The HAS published in October 2006 a guide for the attending physicians about the manner to deal with a patient in serious chronic respiratory failure pursuent to an asthma.
Initial evaluation of a patient suffering from an asthma
HAS recommands :
- Paraclinic examinations by the attending physician:
- EFR systematically
- Evaluation of the degree of chronic respiratory failure
- Examination of reference for follow-up (complete blood count, radiographies of thorax)
- By the lung specialist :
- A confirmation of the diagnosis and the degree of severity
- An adjustment of the treatment
- A consultation to the allergist and ENT specialist.
Therapeutic dealing with a patient with a severe asthmatic without long time oxygen treatment nor assisted distribution
According to the HAS, therapeutic education consists, for the doctor:
- To adapt education to the patient thanks to educational diagnosis,
- To define with the patient the competences which he must acquire,
- To propose constructive activities,
- To evaluate successes and difficulties.
Following these steps, the patient will be able to proceed to:
- The evaluation of the control and the severity of the asthme,
- The management of pharmacological treatment , according to his symptoms.
Modification of lifestyle
- Environment control with the knowledge and the ousting of the allergens and enacting factors,
- Practice a physical exercise according to his tolerance to effort,
- A normal schooling for the child.
Medicinal treatment and therapeutic strategy
The HAS lists, by therapeutic classes , the available treatment:
- Bronchodilator agents of short and long action,
- Inhaled corticosteroids (CSI),
- Receptor antagonists with cystéinyl-leukotrienes,
- Theophylline and its derivatives,
- Oral corticoids,
- Nebulised aerosols.
The HAS specifies that "the choices of the therapeutic classes, the doses and associations depend on the basic treatment in progress and of the degree of control of asthma; the adjustment of the doses and associations is done through successive steps; the length of the therapeutic stages is from 1 to 3 months".
To know the associated treatment and treatments for children, refer to page 7 of the guide
Follow up: contents and rate of the consultations
HAS advise to report during each consultation the following elements:
- Evaluation of the follow-up;
- Measure of peak expiratory flow rate (or EFR);
- Measure of SaO2 ;
- Checking the good use of the inhalation devices ;
- Search of side effects of treatment in progress;
- Education of the patient;
- In the case of an unacceptable control, research for a worsening factor or a related pathology.
Concerning the rate of consultations, the HAS recommends:
- For the adult and the adolescent:
- In case of an acceptable or optimal control : every 3 to 6 months by a physician.
- In case of an unacceptable control: the frequency is to be adapted according to clinical symptomatology and to the opinion of the specialist.
- In the event of oral corticosteroid therapy of short time: 1 week then 1 month after stopping oral corticosteroid therapy, opinion of the specialist.
- For the child:
Long-term illness guide: serious chronic respiratory failure pursuent to an asthma
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Insuffisance respiratoire chronique grave secondaire à un asthme
Insuficiencia respiratoria crónica grave secundaria a un asma