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primary prophyllaxis
breast feeding mixed
smoking - exacerbates but doesn't cause
avoid allergens, irritants - no evidense

Stop smoking - cigarettes dec effectiveness of treatment, in airway hyper responsiveness and cause other lung disease

NICE/SIGN 11 statements
''
5 steps''
1 inhaled SABA prn
2 inhaled steroid 400 /day (200-800)
3 LABA then inc steroid to 800
4 steroid at 2000 or montelukast or theophylline
5 oral steroid / 2ndary care
''
Leukotriene receptor antagonists''
anti-inflammatory and bronchodilator
use when poorly controlled on high dose inhaled steroids and LABA
useful in aspirin induced
associated with Churg Strauss

Fluticasone more lipophilic so longer acting that beclometasone
Chloroflurocarbon propellant is being replaced with hydrofluoroalkane which is smaller so  half previous dose
LABA - bronchodilator and inhibits mediator release from mast cell - improves Sx more than doubling steroid dose