AndningsvägarLäs om Hälsosamma levnadsvanor sid xx Vid långvariga besvär från näsa och bihålor har dagliga sköljningar av näshålan med koksaltlösning gynnsam effekt. Information om hjälpmedel för det kan fås på apotek. Lär patienten korrekt sprayteknik.Inhalera rätt; instruktionsfilmer på janusinfo.se Allergisk rinokonjunktivitNasala steroider är effektivare än perorala antihistaminer mot nästäppa.ANTIHISTAMINdesloratadinDesloratadin …, Aerius, DasseltaNASAL STEROIDLägsta möjliga underhållsdos bör eftersträvas.mometasonMometason …, Aphiahsone, Momenex, Mommox, Nasonex, OrimoxInhalera rätt; Nässpray – instruktionsfilm på janusinfo.se ÖGONDROPPARAllergisk konjunktivit är vanligt och egenvård är ofta tillräckligt. Vid milda besvär kan tårsubstitut lindra. Natriumkromoglikat har inte en omedelbar effekt och behandlingen bör därför helst påbörjas före förväntad exponering för allergen. Natriumkromoglikat lämpar sig för dem som har långdragna besvär. Vid kortvarig exponering kan antihistaminögondroppar vara att föredra. Kombinationsbehandling med antihistamintabletter och ögondroppar mot allergi ger en additiv effekt.Alla här rekommenderade ögondroppar mot allergisk konjunktivit finns att köpa receptfritt. I första handnatriumkromoglikatLecrolyn, LomudalVid överkänslighet mot konserveringsmedel och för kontaktlinsbärare natriumkromoglikatLecrolyn SineI andra handVid otillräcklig effekt eller kortvariga besvärlevokabastinLivostinVid överkänslighet mot konserveringsmedel eller vid mycket sporadiska besvärketotifenZaditen endosbehållareRiktlinjer för behandling av allergiska ögonreaktioner; janusinfo.se Persisterande icke-allergisk rinitNASAL STEROIDLägsta möjliga underhållsdos bör eftersträvas.mometasonMometason …, Aphiahsone, Momenex, Mommox, Nasonex, OrimoxLOKALT ANTIKOLINERGIKUMVid hypersekretionipratropiumRiniventNäspolyposNASAL STEROIDmometasonMometason …, Aphiahsone, Momenex, Mommox, Nasonex, OrimoxÅterkommande rinosinuitVid återkommande akuta episoder av rinosinuit kan förebyggande behandling med nasal steroid prövas.NASAL STEROIDmometasonMometason …, Aphiahsone, Momenex, Mommox, Nasonex, OrimoxAkut rinosinuit sid xxAkut streptokocktonsillit sid xxRecidiv av streptokocktonsillit sid xxPseudokruppFör akutbehandling på mottagningbetametasonBetametason …, BetapredTabletter med betametason kan lösas i vatten, tuggas eller sväljas hela.Astma hos vuxna och barn från 12 årMålet med astmabehandlingen är normal lungfunktion och symtomfrihet dygnet runt, även vid fysisk aktivitet. Eftersom astmasjukdomen varierar i svårighetsgrad över tid bör behandlingen följas upp och anpassas. Säkerställ korrekt inhalationsteknik vid varje återbesök, se länk till instruktionsfilmer Inhalera rätt nedan. Utvärdera behandlingen med ACT (Astmakontrolltest); viss.nu (Astma hos vuxna). Under graviditet och amning behandlas astma på samma sätt som annars.Behandla allergi och astma under graviditet och amning; janusinfo.se Lär patienten att inhalera rätt. Förskriv spacer till sprayanvändare.Vid spraybehandling bör spacer förskrivas som hjälpmedel.Val av spacer vid förskrivning av sprayinhalator; janusinfo.se Inhalera rätt; inhalatorkarta och instruktionsfilmer på janusinfo.se Astma hos vuxna; viss.nu Astma/obstruktiv bronkit hos barn och ungdomar; viss.nu Astma hos barn och vuxna; lakemedelsverket.seHälsosamma levnadsvanorVid rökning, rekommendera rökstopp och erbjud stödjande insatser. Läs om Nikotinberoende sid xx. Även användning av elektroniska cigaretter medför skadliga effekter på luftvägarna och bör undvikas.Behandlingstrappa vid astma; janusinfo.seICS: inhaled