Prevention of Heart Diseases

Largest-ever study of deaths shows heart ailments have replaced communicable diseases as the biggest killer in rural & urban India.

Heart diseases have emerged as the number one killer in both urban and rural areas of the country.

Preliminary results from the largest study, yet to find out the exact causes of mortality in India, have revealed that heart ailments take most lives in both urban and rural areas.

The results are surprising because they indicate a reversal in disease patterns in the country from communicable diseases to non- communicable or lifestyle diseases.

About 25 per cent of deaths in the age group of 25- 69 years occur because of heart diseases. In urban areas, 32.8 per cent deaths occur because of heart ailments, while this percentage in rural areas is 22.9.

If all age groups are included, heart diseases account for about 19 per cent of all deaths. It is the leading cause of death among males as well as females. It is also the leading cause of death in all regions though the numbers vary. The proportion of deaths caused by heart disease is the highest in south India (25 per cent) and lowest - 12 per cent - in the central region.

"What we have found is quite provocative. If you look at rural areas of poorer states like Uttar Pradesh and Bihar, the leading cause of death among middle aged males is cardiovascular disease.

Heart attacks are killing people not just in urban areas," said Dr Prabhat Jha, director of the Centre for Global Health Research at the University of Toronto and lead researcher of the study. The study is being carried out in collaboration with the Registrar General of India ( RGI) and the Indian Council of Medical Research (ICMR).

Rapid change in lifestyle has contributed more to heart diseases among older people across the globe, but the case is entirely different in India with almost 25% of the victims of cardiac arrests falling under the age of 40.

With over 3 million deaths owing to cardiovascular diseases every year, India is set to be the 'heart disease capital of the world' in few years

It is estimated that by 2020 cardiovascular disease will be the cause of over 40 per cent deaths in India as compared to 24 per cent in 1990. Globally, it causes 17.3 million deaths annually.

Heart disease may be a leading cause of death, but that doesn't mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take.

The Risk Factors — and How You Can Reduce Yours
Major risk factors for cardiovascular disease include cigarette smoking, high blood pressure, high cholesterol and/or triglycerides, diabetes mellitus, obesity, sedentary lifestyle, and poor nutrition. Prevention and treatment centers around these risk factors — and these approaches will help you lower risk for many other types of illness, as well as helping you feel great and have more energy overall.
Heart disease is the leading cause of death for both men and women in the United States. Heart Disease is an umbrella term that covers a variety of cardiovascular conditions, including blood vessel diseases, coronary artery disease, arrhythmia, congenital heart defects and infections of the heart. Although heart disease is a serious condition, there are some simple lifestyle choices you can make to lower your risk of developing heart disease.

You can avoid heart problems in the future by adopting a healthy lifestyle today.

1. Don't smoke or use tobacco

Smoking or using tobacco is one of the most significant risk factors for developing heart disease. Chemicals in tobacco can damage your heart and blood vessels, leading to narrowing of the arteries (atherosclerosis). Atherosclerosis can ultimately lead to a heart attack. When it comes to heart disease prevention, no amount of smoking is safe. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke.

In addition, the nicotine in cigarette smoke makes your heart work harder by narrowing your blood vessels and increasing your heart rate and blood pressure. Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This increases your blood pressure by forcing your heart to work harder to supply enough oxygen. Even so-called "social smoking" — smoking only while at a bar or restaurant with friends — is dangerous and increases the risk of heart disease.

Women who smoke and take birth control pills are at greater risk of having a heart attack or stroke than are those who don't do either. This risk increases with age, especially in women older than 35.

The good news, though, is that when you quit smoking, your risk of heart disease drops dramatically within just one year. And no matter how long or how much you smoked, you'll start reaping rewards as soon as you quit.

Cigarette smoking remains the leading preventable cause of cardiovascular disease in women, with more than 50 percent of heart attacks among middle-aged women attributable to tobacco. Risk of cardiovascular disease begins to decline within months of smoking cessation and reaches the level of persons who have never smoked within 3 to 5 years.
If you do not smoke now, don’t start. Find an appropriate method for quitting smoking that works for you. Some people prefer to wean themselves off cigarettes by cutting back on the amount smoked each day. Others find better results when they quit cold turkey and abruptly give up all cigarettes at once.

