Essentials of Asthma Management

Asthma is a common chronic illness seen in almost all age-groups. It is an important cause of debility in both children and adults – frequently responsible for absence from work and school. Management of asthma is a major cause of concern both because of the disease morbidity and associated health-care burden. It is important to realize that currently there is no permanent cure of asthma. But the natural course of asthma may vary from person to person. Long periods of remissions are seen in some patients while others may continue to suffer, sometimes with severe asthma which may occasionally prove to be life-threatening.

Remedies for asthma have varied from the folklore practices to the modern drugs.There are innumerable faith healing and miracle treatments advertised and offered in different societies. In current clinical practice, asthma management comprises of a comprehensive plan which includes the following essential components:

·        Drugs (i.e. Pharmacotherapy) for symptomatic and control therapy

·        Avoidance of trigger factors which aggravate asthma

·        Patient education about the disease and overall management plan.

I.                  Drug – treatment (Pharmacotherapy)

 Asthma is generally managed with two kinds of drugs:

1. Relievers:  drugs which relieve the acute symptoms of Asthma. These drugs are used on “as and when needed” basis, whenever asthma symptoms are present.
2. Controllers or preventers:  These drugs are essential for long-term maintenance treatment on a regular basis. Appropriate and regular use of controllers is essential to avoid the need for the reliever medications. An increasing use of relievers indicates a poor control of asthma.

It is therefore important to remember the message: 

Use Controllers (Preventers) regularly and avoid asthma from worsening. Use of maintenance inhaler medication is very important in the overall prevention strategy. 

 It is also important to remember that most of drugs for asthma treatment are available for the inhalation route. Patients are generally reluctant to use inhalers routinely for treatment. This is more so in case of children and also the female patients who find the treatment as rather stigmatic. It is therefore important to spend time with them, listen to and patiently discuss their doubts and other misgivings. It should be repeatedly stressed that:

1. Inhalation is the most effective route for administration of anti-asthma drugs – direct approach to the respiratory system.
2. Inhalers contain minute quantities of drugs and are therefore safe for asthma patients.
3. There is no addicting potential of inhalers; they do not contain any such drug.
4. Use of inhalers is somewhat difficult – requires practice and active cooperation of patient.

 II.               Avoidance of triggers of asthma

All attempts should be made to recognize and avoid the situations which trigger the asthma attacks - it is as important as the use of drugs. Incidentally, it is generally difficult to practice and beyond the means of an individual patient. Alterations in living conditions are required to minimize the exposure to dust, smoke and other allergens in the house.  Particular attention must be paid to the bedroom where contact with dust mites and other allergens is highly likely..

 Some of the exposures are easy to avoid while others may require major changes.

1. Patient should preferably stay away from dusty conditions such as during sweeping, cleaning, white washing or when similar activities are being carried out.
2. Replace sweeping of floors and dusting of walls with vacuum cleaning, or at least with wet cleaning (or mopping).
3. Give sufficient exposure of sun and air to the clothes taken out from the closets after storage.
4. Keep the bedroom and possibly other places in the house as simple as possible.  Furnishing items that are likely to collect dust such as the stuffed toys, curtains, carpets, mattresses (etc.) should be either removed or replaced and covered with easily washable/plastic materials. It is important to keep them as dust-free as possible.
5. Avoid exposure to cigarette smoking.
6. Avoid exposure to smoke from domestic cooking in the kitchen.
7. Strong odors of seasoning, condiments, hot and spicy foods should be avoided.

 III.           Patient education

It is important for the patients and his/ her care-giver to understand asthma and overall management plan for and efficient control, especially in the state of an emergency. Although the doctor prescribes the drugs for asthma, asthmatics and their relatives play an important role.  Asthma Particular attention need to be paid to the importance of inhalation therapy, avoidance of triggers and how to correctly use the inhalers. Contact your best chest clinic to educate yourself as well as learn the correct inhalation technique.         

One should keep in mind the possibility of asthma getting out of hand and pose an acute threat. Appropriate and timely use of emergency drugs, especially the relievers, at home can prevent deterioration of disease as well as subsequent hospitalization. Similarly, well-informed asthmatics can regulate the controller drugs at home, either by themselves or with the help of the caregivers. Time to prevent an acute emergency is to maintain an adequate disease control with a comprehensive management plan.