corticosteroid – inhalationssteroid FABA: fast-acting beta-2-receptor agonist – snabbverkande beta-2-stimulerareLABA: long-acting beta-2-receptor agonist – långverkande beta-2-stimulerare SABA: short-acting beta-2-receptor agonist – kortverkande beta-2-stimulerareLAMA: long-acting muscarinic antagonist – långverkande antikolinergikumSteg 1: Vidbehovsmedicinering vid symtom högst 2 gånger i månaden. Steg 2: Vid kontinuerliga eller återkommande astmabesvär >2 gånger per månad. Steg 3: Vid kvarstående astmabesvär. Daglig underhållsbehandling med fast kombination ICS-LABA. Kan även användas vid behov om beta-2-stimulerare är både LABA och SABA (formoterol). SABA i separat inhalator vid behov om risk finns för överskridande av maxdos ICS.Steg 4: Vid behov av mer intensiv behandling för att uppnå astmakontroll höjs den ICS-dos som används för underhållsbehandling. Tillägg av LAMA kan minska risken för exacerbationer och bör övervägas på detta steg.Läkemedelsrekommendationer för Steg 1 – Steg 4 enligt bild ovanTänk på att anpassa förpackningsstorlek till förväntad förbrukning där det är möjligt.KOMBINATIONSPREPARAT ICS OCH FABA/LABA* I första handbudesonid +formoterolBufomix EasyhalerFörpackning med 60 eller 120 doser kan väljas för vissa styrkor.I andra handVid svårighet att hantera pulverinhalatorflutikason +formoterolFlutiform spray (med spacer)*Formoterol är en beta-2-stimulerare som är både långverkande (LABA) och snabbverkande (FABA)INHALATIONSSTEROID (ICS)I första handbudesonidGiona EasyhalerI andra handVid svårighet att hantera pulverinhalatorciklesonidCiclesonide …, Alvesco spray (med spacer)KORTVERKANDE BETA-2-STIMULERARE (SABA)I första handsalbutamolBuventol EasyhalerI andra handVid svårighet att hantera pulverinhalatorsalbutamolAiromir spray (med spacer)LÅNGVERKANDE ANTIKOLINERGIKUM (LAMA)I första handtiotropiumSpiriva, Tiogiva inhalationspulverI andra handVid svårighet att hantera pulverinhalatortiotropiumSpiriva Respimat spray (med spacer)Astma hos barn 6 månader–11 årMålet med astmabehandlingen är normal lungfunktion och symtomfrihet dygnet runt, även vid fysisk aktivitet. Eftersom astmasjukdomen varierar i svårighetsgrad över tid bör behandlingen följas upp och anpassas. Säkerställ korrekt inhalationsteknik vid varje återbesök, se länk till instruktionsfilmer Inhalera rätt nedan. För barn i åldern 4–11 år, utvärdera behandlingen med C-ACT (Astmakontrolltest för barn mellan 4 och 11 år).Använd alltid inhalationssteroid vid astma hos vuxna och barn från 6 år.Lär patienten att inhalera rätt. Förskriv spacer till sprayanvändare.Vid spraybehandling bör spacer förskrivas som hjälpmedel. Till barn under 4 år bör även mask förskrivas. Val av spacer vid förskrivning av sprayinhalator; janusinfo.se Inhalera rätt; inhalatorkarta och instruktionsfilmer på janusinfo.se Astma/obstruktiv bronkit hos barn och ungdomar; viss.nu Astma hos barn och vuxna; lakemedelsverket.seHälsosamma levnadsvanorVid rökning, rekommendera rökstopp och erbjud stödjande insatser för dem i hemmet som röker. Läs om Nikotinberoende sid xx.Även användning av elektroniska cigaretter medför skadliga effekter på luftvägarna och bör undvikas. Behandlingstrappa vid astma; janusinfo.seBarn 6 mån–5 årKortvariga och lindriga infektionsutlösta besvärKORTVERKANDE BETA-2-STIMULERARE (SABA) – vid behov salbutamolAiromir spray (med spacer)Svårare infektionsutlösta besvärINHALATIONSSTEROID (ICS) – periodvis (cirka 10 dagars behandling)flutikasonFlutide Evohaler spray (med spacer)Utvärdera effekten av behandlingen. Om barnet fortfarande har besvär efter cirka 10 dagars behandling bör