Stay away from smokeless tobacco. It contains nicotine, which narrows your blood vessels, forcing your heart to work harder. This leads to an increase in blood pressure and elevates your heart rate, which increases your risk of heart disease.

In addition to nicotine, it is full of carbon monoxide, which replaces some of the oxygen in the bloodstream when inhaled. When this happens, the heart is forced to work harder to supply oxygen to the body, which causes blood pressure to increase and elevates heart disease risk.

2. Exercise for 30 minutes on most days of the week

Getting some regular, daily exercise can reduce your risk of fatal heart disease. And when you combine physical activity with other lifestyle measures, such as maintaining a healthy weight, the payoff is even greater.

Physical activity helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes. It also reduces stress, which may be a factor in heart disease.

Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. However, even shorter amounts of exercise offer heart benefits, so if you can't meet those guidelines, don't give up. You can even break up your workout time into 10-minute sessions.

And remember that activities such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total. You don't have to exercise strenuously to achieve benefits, but you can see bigger benefits by increasing the intensity, duration and frequency of your workouts.

Recent evidence suggests that even moderate-intensity activity, including briskwalking, is associated with substantial reduction of cardiovascular disease risk. These findings support the 1995 federal exercise guidelines endorsing 30 minutes of moderately intense physical activity most days of the week, a program that should be feasible and safe for most of the population. Regular exercise and maintenance of healthy weight should also help reduce insulin resistance and the risk of non–insulin-dependent diabetes mellitus, which appears to be an even stronger risk factor for cardiovascular disease in women than in men. Diabetes is associated with a threefold to sevenfold elevation in cardiovascular disease risk among women, compared with a twofold to threefold elevation among men. Approximately half of all deaths in patients with non–insulin dependent diabetes mellitus are due to heart disease.

Engage in some type of physical activity for a minimum of 30 minutes per day, 5 days per week or more. Not only does exercise directly lower heart disease risk, it also indirectly lowers your chances of developing heart disease.

o          Exercise regularly to help keep your weight at a healthy level, which reduces your risk of developing conditions that can lead to poor heart health, such as high blood pressure, high cholesterol and type 2 diabetes.

o          Exercise regularly to relax and unwind, which can significantly decrease your stress levels. Elevated stress levels are a risk factor for the development of heart disease.

Consider taking an active lifestyle approach to exercise if you cannot fit 30 consecutive minutes of exercise into your daily schedule. Increase the amount of physical activity you perform each day by incorporating tiny changes to your everyday routine. Take the stairs instead of the elevator, go for a 10 minute walk during your lunch break, walk to the bus stop to pick up the kids instead of driving, etc.

Ride your bike 20 minutes a day. You can handle that, can’t you? When German researchers had 100 men with mild chest pain, or angina, either exercise 20 minutes a day on a stationary bike or undergo an artery-clearing procedure called angioplasty, they found that a year after the angioplasty, 21 men suffered a heart attack, stroke, or other problem compared to only 6 of the bikers. Just remember that if you already have angina, you should only begin an exercise program under medical supervision.

Have sex tonight. It counts as physical activity, which, of course, is good for your heart. And that may be why University of Bristol researchers found that men who have sex at least twice a week are less likely to have a stroke or other cardiovascular problems than men who have it less often. As the researchers put it: “Middle-aged men should be heartened to know that frequent sexual intercourse is not likely to result in a substantial increase in risk of strokes, and that some protection from fatal coronary events may be an added bonus.” Women probably stand to benefit too. Yeah, baby!

3. Eat a heart-healthy diet

Eating a special diet called the Dietary Approaches to Stop Hypertension (DASH) eating plan can help protect your heart. Following the DASH diet means eating foods that are low in fat, cholesterol and salt. The diet is rich in fruits, vegetables, whole grains and low-fat dairy products, which can help protect your heart. Beans, other low-fat sources of protein and certain types of fish also can reduce your risk of heart disease.

