Asthma Management Guidelines:
        Asthma treatment is determined by its severity. Asthma is an inflammation of the small airways of the lungs. This
means swelling and excess mucous production inside these tiny airways, causing their obstruction and poor gas exchange.
The treatment therefore is directed against this inflammation to reduce swelling and mucous production. Asthma is classified
by the frequency of symptoms. Symptoms are Coughing, Wheezing, Shortness of breath, or the need to use a broncho-
dilator inhaler. Nighttime cough is the only symptom in some patients, who often don't suspect that they have asthma. The
most important breakthrough in asthma therapy is the developement of inhaled steroids. Not only do inhaled steroids exert
their effects directly on the problem area, they also do not have any of the problems associated with oral steroids.

        A peak flow meter is a useful home tool to monitor asthma, and adjust treatment. The primary mechanical defect in
asthma is in expiration. Inhalation proceeds fairly unhindered, but mucous acts as a ball valve on expiration. Peak flow
therefore measures the strength of expiration reflecting the degree of obstruction. Patients can be taught to use the
inexpensive peak flow meter and make treatment decisions at home.
 

Class                                     symptoms                                                         Treatment
Mild Intermittant
 symptoms less than 3 times per week. Nighttime symptoms less than 3 times per month. Peak Flow over 80% Short acting bronchodilator ( Albuteral )
as needed. No daily treatments
Mild Persistant
 symptoms 3 or more times per week. but not daily. Night symptoms 3 or more times per month. Peak Flow above 80% Low dose inhaled steroids, in addition to albuteral
Moderate Persistant
 Daily symptoms. Peak Flow 60-80% Low dose inhaled steroids, plus long acting bronchodilator ( Serevent ), plus episodic albuteral.
Severe Persistant
 Continual symptoms, limiting physical activity. Frequent nighttime symptoms. Peak flow less than 60% High dose inhaled steroids plus Serevent. For flareups, oral steroids and albuteral

Peak Flow:   Highest velocity of expelled air ( in Liters per minute, or Liters per second. The numbers below are in Liters/Minute ). A good indicator of asthma control.
 
Children's Normal peak Flow( male & female, by height in inches )
Height
Inches		 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
Peak Flow 147 160 173 187 200 214 227 240 254 267 280 293 307 320 334 347 360 373 387 400 413 427 440 454 467

Peak Flow for normal Males based on age and height ( in inches )
       Age(years)
   60"
            65"             70"               75"              80"
           20              554           602            649               693              740
25
              543            590            636               679             725
           30              532
577
622
664
710
           35              521
565
609
651
695
           40              509
552
596
636
680
           45              498
540
583
622
665
           50               486
527
569
607
649
           55              475
515
556
593
634
           60              463
502
542
578
618
           65              452
490
529
564
603
           70              440
477
515
550
587
Peak Flow for normal Females based on age & Height in inches
Age
55"
60"
65"
70"
75"
20
390
423
460
496
529
25
385
418
454
490
523
30
380
413
448
483
516
35
375
408
442
476
509
40
370
402
436
470
502
45
365
397
430
464
495
50
360
391
424
457
488
55
355
386
418
451
482
60
350
380
412
445
475
65
345
375
406
439
468
70
340
369
400
432
461