Summary

The primary care management of recurrent wheeze in adults

PEAK FLOW

• diurnal variability >19% is highly suggestive of asthma
• can be useful to assess patients and inform management
• routine use of peak flow meters is not mandatory
• 'morning dipping' is a sign of transient poor control

DRUG TREATMENT

• check compliance particularly if control is poor or treatment is to be increased
• check inhaler technique whenever control is in doubt
• oral treatment should be considered as second line therapy to inhaled treatment

DELIVERY DEVICES

• use the cheapest delivery device the patient can use and comply with effectively
• Suggested Sequence:
  • 1. use a metered dose inhaler
  • 2. add a large volume spacer
  • 3. use a dry powder or automatic aerosol inhaler

UNCONTROLLED ASTHMA

• treat with prednisolone 30-40mg daily until symptoms settle and PEFR returns to normal
• treat with a short acting inhaled beta 2 agonist via a nebuliser or a large volume spacer

LIFESTYLE AND EDUCATION

• patients smoking status should be known
• patients who smoke should be advised to stop
• advice should be tailored to individuals
• patients should be offered education about their condition and its management

REFERRAL

• Referral to a chest physician is appropriate for patients in whom the diagnosis is in doubt
• patients with possible occupational asthma
• patients who present problems in their management