Limiting certain fats you eat also is important. Of the types of fat — saturated, polyunsaturated, monounsaturated and trans fat — saturated fat and trans fat increase the risk of coronary artery disease by raising blood cholesterol levels.

Major sources of saturated fat include:

·         Red meat

·         Dairy products

·         Coconut and palm oils

Sources of trans fat include:

·         Deep-fried fast foods

·         Bakery products

·         Packaged snack foods

·         Margarines

·         Crackers

Look at the label for the term "partially hydrogenated" to avoid trans fat.

Heart-healthy eating isn't all about cutting back, though. Most people need to add more fruits and vegetables to their diet — with a goal of five to 10 servings a day. Eating that many fruits and vegetables can not only help prevent heart disease, but also may help prevent cancer.

Following a heart-healthy diet also means drinking alcohol only in moderation — no more than two drinks a day for men, and one a day for women. At that moderate level, alcohol can have a protective effect on your heart. More than that becomes a health hazard.

Opt for whole grains. They are an excellent source of fiber and contain several healthy nutrients that can help regulate blood pressure and improve overall heart health.

o          Replace refined grain products with whole grain products.

o          Choose whole-wheat flours, 100% whole grain bread, high-fiber cereal, whole grain pasta, steel-cut oats, brown rice and barley.

o          Stay away from white or refined flours, white bread, frozen waffles, biscuits, corn bread, egg noodles, granola bars, high-fat snacks, quick breads, cakes, pies, donuts and buttered popcorn.

Pay attention to your portion size when eating. Although what you eat is important for heart health, how much you eat is also a factor in improving overall heart health. Refrain from overeating, which can lead to excess fat, cholesterol and calorie intake.

Learn to recognize what a healthy portion size is. Use measuring cups and spoons and weight scales to measure your portion sizes until you become familiar enough to recognize them by sight only.

Make fresh salad dressing with one tablespoon of flaxseed oil. It packs a whopping 7 grams of omega-3 fatty acids, which, as we’ve just mentioned, are a great way to improve your overall heart health.

Drink at least two cups of tea a day. Black or green, it doesn’t seem to matter. At least, that’s the result of a Dutch study that found only 2.4 percent of 5,000 healthy Rotterdam residents who drank two or more cups of tea a day had a heart attack within six years, compared with 4.1 percent of those who never drank tea. Another major analysis of 17 studies on tea drinkers found three cups a day could slash the risk of a heart attack by 11 percent.

Stir a handful of hazelnuts into a vegetable-and-chicken stir-fry. Just 1.5 ounces of these healthy nuts a day can reduce your risk of cardiovascular disease. Another hazelnut idea: Crush them and use to coat fish or chicken, then bake.

Include beans or peas in four of your dishes every week. Researchers at Tulane University found that people who followed this advice slashed their risk of heart disease by 22 percent compared to those who ate fewer legumes.

Eat a piece of dark chocolate several times a week. Believe it or not, several small studies suggest dark chocolate could be good for your heart! The beneficial effects are likely due to chemicals in chocolate called flavonoids, which help arteries stay flexible. Other properties of the sweet stuff seem to make arteries less likely to clot and prevent the “bad” cholesterol, LDL, from oxidizing, making it less likely to form plaque. Dark chocolate is also rich in magnesium and fiber. But steer clear of milk chocolate, which is high in butterfat and thus tends to raise cholesterol.

A study published in the Journal of Agricultural and Food Chemistry found that men who drank one beer a day for one month lowered their cholesterol levels, increased their blood levels of heart-healthy antioxidants, and reduced their levels of fibrinogen, a protein that contributes to blood clots. Of course, red wine might be even better. Choose either beer or wine — not both.

Eat 15 cherries a day. Studies find the anthocyanins (plant chemicals) that give cherries their scarlet color also work to lower levels of uric acid in blood, a marker for heart attacks and stroke. Cherries out of season? Try sprinkling dried cherries on your salad or substituting a cup of cherry juice for orange juice in the morning.

