Aims of treatment
- Abolish symptoms
- Restore best possible lung function
- Reduce risk of severe attacks
- Enable normal growth in children
Control of extrinsic factors
- Sublingual allergen immunotherapy (SLIT) with house dust mites
- Avoid smoking, beta blockers, non-selective NSAIDs
Stepwise treatment
Doses
- Salbutamol – 100mcg 2 puffs when required
- Salmeterol – 50mcg bid
- Fomoterol – 12mcg bid
- Budesonide – 200-400mcg od (lower side effects)
- Beclomethasone
- Low dose – 800mcg
- High dose – 2000mcg
- Prednisolone – 40mg
- Montelukast – 10mg/day
- Ipratropium – 20-40mcg
- Theophylline – 200-400mg/day
Steroid sparing
- Methotrexate 15mcg + lower dose of corticosteroid