Gerd Guidelines Canada

[Alethia Tiell]

Mostasthma diagnosis and management information is consistent across patient age ranges. However, there are some age-specific diagnostic and medication considerations, identified in the circles next to each section.

In patients with an existing asthma diagnosis, ensure there is documented evidence of variable airflow obstruction. See Table 2. Diagnosis of asthma for an overview of the diagnostic criteria of asthma by age.

Clinical features of asthma (see Table 1. Clinical features that impact the probability of asthma diagnosis) often mimic or overlap with other respiratory conditions. Ensure other possible diagnoses are considered before diagnosing a patient with asthma (see Differential Diagnosis).

Since children under the age of 6 cannot do spirometry reliably, the diagnosis of asthma is based on physical exam findings and response to medication as objective evidence of reversible airflow obstruction. Once they reach the age of 6, the diagnosis can be confirmed with spirometry.

Work-related asthma includes both occupational asthma (asthma symptoms that are a result of exposure to workplace irritant/allergen) and work-aggravated asthma (pre-existing asthma symptoms that worsen due to exposure of workplace irritant/allergen).19

Approach poorly controlled asthma gently, as the patient (or caregiver) may be reluctant to admit to cost concerns, forgetfulness, or physical barriers (e.g., arthritis) that impact adherence to their medication and/or treatment plan.

DPIs rely on the force a patient generates to inhale their medication rather than a propellant, which makes them a more environmentally friendly option. DPIs are contraindicated for young children or adult patients with comorbidities such as neuromuscular weakness or frailty.

Propellant-free devices may also have an impact in other environmental spheres.33 One of the reasons correct diagnosis is so important is to avoid prescribing needless medication including containers and chemicals.33

Nebulizers are no longer recommended for any age group. MDI with spacer is as effective as a nebulizer34 and spacer devices carry lower infection risk than nebulizers.

For patients to be eligible for PharmaCare coverage of asthma biologics, good adherence to asthma controllers (as assessed by prescription refills in PharmaNet) is needed, so it is useful to ensure that patients are appropriately filling their controller prescription prior to referring them to a specialist.

In adults who have had an exacerbation in the last year, a trial of a 4- or 5-fold increase in maintenance ICS dose for 7-14 days is suggested.7 Please note: this dose exceeds product monograph total daily dose limits and is not intended for chronic daily use. A short-term dose increase beyond these limits is unlikely to carry any significant safety risks, however formal safety testing data are not available and the decision to pursue this approach should be based on patient and clinician comfort. Prescribers should be aware of the maximum doses of ICS and LABA approved for use in Canada (see Appendix C: Asthma Medication Table).

Some guidelines recommend that no patient with asthma should be prescribed a SABA alone given the evidence for decreasing exacerbations in patients with mild to severe asthma. Others leave PRN SABA as an option for those with very mild asthma (see Asthma severity) who are at lower risk for exacerbations (see Assessing control and risk).

Some guidelines advise adults with mild asthma be prescribed PRN ICS-formoterol regimens as patients generally do not adhere to daily medication. Others recommend daily ICS as first-line (as this leads to better asthma control and improved lung function) and PRN ICS-formoterol regimens only as first-line treatment in patients ages 12+ with poor adherence to daily medication despite adequate asthma education and support.

20 Government of Canada. Canadian Tobacco and Nicotine Survey (CTNS): summary of results for 2019 [Internet]. 2020 Jul. Available from: en/health-canada/services/canadian-tobacco-nicotine-survey/2019-summary.html

29 Hauptman M, Anderko L, Sacks J, Strine L, Damon S, Stone S, et al. Wildfire Smoke Factsheet: Protecting Children from Wildfire Smoke and Ash [Internet]. 2021. Available from: -06/pehsu-protecting-children-from-wildfire-smoke-and-ash-factsheet.pdf

41 Face Masks and Other Prevention Strategies [Internet]. American Academy of Pediatrics; 2022. Available from: -novel- coronavirus-covid-19-infections/clinical-guidance/face-masks-and-other-prevention-strategies/

44 Extreme Heat and Human Mortality: A Review of Heat-Related Deaths in BC in Summer 2021 [Internet]. BC Coroners Service; 2022 Jun [cited 2022 Jul 11] p. 56. Available from: -adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/extreme_heat_death_ review_panel_report.pdf

Note: We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.

The B.C. Public Service acknowledges the territories of First Nations around B.C. and is grateful to carry out our work on these lands. We acknowledge the rights, interests, priorities, and concerns of all Indigenous Peoples - First Nations, Mtis, and Inuit - respecting and acknowledging their distinct cultures, histories, rights, laws, and governments.

3a8082e126