Eat an orange every day. Or drink a glass of orange juice. Oranges, as you know, are a great source of vitamin C. Studies suggest diets high in this vitamin may reduce your risk of stroke, especially if you smoke. Tired of oranges? Substitute a bowlful of strawberries, a serving of brussels sprouts or broccoli, or a chopped red bell pepper, all excellent sources of vitamin C.

Skip the soda and have orange juice instead. The reason has to do with inflammation, the body’s response to damage or injury. Chronic inflammation, linked to heart disease, is significantly affected by what you eat. For instance, researchers at the State University of New York found that drinking glucose-sweetened water triggered an inflammatory response in volunteers, but drinking the same calories in a glass of orange juice didn’t. They theorize that the anti-inflammatory effects of vitamin C and various flavonoids in juice may provide some protection. Choose 100 percent juice instead of drinks that are mostly sweetened, flavored water. Other studies on orange juice find it can increase blood levels of heart-protective folate almost 45 percent and reduce levels of heart-damaging homocysteine by 11 percent.

Drink an 8-ounce glass of water every two hours. A study from Loma Linda University in California found that women who drank more than five glasses of water a day were half as likely to die from a heart attack as those who drank less than two. This is likely due to the fact that maintaining good hydration keeps blood flowing well; dehydration can cause sluggish blood flow and increase the risk of clots forming. Water works best when it comes to improving blood flow; soda is worthless.

Cook with ginger or turmeric twice a week. They have anti-inflammatory benefits, and inflammation is a major contributor to heart disease.

4. Maintain a healthy weight

As you put on weight in adulthood, your weight gain is mostly fat rather than muscle. This excess weight can lead to conditions that increase your chances of heart disease — high blood pressure, high cholesterol and diabetes.

One way to see if your weight is healthy is to calculate your body mass index (BMI), which considers your height and weight in determining whether you have a healthy or unhealthy percentage of body fat. BMI numbers 25 and higher are associated with higher blood fats, higher blood pressure, and an increased risk of heart disease and stroke.

The BMI is a good, but imperfect guide. Muscle weighs more than fat, for instance, and women and men who are very muscular and physically fit can have high BMIs without added health risks. Because of that, waist circumference also is a useful tool to measure how much abdominal fat you have:

·         Men are considered overweight if their waist measurement is greater than 40 inches (101.6 centimeters, or cm)

·         Women are overweight if their waist measurement is greater than 35 inches (88.9 cm)

Even a small weight loss can be beneficial. Reducing your weight by just 10 percent can decrease your blood pressure, lower your blood cholesterol level and reduce your risk of diabetes.

5. Get regular health screenings

High blood pressure and high cholesterol can damage your heart and blood vessels. But without testing for them, you probably won't know whether you have these conditions. Regular screening can tell you what your numbers are and whether you need to take action.

·         Blood pressure. Regular blood pressure screenings start in childhood. Adults should have their blood pressure checked at least every two years. You may need more-frequent checks if your numbers aren't ideal or if you have other risk factors for heart disease. Optimal blood pressure is less than 120/80 millimeters of mercury.

·         Cholesterol levels. Adults should have their cholesterol measured at least once every five years starting at age 20. You may need more frequent testing if your numbers aren't optimal or if you have other risk factors for heart disease. Some children may need their blood cholesterol tested if they have a strong family history of heart disease.

·         Diabetes screening. Since diabetes is a risk factor for developing heart disease, you may want to consider being screened for diabetes. Talk to your doctor about when you should have a fasting blood sugar test to check for diabetes. Depending on your risk factors, such as being overweight or a family history of diabetes, your doctor may recommend first testing you for diabetes sometime between ages 30 and 45, and then retesting every three to five years.