barnläkare konsulteras. Om behov av behandling föreligger mer än 4 gånger per år är kontakt med barnläkare indicerad.Barn 6–11 årSteg 1Astmabesvär högst 1 gång per månadKOMBINATIONSPREPARAT ICS* OCH FABA** – vid behovbudesonid +formoterolBufomix EasyhalerVid svårighet att hantera pulverinhalatorflutikason +formoterolFlutiform spray (med spacer)*Inhalationssteroid**Snabbverkande (fast-acting) beta-2-stimulerareFormoterol är en beta-2-stimulerare som är både långverkande (LABA) och snabbverkande (FABA)Steg 2Kontinuerlig behandling vid astmabesvär minst 2 gånger per månad eller anamnes på exacerbationUtvärdera effekten av behandlingen. Säkerställ korrekt inhalationsteknik vid varje återbesök.UnderhållsbehandlingI första handINHALATIONSSTEROIDER (ICS) – kontinuerligtbudesonidGiona EasyhalerVid svårighet att hantera pulverinhalatorflutikasonFlutide Evohaler spray (med spacer)I andra handLEUKOTRIENANTAGONIST – kontinuerligtmontelukastMontelukast …, SingulairSymtomlindrande medicineringKOMBINATIONSPREPARAT ICS* OCH FABA**– vid behovbudesonid +formoterolBufomix Easyhaler*Inhalationssteroid**Snabbverkande (fast-acting) beta-2-stimulerareFormoterol är en beta-2-stimulerare som är både långverkande (LABA) och snabbverkande (FABA)ellerKORTVERKANDE BETA-2-STIMULERARE (SABA) – vid behovsalbutamolBuventol EasyhalerVid svårighet att hantera pulverinhalatorKOMBINATIONSPREPARAT ICS* OCH FABA**– vid behovflutikason +formoterolFlutiform spray (med spacer)*Inhalationssteroid**Snabbverkande (fast-acting) beta-2-stimulerareFormoterol är en beta-2-stimulerare som är både långverkande (LABA) och snabbverkande (FABA)ellerKORTVERKANDE BETA-2-STIMULERARE (SABA) – vid behovsalbutamolAiromir spray (med spacer)Steg 3Vid kvarstående astmabesvär kontakta barnläkare.Akutbehandling/korttidsbehandling av astma för vuxna och barnLUFTRÖRSVIDGANDESpray med spacer har lika god effekt som nebulisator, är enkla att använda, prisvärda och kan vara fördelaktiga för att minska smittspridning. Val av spacer vid förskrivning av sprayinhalator; janusinfo.se I första handsalbutamolAiromir spray (med spacer)ipratropiumAtrovent, Ipravent spray (med spacer)I andra handsalbutamolAiromir, Ventoline lösning för nebulisatoripratropiumAtrovent, Ipraxa lösning för nebulisatorPERORALA STEROIDERbetametason*Betametason …, BetapredprednisolonPrednisolon ...*Tabletter med betametason kan lösas i vatten, tuggas eller sväljas hela.Astma – akut hos vuxna; viss.nuAstma – akut hos barn och ungdomar; viss.nuAstma hos barn och vuxna; lakemedelsverket.seKroniskt obstruktiv lungsjukdom (KOL)Målet med behandlingen är att minska symtomen, förhindra exacerbationer och förbättra livskvaliteten. Säkerställ korrekt inhalationsteknik vid varje återbesök, se Inhalera rätt nedan. Värdera symtom med CAT (COPD Assessment Test); viss.nu (KOL – Kroniskt obstruktiv lungsjukdom). Lär patienten att inhalera rätt. Förskriv spacer till sprayanvändare.Val av spacer vid förskrivning av sprayinhalator; janusinfo.se Inhalera rätt; inhalatorkarta och instruktionsfilmer på janusinfo.se KOL – kroniskt obstruktiv lungsjukdom; viss.nu Kroniskt obstruktiv lungsjukdom (KOL); lakemedelsverket.se Hälsosamma levnadsvanorRökstopp bromsar sjukdomens progress och är den enskilt viktigaste åtgärden. Vid rökning, rekommendera rökstopp och erbjud stödjande insatser. Läs om Nikotinberoende sid xx. Även användning av elektroniska cigaretter medför skadliga effekter på luftvägarna och bör undvikas.Fysisk aktivitet är viktigt i alla stadier av sjukdomen. Vid otillräcklig fysisk aktivitet, rekommendera regelbunden fysisk aktivitet och begränsning av