, Management of Asthma in Adults
Published by:
Malaysian Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre 62590
Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium
provided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-2173-14-4
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://mts.org.my
Also available as an app for Android and IOS platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily guar-
antee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
, Management of Asthma in Adults
UPDATING THE CPG
These guidelines were issued in 2017 and will be reviewed in a
minimum period of four years (2021) or sooner if new evidence becomes
available. When it is due for updating, the Chairman of the CPG or
National Advisor of the related specialty will be informed about it. A
discussion will be done on the need for a revision including the scope of
the revised CPG. A multidisciplinary team will be formed and the latest
systematic review methodology used by MaHTAS will be employed.
Every care is taken to ensure that this publication is correct in every
detail at the time of publication. However, in the event of errors or
omissions, corrections will be published in the web version of this
document, which is the definitive version at all times. This version can
be found on the websites mentioned above.
, Management of Asthma in Adults
TABLE OF CONTENTS
No. Title Page
Levels of Evidence and Grading Recommendations, i
Assessment, Development and Evaluation
Key Recommendations ii
Guidelines Development and Objectives iv
Development Group vii
Review Committee viii
External Reviewers ix
Algorithm 1. Stepwise Treatment Ladder x
in Stable Asthma
Algorithm 2. Management of Acute Exacerbation of Asthma xi
in Primary Care
Algorithm 3. Management of Acute Exacerbation of Asthma xii
in Emergency Department
1. INTRODUCTION 1
2. EPIDEMIOLOGY AND RISK FACTORS 1
2.1 Epidemiology 1
2.2 Risk Factors 2
3 DIAGNOSIS 4
4. GENERAL PRINCIPLES OF MANAGEMENT 7
5. ASTHMA SELF-MANAGEMENT 8
5.1 Role of Self-management 8
5.2 Written Asthma Action Plan 8
5.3 Education Modality 8
6. STABLE ASTHMA 11
6.1 Assessment of Severity for Future Risk 12
6.2 Criteria for Step Up/Step Down 14
6.3 Treatment 14
6.3.1 As-needed reliever therapy 16
6.3.2 Controller therapy (In addition to as-needed 17
reliever inhaler)
a. Step 1 18
b. Step 2 18
c. Step 3 19
d. Step 4 20
e. Step 5 20
Published by:
Malaysian Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre 62590
Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium
provided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-2173-14-4
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://mts.org.my
Also available as an app for Android and IOS platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily guar-
antee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
, Management of Asthma in Adults
UPDATING THE CPG
These guidelines were issued in 2017 and will be reviewed in a
minimum period of four years (2021) or sooner if new evidence becomes
available. When it is due for updating, the Chairman of the CPG or
National Advisor of the related specialty will be informed about it. A
discussion will be done on the need for a revision including the scope of
the revised CPG. A multidisciplinary team will be formed and the latest
systematic review methodology used by MaHTAS will be employed.
Every care is taken to ensure that this publication is correct in every
detail at the time of publication. However, in the event of errors or
omissions, corrections will be published in the web version of this
document, which is the definitive version at all times. This version can
be found on the websites mentioned above.
, Management of Asthma in Adults
TABLE OF CONTENTS
No. Title Page
Levels of Evidence and Grading Recommendations, i
Assessment, Development and Evaluation
Key Recommendations ii
Guidelines Development and Objectives iv
Development Group vii
Review Committee viii
External Reviewers ix
Algorithm 1. Stepwise Treatment Ladder x
in Stable Asthma
Algorithm 2. Management of Acute Exacerbation of Asthma xi
in Primary Care
Algorithm 3. Management of Acute Exacerbation of Asthma xii
in Emergency Department
1. INTRODUCTION 1
2. EPIDEMIOLOGY AND RISK FACTORS 1
2.1 Epidemiology 1
2.2 Risk Factors 2
3 DIAGNOSIS 4
4. GENERAL PRINCIPLES OF MANAGEMENT 7
5. ASTHMA SELF-MANAGEMENT 8
5.1 Role of Self-management 8
5.2 Written Asthma Action Plan 8
5.3 Education Modality 8
6. STABLE ASTHMA 11
6.1 Assessment of Severity for Future Risk 12
6.2 Criteria for Step Up/Step Down 14
6.3 Treatment 14
6.3.1 As-needed reliever therapy 16
6.3.2 Controller therapy (In addition to as-needed 17
reliever inhaler)
a. Step 1 18
b. Step 2 18
c. Step 3 19
d. Step 4 20
e. Step 5 20
