Asthma: Management

Asthma being a long term chronic condition has no definitive curative therapy, but the symptoms can be controlled and to help a asthmatic to life a normal life ,a structured and disciplined plan should be made and executed.The plan mainly includes identification of allergen and its avoidance, life style modifications and religious use of medications as prescribed. The lung function should also be monitored from time to time and patient should know when to contact emergency.

Asthma management plan includes:

  • Lifestyle modification.
  • Avoidance of allergens
  • compliance to medications
  • maintaining a symptom dairy
  • emergency visit: when required

Lifestyle Modification and avoidance of allergens:

Asthmatics should avoid triggers that precipitate the attacks, like, avoid going out in dust, smoke,  avoid using strong perfumes, and avoid cigarette smoking. Comprehensive allergic panel can also be done to know the allergens which should be avoided. Dust mites control measures, avoidance of pets using air filters are other household measures which can be done. Mild to moderate amount of exercise is beneficial, Yoga has also proven for some amount of improvement.

Compliance to medication:

Compliance is an important part of asthma treatment regimen. The medications available :

  • relievers
  • controllers

Relievers are short acting inhaled (beta-2 agonist) medications which give quick relief during an attack, they should be used as prescribed when they have an attack for for appropriate duration.They can be short acting ( duration of action 2-4 hours) or long acting (8-12 hours). Short acting are given for quick relief in case of emergency, the long acting are always given in combination with steroids.

Controllers are inhaled steroids which help in treating the inflammation and hence, prevent further attack of asthma. Steroids used are budesonide and Fluticasone. They are used in combination with long acting beta-2 agonist formetrol and salmetrol respectively in severe asthma. Use of inhaled steroids should always be followed by warm saline gargle as hoarsness of voice can occur.

Maintaining a symptom dairy:

A patient should maintain a symptom dairy as to asses the control level of asthma:

  • number of symptoms present during day per week and night  per month.(more than 2 days per week and more than 2 nights per month suggest lack of control.)
  • You can do all your normal activities.
  • number of times you take relievers per week.(more than 2 per week- uncontrolled).
  • number of emergency visit for asthma attack with intake of oral steroid medication.(more than 1 attack relates to uncontrolled).
  • measure your own PEFR and it should not drop less than 80% of your personal best.

When to visit emergency?

mild attacks of asthma can be managed at home with quick relievers.Sometimes the attack is severe and medical attention needs to be taken. The following conditions indicate severity:

  • if your medicines don’t abort the attack
  • if there is severe respiratory distress.
  • extremities getting cold
  • patient is unable to speak in sentences.
  • uncontrollable cough

 

Special group who require special attention:

  • children
  • elderly people
  • people having exercise induced asthma

 

    Dr. Mukesh Joshi
    Chest Physician