• • NATIONAL GUIDELINES STHMA RONCHIOLITIS ....OPD • • 3rd Edition 2005 . " " • - - • • • • Asthma Association • Bangladesh National Asthma Centre, National Institute of Diseases of the Chest & Hospital Mohakhali, Dhaka·1212, Bangladesh www.asthmabd.org Published by: PREFACE Asthma Association, Bangladesh An Appeal for Dissemination of Knowledge National Asthma Center NIDCH Campus, Mohakhali Bismillahir Rahmanir Rahim. Dhaka-1212, Bangladesh Assalamu Alaikum. Address for correspondence: It is a pleasure for me as we got the opportunity from Almighty Allah to National Asthma Center publish the 3rd edition of our National Guidelines with an intention to National Institute of Diseases of the Chest and Hospital disseminate proper knowledge through out the country. The 1st edition of Mohakhali, Dhaka-1212, Bangladesh "National Asthma Guidelines" was published in 1999, which was revised and Tel: +88-02-9887050 the 2nd edition was published in 2001. By this time new information has came E-mail: asmaasso@bttb• .net.bd out from different research papers in home and abroad. Many physicians of the Web : www.asthmabd.org country took interest and send comments. After having long discussion with various groups we are now providing this updated version of the guidelines. First Edition : November 1999 Second Edition : April 2001 This time we included management updates of bronchiolitis and COPD in our Third Edition : May 2005 guidelines. It is essential for all phYSicians dealing with asthma to know the diagnosis and management of bronchiolitis and COPD, because they are, to some extent, symptomatically looking alike asthma. Contents of this book, whole or in part can be reproduced for research, academic or educational purposes. Acknowledgement to the Asthma In Bangladesh more than 100 million people are suffering from cough and Association, Bangladesh will be highly appreciated. No part of this book shortness of breath. Still our people are getting unplanned treatment and can be reproduced for commercial purposes as per copyright rules. taking unscientific, indigenous and sometimes harmful products to get relief. Our aim is to disseminate knowledge to all groups of doctors, nurses, health care providers, medical students as well as affected peoples of the country to mitigate these sufferings. Graphic Design & Production: • We request all of you to follow these updated guidelines to put into practice a Graphic Arts Jr. uniform, practical-oriented and scientific treatment regimen of asthma, 59/3-2 Purana Paltan bronchiolitis and COPD for the patients of Bangladesh. Dhaka-lOOO Tel- 9561801 Please disseminate the knowledge by implementation of guidelines and include it as teaching materials for undergraduate and postgraduate medical students as well as nursing students. Price: Tk. 100.00 only Prof. Md. Rashidul Hassan General Secretary Asthma Association On behalf of Board of Editors PREFACE TO THE SECOND EDITION EXECUTIVE COMMITTEE 2004-06 The first "National Asthma Prevalence Study" (NAPS) conducted throughout Asthma Association, Bangladesh Bangladesh in 1999 has shown that about 7 million people suffer from asthma in our country. Proper scientific management practiced uniformly is imperative for amelioration of the sufferings of our fellow countrymen. President Prof. Md. Mostafizur Rahman The Asthma Association published the first edition of the National Asthma Guidelines Vice-President Dr. Md. Ali Hossain for Medical Practitioners in 1999 on a provisional basis. It has been updated and Dr. AKM Kamal Uddin modified on the basis of detailed discussions held at the Fourth National Workshop on General Secretary Prof. Md. Rashidul Hassan Asthma. By the Grace of Almighty Allah, we are publishing the 2nd edition of these guidelines for distribution within the medical community. Treasurer Dr. Mahmud Masum Attar Even the best policies or guidelines be miserable formulated by top most experts can Joint Secretary Dr. Md. Rafiqul Islam failures, if they are not implemented properly. We hope that through our concerted Dr. AFM Kamaluddin efforts, our guidelines shall see the light of success. We earnestly request you to leave no stone unturned for the thorough implementation Organising Secretary Dr. Md. Mizanur Rahman of these guidelines. Implementation of these guidelines can properly control asthma in Office Secretary Dr. Md. Mohiuddin Ahmad majority of the patients and help them lead normal healthy lives. It can be our main pathway to achieve our cherished goal of effortless easy breathing. Press & Publication Secretary Dr. Kazi Saifuddin Bennoor Dr. Md. Rashidul Hassan Scientific Secretary Dr. Asif Mujtaba Mahmud General Secretary, Asthma Association On behalf of Board of Editors Social Welfare Secretary Dr. Rahmatul Bari Members PREFACE