6. Eat less saturated fat, more produce & more fiber.
Diets low in saturated fat and high in fruits, vegetables, whole grains, and fiber are associated with a reduced risk of cardiovascular disease. Also, a recent study reported in the Annals of Internal Medicine journal confirmed that eating fruits and vegetables, particularly green leafy vegetables and vitamin C-rich fruits and vegetables, seems to have a protective effect against coronary heart disease. You may even think about moving toward more flexitarian or vegetarian eating habits: A vegetarian diet reduces the risk of coronary artery disease, and may even reverse existing coronary artery disease when combined with other lifestyle changes. A Mediterranean diet that uses olive oil can reduce the risk of coronary artery disease.

Eat fish at least once a week. Have it grilled, sautéed, baked, or roasted — just have it. A study published in the Journal of the American Medical Association in April 2002 found that women who ate fish at least once a week were one-third less likely to have a heart attack or die of heart disease than those who ate fish only once a month. Other studies show similar benefits for men. Another major study found regular fish consumption reduced the risk of atrial fibrillation — rapid, irregular heartbeat — a major cause of sudden death.

Eat a high-fiber breakfast cereal at least four times a week. In a study published in the American Journal of Clinical Nutrition in September 1999, Harvard University scientists found that women who ate 23 grams of fiber a day — mostly from cereal — were 23 percent less likely to have heart attacks than those who consumed only 11 grams of fiber. In men, a high-fiber diet slashed the chances of a heart attack by 36 percent.

7. Arm yourself with risk-reducing vitamins.
Antioxidant vitamin supplements, particularly vitamin E and homocysteine-lowering agents such as folate and B6, have promising roles in prevention of cardiovascular disease, but conclusive evidence may hinge on the results of several ongoing randomized clinical trials. When it is found in unusually high levels, homocysteine brings the same degree of risk as having high cholesterol does. The B vitamins, especially folic acid and B12, will drive elevated homocysteine levels down to normal, often without the need of any prescription medication.

Take a B vitamin complex every morning. When Swiss researchers asked more than 200 men and women to take either a combination of three B vitamins (folic acid, vitamin B6, and vitamin B12) or a placebo after they had surgery to open their arteries, they found that levels of homocysteine, a substance linked to an increased risk of heart disease, were 40 percent lower in those who took the vitamins. The placebo group had no change. Plus, the vitamin group had wider-open blood vessels than those taking the sugar pill.

8. Give yourself some new stress-management tools.
Poorly controlled stress may have an adverse effect on blood lipids. An attitude of hostility has been powerfully linked with a higher incidence of cardiac events, and cynical distrust has been associated with accelerated progression of carotid artery disease. Relaxation methods (meditation, breathing exercises), yoga, and stress management techniques are essential for preventing cardiovascular disease and coronary artery disease and for reducing the risk of recurrent cardiac problems. Meditation improves exercise tolerance and decreases electrical changes associated with poor circulation to the heart. Meditation has also been shown to lower cholesterol and reverse carotid artery thickening. Also consider acupuncture, which has been shown to help relax the myocardium and improve circulation.

Identify situations in your life that cause stress and try to eliminate or modify them. Learn coping mechanisms for sources of stress that cannot be eliminated, such as stress in the workplace. Explore stress relief options such as yoga, meditation, visualization, aromatherapy and deep breathing techniques.

Laugh. Laughing lowers blood pressure and heart rate, and may improve the lining of the blood vessels.

9. Sleep

Take measures to improve your sleep quality and ensure that you get 7-8 hours of sleep each night.

o          Limit caffeine consumption and cut out all caffeine after 2 pm.

o          Try to go to sleep at the same time every night to regulate your sleep-wake cycle.

o          Exercise regularly to boost serotonin levels.

o          Refrain from watching television or using a laptop while in bed.

Tape-record yourself at night. If you hear yourself snoring (or if your sleeping partner has been kicking you a lot), make an appointment with your doctor. You may have sleep apnea, a condition in which your breathing stops hundreds of times throughout the night. It can lead to high blood pressure and other medical problems, and even increase your risk for heart attack and stroke.

