Overview

Asthma is a common inflammatory disorder of the airways/lungs. Its prevalence is nearly 5% in the Indian population and the cases of asthma are on rise in previous two to three decades. It is usually accompanied by exacerbations or commonly called as “asthma attacks” during which patient accompanies increased symptoms. 

Symptoms/clinical feature

1. Chronic cough

2. Episodic shortness of breath

3. Chest tightness

4. Wheezing

Patient usually gives history of associated allergic symptoms like sneezing and/or associated skin rash etc. Patient might give a family history of similar symptoms. The symptoms may start at an early age or may be diagnosed in the later life. Asthma attacks/ exacerbations may be caused by exposure to allergens, dust exposure, stress, and change in weather or respiratory tract infections.

Diagnosis:

Asthma is usually diagnosed on clinical basis. However, there are conditions like bronchitis, upper airway cough syndrome etc. which may resemble asthma. It is very important to distinguish these conditions from asthma as the line of treatment for each of the above mentioned condition is different. The diagnosis of bronchial asthma is made on basis of pulmonary function tests or spirometry which is a test for measure of the lung volumes. Other tests which help to assess lung conditions and exclude other associated conditions with asthma are chest x-ray, complete blood count, allergy testing etc.

Treatment:

Aim of treatment of asthma is achieve good symptom control, prevent exacerbations and prevent decrease in lung functions, so that the patient is able to live as normal life as his/her counterparts of same age and gender. Asthma management requires effective partnership between patient and doctor, where the role of patient is to understand his disease and make appropriate health decisions. Management of asthma requires following steps:

A.      Medications

B.      Managing risk factors

C.      Non pharmacological therapies

D.      Managing of asthma attacks/exacerbations

Medications

The mainstay of management of asthma is inhaled short acting or long acting beta agonists and inhaled corticosteroids which are provided in the form of pMDI’s , DPI or  “inhalers” as they are commonly known. There are many myths with the use of these drugs like they are habitual or cause more side effects. However, contrary to the myths they are the safest drugs available for the management of asthma when they are used in as prescribe manner. It is very important that the patient uses the device advised by the doctor in the correct manner to ensure maximum delivery of the drug to the lungs.

Besides these there are medications like leukotriene receptor antagonists like monteleukast, theophyllines or rarely oral steroids which are prescribed for the management of stable asthma.

Managing risk factors

Associated risk factors which hinder the control of asthma need to be identified at an early stage which includes psychosocial factors, allergen exposure or food allergy, obesity, smoking etc. Certain drugs like aspirin, NSIADS, beta blockers may worsen asthma so patient should discuss his/her drug history with the doctor. Identifying and treating these risk factors at an early stage helps to prevent exacerbations or decline in further lung functions.

Non pharmacological methods

In addition to the medications there are few non pharmacological methods which are advised to the patient so as to improve his/her general well being. These non pharmacological methods are to be followed on the advise of the doctor as they are tailor made depending on the patient’s need and health status. Some of the non pharmacological methods which are advised are as follows:

1. Regular physical activity

2. Weight reduction

3. Avoiding stress

4. Breathing exercises

5. Avoidance of occupational exposure

6. Vaccination

7. Healthy diet like fruits or vegetables

Management of asthma exacerbation

Asthma exacerbation or asthma attacks are the conditions during which the patient more often than not lands up in emergency hospital. These may be life threatening and need to be catered in a hospital with facility to manage asthma exacerbations and have ventillatory support for worst case scenarios. Patient might require parenteral steroids along with inhaled bronchodilators during these episodes. However, it is advised to prevent exacerbations by taking regular medications.

 

 

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