Outpatient management of asthma in adults

The diagnosis of asthma is made by demonstrating episodic and reversible airway obstruction. Office spirometry or peak flow meters should be used to objectively measure pulmonary status, since the history and physical examination do not correlate well with asthma severity. Reducing exposure to indoor and outdoor allergens may prevent exacerbations. Asthma medications are prescribed in a step-wise fashion. Inhaled beta 2 agonists should be used by patients with mild asthma during brief and limited symptomatic episodes. Anti-inflammatory agents, such as inhaled corticosteroids or cromolyn, should be added for moderate degrees of asthma. If symptoms persist, a long-acting bronchodilator, such as an oral beta agonist or oral theophylline, may be added in the evening. A short course of oral steroids may also be prescribed as needed. Patients should be taught to correctly use metered-dose inhalers, to keep a daily record with home peak flow measurements that monitor their pulmonary status and to follow a prescribed medication plan for exacerbations.