TO THE FIRST EDITION Prof. AKM Shamsul Huq Prof. ARM Luthful Kabir Most experts throughout the world believe that with appropriate management asthma Dr. Mirza Mohammad Hiron is an evidently treatable condition. Yet recent studies of practice standards in our Dr. Md. Atiqur Rahman country have indicated that many physicians do not treat their patients optimally, prescribing too much "reliever" (bronchodilator) medicine and too little "preventer" Dr. Shafiqul Ahsan (anti-inflammatory) medicine. Dr. Mohammad Enamul Haque . Dr. Md. Solaman Siddique Bhuiyan On the basis of this background, Asthma Association has been trying to develop a Dr. Md. Zillur Rahman 'National Asthma Guidelines for Medical Practitioners' for the last 3 years. By the grace Dr. AKM Mustafa Hussain of Almighty Allah, we are pubiishing the first edition of the guidelines. We hope these guidelines shall encourage physicians to manage asthma patients in an appropriate way. Dr. Biswas Akhtar Hossain Insha-Allah we intend to publish the 2nd edition next year. Dr. Vikarunnessa Begum Dr. Nawab Tahsin Uddin We shall be highly pleased if you kindly send your valuable comments and corrections Dr. Bashir Ahmed to us regarding this 'National Asthma Guidelines for Medical Practitioners' within Dr. GM Monsur Habib February 2000. Constructive criticism will be highly appreCiated. Valuable contributions will be duly acknowledged. Dr. Md. Zahidul Islam Dr. Md. Naimul Hoque We intend to organize a workshop for further corrections and necessary modifications Dr. Md. Zahirul Islam Shakil before publishing the 2nd edition. Dr. Golam Sarwar Liaquat Hossain Dr. Md. Rashidul Hassan General Secretary, Asthma Association On behalf of Editorial Board BOARD OF EDITORS CONTRIBUTING AUTHORS Prof. Md. Rashidul Hassan Dr. Md. Mohiuddin Ahmad Dr. M.A. Jalil Chowdhury FCPS (Medicine), MD (Chest) FCPS (Medicine), MD (Chest) Associate Professor, Medicine Professor, National Asthma Center Assistant Professor, Respiratory Bangabandhu Sheikh Mujib Medical National Institute of Diseases of the Chest & Hospital Medicine University, Shahbag, Dhaka Mohakhali, Dhaka-1212, Bangladesh National Institute of Diseases of the Dr. Md. Solaman Siddique Bhuiyan Chest & Hospital, Mohakhali, Dhaka Dr. Md. Ali Hossain DICD, MD (Chest) FCPS (Medicine), MD (Chest) I Dr. G.M. Monsur Habib Associate Professor, National Asthma Associate Professor, Respiratory Medicine President, Asthma Library Center, NIDCH, Mohakhali, Dhaka Sher-e-Bangla Road, Khulna National Institute of Diseases of the Chest & Hospital Dr. Md. Rafiqui Islam & Member, Advisory Committee Mohakhali, Dhaka-1212, Bangladesh International Primary Care DICD Dr. Asif Mujtaba Mahmud Respiratory Group (IPCRG) Assistant Professor (R. P.) National Institute of Diseases of the DICD, Ph.D. (Respiratory Medicine) Dr. Mirza Mohammad Hiron Chest & Hospital, Mohakhali, Dhaka Associate Professor, Respiratory Medicine FCPS (Medicine), MD (Chest) Dr. Md. Atiqur Rahman National Institute of Diseases of the Chest & Hospital Associate Professor, Medicine Mohakhali, Dhaka-1212, Bangladesh National Institute of Diseases of the DICD, MD (Chest) Chest & Hospital, Mohakhali, Dhaka . Associate Professor, Respiratory Prof. ARM Luthful Kabir Medicine FCPS (Paediatrics) Dr. Shafiqui Ahsan National Institute of Diseases of the Professor, Paediatrics MS (Cardiothoracic Surgery) Chest & Hospital, Mohakhali, Dhaka Associate Professor (Ihoracic Institute of Child and Mother Health Dr. Biswas Akhter Hossain Matuail, Dhaka-1362, Bangladesh Surgery) National Institute of Diseases of the DICD Prof. Md. Ruhul Amin Chest & Hospital, Mohakhali, Dhaka Assistant Professor, Medicine Faridpur Medical College FCPS (Paediatrics) Dr. A.EM. Kamaluddin Faridpur Professor, Paediatrics DICD Dr. ShakiI Ahmed Bangladesh Institute of Child Health (BICH) Registrar Dhaka Shishu Hospital National Institute of Cancer Research FCPS, MD (Paediatrics) Sher-e-Bangla Nagar, Dhaka-1207, Bangladesh & Hospital, Mohakhali, Dhaka Registrar, Paediatrics Dhaka Medical College, Dhaka Prof. Md. Mostafizur Rahman Dr. Muhammad Khurshidul Islam Dr. S.M. Abdullah Al Mamun FCPS (Medicine) DICD MCPS (Medicine), MD (Chest) Professor & Director Associate Professor (Rtd.) . Registrar (Medicine) & National Institute of Diseases of the National Institute of Diseases of the Chest Hospital National Institute of Diseases of the Chest & Hospital, Mohakhali, Dhaka Mohakhali, Dhaka-1212, Bangladesh Chest & Hospital, Mohakhali, Dhaka Dr. Kazi Saifuddin Bennoor • Dr. Mohammed Enamul Hoque Dr. Syed Azizul Haque DICD DICD Associate Professor, Cardiology Registrar (Medicine) Superintendent National Institute of Cardiovascular & National Institute of Diseases of the Chest & Hospital Chest Clinic Iraining Center Diseases, Sher-e-Bangla