The Update GINA guideline 2006 in Adult

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Contents . Changing concept in asthma treatmentOld GINA guidelinesNew GINA2006. . . . . . . . . . . . . . . . 1975. 1980. 1985. 1990. 1995. 2000. Changing concept in asthma treatment. Airway Hyperresponsiveness. Bronchospasm. . Inflammation. Remodelling. . . . . . short-acting b2-agonists. Inh corticosteroid.

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The Update GINA guideline 2006 in Adult

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1. The Update GINA guideline 2006 in Adult ??. ??. ????? ?????????? M.D., Ph.D. ?????????????????? ?????????????? ??????????????????

6. Six-part Asthma Management Program Goals of Long-term Management Achieve and maintain control of symptoms Prevent asthma episodes or attacks Maintain pulmonary function as close to normal levels as possible Maintain normal activity levels, including exercise Avoid adverse effects from asthma medications Prevent development of irreversible airflow limitation Prevent asthma mortality

7. Six-part Asthma Management Program Control of Asthma Minimal (ideally no) chronic symptoms Minimal (infrequent) exacerbations No emergency visits Minimal (ideally no) need for “as needed” use of ß2-agonist No limitations on activities, including exercise PEF circadian variation of less than 20 percent (Near) normal PEF Minimal (or no) adverse effects from medicine

8. Six-Part Asthma Management Program 1. Educate Patients 2. Assess and Monitor Severity 3. Avoid Exposure to Risk Factors 4. Establish Medication Plans for Chronic Management 5. Establish Plans for Managing Exacerbations 6. Provide Regular Follow-up Care

16. Common views of control? Should control be some symptoms, some rescue medication use etc. or can we achieve control that offers no symptoms etc.Should control be some symptoms, some rescue medication use etc. or can we achieve control that offers no symptoms etc.

17. TOTAL CONTROL definition

18. GOAL: a unique and innovative study GOAL is a unique and innovative study Supporting information Patients were randomised for treatment, provided that their asthma was not Well-Controlled for 2 or more weeks of the 4-week run-in period. Eligible subjects were allocated to one of three strata based on ICS dose ?6 months before the study: Stratum 1: patients not taking ICS Stratum 2: patients currently taking ICS at a maximum dose of 500 ?g/day beclomethasone (BDP) or equivalent Stratum 3: patients currently taking ICS at a dose of >500–?1000 ?g/day BDP or equivalent. The trial consisted of two phases: Phase I: the dose of inhaled corticosteroid in each treatment limb was titrated upwards sequentially at 12-week intervals if needed, (SFC 50/100, 50/250, 50/500 ?g bid or FP 100, 250, 500 ?g bid) until Total Control was achieved or maximum dose reached. In Stratum 3 the starting dose was SFC 50/250 or FP 250 ?g bid resulting in one less treatment step. Phase II: patients continued on the dose of study medication at which they achieved control (or on the highest dose of study medication if control was not reached) for a total treatment duration of 1 year from randomisation. To ensure asthma control was both achieved and maintained, control was assessed over an 8-weeks of each 12-week period in Phase I (to allow time for stabilisation of asthma after changing therapy) and over the last 8 weeks of Phase II. If Total Control was not achieved in either Phase I or II, a short course of oral corticosteroids was given (10 days, 0.5 ?g/kg up to 60 ?g) , in addition to open-label SFC 50/500 ?g bd for 4 weeks, to identify the best possible level of control for each patient. GOAL is a unique and innovative study Supporting information Patients were randomised for treatment, provided that their asthma was not Well-Controlled for 2 or more weeks of the 4-week run-in period. Eligible subjects were allocated to one of three strata based on ICS dose ?6 months before the study: Stratum 1: patients not taking ICS Stratum 2: patients currently taking ICS at a maximum dose of 500 ?g/day beclomethasone (BDP) or equivalent Stratum 3: patients currently taking ICS at a dose of >500–?1000 ?g/day BDP or equivalent. The trial consisted of two phases: Phase I: the dose of inhaled corticosteroid in each treatment limb was titrated upwards sequentially at 12-week intervals if needed, (SFC 50/100, 50/250, 50/500 ?g bid or FP 100, 250, 500 ?g bid) until Total Control was achieved or maximum dose reached. In Stratum 3 the starting dose was SFC 50/250 or FP 250 ?g bid resulting in one less treatment step. Phase II: patients continued on the dose of study medication at which they achieved control (or on the highest dose of study medication if control was not reached) for a total treatment duration of 1 year from randomisation. To ensure asthma control was both achieved and maintained, control was assessed over an 8-weeks of each 12-week period in Phase I (to allow time for stabilisation of asthma after changing therapy) and over the last 8 weeks of Phase II. If Total Control was not achieved in either Phase I or II, a short course of oral corticosteroids was given (10 days, 0.5 ?g/kg up to 60 ?g) , in addition to open-label SFC 50/500 ?g bd for 4 weeks, to identify the best possible level of control for each patient.

19. Patients can achieve total control regardless of asthma severity

20. More patients achieved well controlled asthma with Seretide versus FP Key Points Well controlled definition was stringent and this slide shows that significantly more patients achieved well controlled asthma with Seretide This result was reflected across all the patient groups. Slide present results for Phase 1. Table E02Key Points Well controlled definition was stringent and this slide shows that significantly more patients achieved well controlled asthma with Seretide This result was reflected across all the patient groups. Slide present results for Phase 1. Table E02

23. Levels of Asthma Control

27. Simplified asthma treatment

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