Go to bed an hour earlier tonight. A Harvard study of 70,000 women found that those who got less than seven hours of sleep had a slightly higher risk of heart disease. Researchers suspect lack of sleep increases stress hormones, raises blood pressure, and affects blood sugar levels. Keep your overall sleeping time to no more than nine hours, however. The same study found women sleeping nine or more hours had a slightly increased risk of heart disease.

10. Ask your health professional about herbs and nutritional supplements that may be useful in preventing and treating cardiovascular disease, including:

·         Bilberry

·         Turmeric (curcumin)

·         Fenugreek

·         Ginger

·         Guggul

·         Ginkgo

·         Garlic (one garlic clove is roughly equal to 4 mg to 1 gram of garlic; a daily dose of 600 to 800mg may be recommended)

·         Onion

·         Vitamin B12

·         Folic acid (500 to 5000 micrograms daily may be recommended)

·         B6

·         L-Carnitine

·         Coenzyme Q10 (100 to 300 mg daily may be recommended)

·         Vitamin E (400 to 800 International Units daily may be recommended)

·         Magnesium (200 to 400 mg daily may be recommended)

·         Niacin (A typical oral dose of 100 mg, three times daily; may gradually increase to avg. dose of 1 gram three times daily, with a maximum dose of 6 grams. Extended release tablets: Dosing may begin with one 375-milligram tablet at bedtime and be increased by no more than 500 mg per four-week period, to a maximum of 2,000 mg, given as two 1,000-milligram tablets before bed)

·          Fish oils (6 grams daily may be recommended)

·         Soy (Isoflavones may be recommended)

11. Go to the loo whenever you feel the urge. Research at Taiwan University found that a full bladder causes your heart to beat faster and puts added stress on coronary arteries, triggering them to contract, which could lead to a heart attack in people who are vulnerable.

12. Ask for next Monday and Friday off. Researchers at the University of Pittsburgh analyzed data on more than 12,000 middle-aged men from the Framingham Heart Study and found that those who took regular vacations sliced their risk of death from heart disease by a third. And no, taking along the cell phone, laptop, and a briefcase full of papers will not help you achieve the stress-reducing effects of a vacation that, in turn, reduces your risk of heart disease.

13. Drive with the windows closed and the air conditioning on. This reduces your exposure to airborne pollutants, which a Harvard study found reduces something called “heart rate variability,” or the ability of your heart to respond to various activities and stresses. Reduced heart rate variability, also called HRV, has been associated with increased deaths among heart attack survivors as well as the general population.

14. Call a friend and arrange dinner. A study published in the journal Heart in April 2004 found that having a very close relationship with another person, whether it’s with a friend, lover, or relative, can halve the risk of a heart attack in someone who has already had a heart attack.

15. Pay attention to the basics. Two major studies published in the summer of 2003 found that nearly everyone who dies of heart disease, including heart attacks, had at least one or more of the conventional risk factors, such as smoking, diabetes, high blood pressure, or high cholesterol levels.

16. If you find you’re having trouble getting out of bed in the morning, have lost interest in your normal activities, or just feel really blah, call your doctor. You may be depressed, and untreated depression significantly increases your risk for a heart attack.

17. Go to the pound this weekend and adopt a dog. The power of furry friends to improve heart health is proven. Not only will a dog force you to be more active (think about all the extra walking you’ll be doing), but the companionship and unconditional affection a pooch provides has been shown to reduce the risk of heart attack and other cardiovascular problems.

Management of Asthma

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.

Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by.

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

·         Animals (pet hair or dander)

·         Dust

·         Changes in weather (most often cold weather)

·         Chemicals in the air or in food

·         Exercise

·         Mold

·         Pollen

·         Respiratory infections, such as the common cold

·         Strong emotions (stress)

·         Tobacco smoke

In the United States, asthma affects more than 22 million persons. It is one of the most common chronic diseases of childhood, affecting more than 6 million children. India accounts for one third of the world's 115 million asthma patients.

Management of Asthma

General Measures

·         The most effective treatment for asthma is identifying the triggers and avoiding exposure to those agents.

