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Lung Expert in Jaipur - Dr. Nishtha Singh

Dr. Nishtha Singh is an experienced Lung Expert in jaipur at Asthma Bhawan with special interests in respiratory medicine, critical care, and sleep medicine. Dr. Nishtha Singh offers complete diagnostic and treatment of all Respiratory conditions, including Tuberculosis, Allergy, Asthma, Lung Cancer, and SLEEP APNEA.<br>Make an appointment with the best doctor or call us: 91 946 1685 766 and get more information.

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Lung Expert in Jaipur - Dr. Nishtha Singh

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  1. New approach to intermittent & mild asthma therapy: evolution or revolution in the GINA guidelines? Dr Nishtha Singh Executive Director & Senior Pulmonary Consultant Asthma Bhawan, Jaipur

  2. GINA 2018 Severe Asthma Moderate Asthma STEP 5 Mild Asthma Refer for add-on treatment e.g. tiotropium* omalizumab mepolizumab* STEP 4 STEP 3 STEP 1 STEP 2 Med/high ICS/LABA Low dose ICS/LABA** PREFERRED CONTROLLER CHOICE Low dose ICS Add tiotropium* High dose ICS + LTRA (or + theoph*) Med/high dose ICS Low dose ICS+LTRA (or + theoph*) Consider low dose ICS Other controller options Leukotriene receptor antagonists (LTRA) Low dose theophylline* Add low dose OCS As-needed short-acting beta2-agonist (SABA) As-needed SABA or low dose ICS/formoterol# RELIEVER *Not for children <12 years. **For children 6–11 years, the preferred Step 3 treatment is medium dose ICS. # Low dose ICS/formoterol is the reliever medication for patients prescribed low dose budesonide/formoterol or low dose beclometasone/formoterol for maintenance and reliever therapy. Tiotropium by mist inhaler is an add-on treatment for patients with a history of exacerbations (not for children <12 years) . © Global Initiative for Asthma

  3. Asthmatic Steroid-treated Asthmatic Symptoms are intermittent but inflammation is continuous

  4. Risk of asthma exacerbation in patients  using SABA monotherapy • Stanford et al - Consumption of ≥3 SABA canisters/y ↑ the risk of asthma exacerbation. • For adults, such a marker may be the use of 2 or more SABA canisters in a shorter 3–6 month period. • The use of an additional SABA canister resulted in a corresponding increase in the risk of asthma exacerbation by 8% to 14% and 14% to 18% in children and adults, respectively.

  5. Mild asthma: Is it so mild? • About 60% of the 334 million people have mild asthma • Over 10 years about 8% progress to moderate to severe disease • Patients with apparently mild asthma are at risk of serious adverse events • Acute asthma: 30–37% are mild • Near-fatal asthma: 16% are mild • Dying of asthma: 15–20% from mild asthmatics https://www.aaaai.org/global/latest-research-summaries/New-Research-from-JACI-In-Practice/mild-asthma accessed 6 May 2019 GINA 2019; Dusser, Allergy 2007

  6. Long-term Goals Of Asthma Management 1. Achieve good control of symptoms & maintain normal activities 2. Minimize future risk • Exacerbations • Fixed airflow limitation • Side-effects of medicines

  7. Key learnings from SYGMA 1 and 2 • As needed Bud/Form • was superior to as needed SABA for symptom control and exacerbations • as effective as maintenance Bud in reducing exacerbations but not symptom control and lung function and at a substantially lower dose • No evidence of overuse of Bud/Form • Compliance rate in SYGMA 1 was 78% and SYGMA 2 was 60% (less intensive monitoring) far greater than the 30-35% in the real world

  8. Thank you!

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