Focuses on the management of airway inflammation
Prevent exacerbations (asthma attack)
Minimize symptoms
Maintain near normal lung function

Strategies
Educate patient and family about asthma and participating in the management
Allergen and irritant avoidance strategies avoidance of identified causes where possible
Use of the lowest effective does of convenient medications to minimized short-term and long term side effects

Control of Extrinsic Factors
Avoid causative allergens such as house-dust mite, pets, moulds, certain food stuff, smokes and etc..
Skin Scratch testing to identify causative allergens

Drug treatment
Short acting bronchodilators such as Beta 2-2 agonist and anti-muscarinic on acute management of exacerbations
Long acting anti-inflammatory such as corticosteroids to prevent chronic inflammation of the airways

Beta 2 Adrenergic Agonist
Reverse smooth muscle bronchospasm regardless of the stimulus, inhibit histamine and other mediator release from inflammatory cells, inhibit cholinergic neurotransmitter, inhibit airway vascular leakage and increase mucocilliary clearance.

Effective in relieving symptoms of acute asthma attack not preventing asthma occurrence
Can be use as a marker of disease control base on the frequency of usage.
Eg.--> R-albuterol, Salbutamol (100 micro g) and terbutaline (250) Short acting Delivered through Metered Dose Inhaler with a spacer or wet nebuliser if air flow is severely restricted.
Long Acting Beta-2 agonist—Salmeterol and formoterol used in conjunction with inhaled steroids. Effective by inhalation for up to 12 hours reducing the need for administration to once or twice daily. Improve symptoms, lung function and reduce exacerbations in patients who are poorly controlled on standard doses of inhaled steroids.

Steroids
Preferably inhaled than oral.
Inhibitors of Inflammatory mediator production to control chronic asthma.
Side Effects oral candidiasis (5%of patients) and hoarseness due to effect if corticosteroids on the laryngeal muscles. Abnormal bone metabolism if on high doses of beclometasone or budesonide >800. In children doses greater than 400 can retart short-term growth.

Oral Corticosteroids Necessary for individual whos asthma are not controlled well by inhaled steroids. Eg Prednisolone 30mg daily, or methotrexate 15mg weekly

Leukotriene Modifiers
Inhibiting the cysteinyl LT1 receptor, inflammation cascade.
Acceptable second choice to treat chronic asthma synergistically with steroids.
Improves lung function and decreases beta agonist rescue and inhaled corticosteroids use.

Ipratropium Bromide
anti muscarinic bronchodilator but less potent than beta agonist.
Indications- patient on beta blockers and children and severe adult exacerbations when routine agents fail.

Inhaler Devices
Pressurised aerosol inhaler aka. Metered Dose Inhaler
MDI and spacer
Dry powder Inhaler
Breath activated inhaler
Nebuliser