·         Desensitization to allergens has been shown to be a treatment option for certain patients.

·         Smoking cessation and avoidance of secondhand smoke is recommended for all asthmatics.

·         In patients with EIA, higher levels of ventilation and cold, dry air tend to exacerbate attacks. Therefore, it is advisable to avoid activities, which results in inhalation of large amounts of cold air such as skiing and running. Activities such as swimming in an indoor, heated pool with warm, humid air is less likely to provoke a response.

Self-Management of Asthma

Guided self-management of asthma is a treatment strategy in which patients are taught to act appropriately when the first signs of asthma exacerbations appear. Patient education can allow patients with asthma to begin guided self-management of the disease. Self-management of asthma prevents exacerbations, improves care and is cost-effective. Such practice will ensure a favorable clinical outcome and an enhanced quality of life.

The aim of asthma management is to achieve a symptom-free, normal life for the person with asthma and prevent the development of permanent lung damage and abnormal lung function. To do that, physicians and people with asthma must work in partnership. Good asthma management depends as much upon the person as it does on the treating doctor and other health professionals.

Asthma management education by doctors and others in asthma care means that people with asthma understand their condition and treatment and can successfully manage it themselves between doctor visits. To do this, an individual written asthma action plan is essential.

These details:

1.    What to do if symptoms return or increase?

2.    When and how much to increase medications?

3.    When to seek medical help?

Long-term control medications are taken daily to maintain control of persistent asthma. They primarily serve to control airway inflammation.

The quick-relief medications are taken to achieve prompt reversal of an acute asthma attack by relaxing bronchial smooth muscle.

Many asthma medications can be administered orally or by inhalation. Metered-dose inhalers (MDI’s) are the most widely used method, but dry powder inhalers are becoming popular. Metered-dose inhalers are changing from the type propelled by liquefied chlorofluorocarbons (CFCs) to a new, CFC-free delivery system. Nebulizer therapy is reserved for patients who are unable to use MDI’s because of difficulties with coordination.

Treatment of Asthma Treatment

Asthma cannot be cured, but it can be controlled with proper asthma management.

1.    The first step in asthma management is environmental control. Asthmatics cannot escape the environment, but through some changes, they can control its impact on their health.

Listed below are some ways to change the environment in order to lessen the chance of an asthma attack:

·         Clean the house at least once a week and wear a mask while doing it

·         Avoid pets with fur or feathers

·         Wash the bedding (sheets, pillow cases, mattress pads) weekly in hot water

·         Encase the mattress, pillows and box springs in dust-proof covers

·         Replace bedding made of down, kapok or foam rubber with synthetic materials

·         Consider replacing upholstered furniture with leather or vinyl

·         Consider replacing carpeting with hardwood floors or tile

·         Use the air conditioner

·         Keep the humidity in the house low

2.    The second step is to monitor lung function. Asthmatics use a peak flow meter to gauge their lung function. Lung function decreases before symptoms of an asthma attack - usually about two to three days prior. If the meter indicates the peak flow is down by 20 percent or more from your usual best effort, an asthma attack is on its way.

3.    The third step in managing asthma involves the use of medications. There are two major groups of medications used in controlling asthma - anti-inflammatory (corticosteroids) and bronchodilators.

Anti-inflammatory reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the spontaneous spasm of the airway muscle. Anti-inflammatory are used as a preventive measure to lessen the risk of acute asthma attacks. The corticosteroids are given in two ways - inhaled via a metered dose inhaler (MDI) or orally via pill/tablet or liquid form.

Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases to and from the lungs.

Some people cannot control the symptoms by avoiding the triggers or using medication. For these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of allergen extracts to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing.

Prevention of Asthma Treatment

·         Periodic assessments and ongoing monitoring of asthma are essential to determine if therapy is adequate. Patients need to understand how to use a peak flow meter and understand the symptoms and signs of an asthma exacerbation.

·         Regular follow-up visits (at least every six months) are important to maintain asthma control and to reassess medication requirements.