stillasittande. Rekommendation enligt eFyss. Överväg FaR.Erbjud patientutbildning och kontakt med fysioterapeut.Nutritionsbedömning och individuella råd hos dietist kan behövas. Relaterat till sjukdomens progress kan det föreligga risk för undervikt och undernäring. Detta kan bero på ökat energibehov, lågt energiintag och minskad aptit. Läs mer om Hälsosamma levnadsvanor sid xx Terapival vid KOL baseras på GOLD A, B och E (symtombild och excacerbationfrekvens).GOLD A: Lindriga eller sporadiska symtom (CAT<10 p) och 0–1 exacerbationer i öppenvården senaste året. GOLD B: Betydande symtom (CAT≥10 p) och 0–1 exacerbation i öppenvård senaste året.GOLD E: Vid ≥2 exacerbationer i öppenvård eller ≥1 i slutenvård senaste året oavsett symtomBehandlingstrappa vid KOL; janusinfo.se*Vid upprepade exacerbationer. Har associerats med ökad risk för pneumoni.**Vid kronisk bronkit, ≥2 exacerbationer per år och FEV1 <50 % av förväntat.***Bör inte användas tillsammans med LAMASABA: short-acting beta-2-receptor agonist – kortverkande beta-2-stimulerareSAMA: short-acting muscarinic antagonist – kortverkande antikolinergikumLAMA: long-acting muscarinic antagonist – långverkande antikolinergikumLABA: long-acting beta-2-receptor agonist – långverkande beta-2-stimulerare ICS: inhaled corticosteroid – inhalationssteroid Steg 1: Individer i GOLD A med tillfälliga symtomSteg 2: Individer i GOLD A med behov av regelbunden underhållsbehandling Steg 3: Individer i GOLD B inleder sin behandling på steg 3 i trappan. Även individer i GOLD E kan inleda sin behandling här. Steg 4: Individer i GOLD ELäkemedelsrekommendationer för Steg 1 – Steg 4 enligt bild ovanKORTVERKANDE BETA-2-STIMULERARE (SABA)I första handsalbutamolBuventol EasyhalerI andra handVid svårighet att hantera pulverinhalatorsalbutamolAiromir spray (med spacer)KORTVERKANDE ANTIKOLINERGIKUM (SAMA)ipratropiumAtrovent, Ipravent spray (med spacer)Bör inte användas tillsammans med långverkande antikolinergikum (LAMA).LÅNGVERKANDE ANTIKOLINERGIKUM (LAMA)I första handumeklidiniumIncruse ElliptaVid insättning av LAMA bör SAMA sättas ut.I andra handVid svårighet att hantera pulverinhalatortiotropiumSpiriva Respimat spray (med spacer)Vid insättning av LAMA bör SAMA sättas ut.LÅNGVERKANDE BETA-2-STIMULERARE (LABA)I första handindakaterolOnbrez BreezhalerI andra handVid svårighet att hantera pulverinhalatorsalmeterolSerevent Evohaler spray (med spacer)KOMBINATIONSPREPARAT LAMA OCH LABAI första handumeklidinium +vilanterolAnoro ElliptaI andra handEndast för itereringglykopyrron +indakaterolUltibro Breezhaler**Begränsad subvention; tlv.seI andra handVid svårighet att hantera pulverinhalatortiotropium +olodaterolSpiolto Respimat* spray (med spacer)*Begränsad subvention; tlv.seKOMBINATIONSPREPARAT LAMA + LABA + ICSI första handumeklidinium +vilanterol +flutikasonfuroatTrelegy ElliptaI andra handVid svårighet att hantera pulverinhalatorglykopyrron +formoterol +budesonidTrixeo Aerosphere spray (med spacer)Endast för itereringglykopyrron +formoterol +beklometasonTrimbow spray (med spacer)Vid kronisk bronkit, ≥2 exacerbationer per år och FEV1 <50 % av förväntatTillägg avFOSFODIESTERAS-4-HÄMMAREroflumilastRoflumilast…, DaxasAkutbehandling/korttidsbehandling av KOLLUFTRÖRSVIDGANDESpray med spacer har lika god effekt som nebulisator, är enkla att använda, prisvärda och kan vara fördelaktiga för att minska smittspridning.Val av spacer vid förskrivning av sprayinhalator; janusinfo.se I första handsalbutamolAiromir spray (med spacer)ipratropiumAtrovent, Ipravent spray (med spacer)I andra 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