lead to side effects. So having a SABA on hand helps prevent over-reliance on the MART inhaler as a reliever. I hope that this helps 🙏