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.