![]() In addition, a reducing effect on mortality has been shown by this treatment. Diagnosis and management is largely undertaken in primary care, with complex cases supported by secondary care and ‘difficult asthma’ services ( NICE, 2017 BTS/SIGN, 2019 GINA, 2020). Long-acting beta-agonists (LABAs) relax smooth muscle in asthmatic lungs, potentially preventing attacks and improving symptoms. Background Recently, the addition of inhaled corticosteroid (ICS) to long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist (LABA) combination therapy has been recommended for patients with COPD who have severe symptoms and a history of exacerbations because it reduces the exacerbations. Treatment relies on evidence-based inhaled therapy, with both drug and device being prescribed. In 2008, the FDA banned asthma inhalers containing chlorofluorocarbons because of environmental concerns (ozone depletion) Immediately following the ban, the price of beta-agonist inhalers rose from an avg of 13. Effective inhaled therapy requires knowledge and ability to use an inhaler device, and the patient should be shown how to use this and have their technique checked by a healthcare professional who is competent to do so. When compared to oral medication, inhaled therapy works faster, requires lower doses, and has fewer side effects ( Allen et al, 2003). ![]() ![]() Treatment involves bronchodilator and anti-inflammatory drugs, which are mostly delivered straight to the lungs via an inhaler device ( National Institute for Health and Care Excellence (NICE), 2017 BTS/SIGN, 2019 Global Initiative for Asthma (GINA), 2020). When exposed to a trigger, the smooth muscle that surrounds the airway contracts (bronchoconstriction) and the inside mucosal lining becomes inflamed ( Kudo et al, 2013). Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus addition of long-acting beta2-agonists (LABA) for adults with asthma. Symptoms are brought on by triggers such as cold weather, respiratory virus, exercise, allergens, and stress ( British Thoracic Society (BTS) / Scottish Intercollegiate Guideline Network (SIGN), 2019). ![]() How to step down combination inhalers If patient is on a combination inhaler. Asthma is a disease of the airways, characterised by airflow obstruction that varies over time, with symptoms including an unproductive cough, chest tightness, breathlessness, and wheeze that is detected by chest auscultation. LAMA + inhaled corticosteroids ICS), ensure that the patient has been referred. ![]()
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