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Risk factors for uncontrolled asthma - Dr. Sheetu Singh

Excessive SABA use, Obesity, Rhinitis, GERD, Pregnancy, Smoking, Psychological issues, FEV1<60%, High blood eosinophilsHigh FeNO, Ever intubated Admission for exacerbation in past 12m www.drsheetusingh.com

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Risk factors for uncontrolled asthma - Dr. Sheetu Singh

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  1. Risk factors for uncontrolled asthma • Excessive SABA use • Obesity • Rhinitis • GERD • Pregnancy • Smoking • Psychological issues • FEV1<60% • High blood eosinophils • High FeNO • Ever intubated • Admission for exacerbation in past 12m

  2. Review: TAD TOS Technique inhaler Adherence Diagnosis: Confirm asthma diagnosis & check for co-morbids (Obesity, GERD, Sinusitis, OSA) Triggers: smoke, dust, climate, damp, smell, pollen, anxiety-depression, medicines, URTI Optimize treatment Spirometry

  3. Review: TAD TOS X Technique inhaler Adherence Diagnosis: confirm Asthma diagnosis and check for co-morbids (Obesity, GERD, Sinusitis, OSA) Triggers: smoke, dust, climate, damp, smell, pollen, anxiety-depression, medicines, URTI Optimize treatment Spirometry X

  4. The odds ratios for the risk of asthma with traffic pollution: 6-7 yr children:1.4 to 1.6 • 13-14 yr 1.2 to 1.5

  5. Mrs Sheela, 42 yr Uncontrolled Asthma • Formoterol + Budesonide 400 Twice a day • Tiotropium once a day • Salbutamol RC as needed • Tab Cetrizineas needed • Avoid pollution • Check inhaler technique next time • Serum IgE For 2 months Dr Sheetu Singh No improvement in asthma at end of 2 m

  6. Terminology Uncontrolled asthma • Frequent symptoms and/or flare-ups (exacerbations) • Many of these patients may potentially have mild asthma, i.e. their asthma could be well-controlled with low dose ICS, if taken regularly Difficult-to-treat asthma • Asthma uncontrolled despite prescribing high dose preventer treatment • Contributory factors may include incorrect diagnosis, incorrect inhaler technique, poor adherence, comorbidities Severe asthma • Asthma that is uncontrolled despite maximal optimised therapy and treatment of contributory factors, or that worsens when high dose treatment is decreased

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