Asthma Treatment

  • Treatment

    Seek emergency medical help if you have a severe asthma attack. Once an asthma attack begins, it can progress very quickly or very slowly. What may appear to be a mild attack at first may very rapidly warrant a trip to the hospital. Urgent care at the hospital for severe asthma may involve administration of beta2-agonists. If you do not respond to other medications, you may be given a corticosteroid. Most patients are given oxygen therapy.

    Learn how to monitor your symptoms Table 01Table 02. Learn to recognize your symptom patterns to determine whether your asthma is under control. This can be achieved by using a daily diary and a periodic self-assessment form.

    The daily diary should include symptoms and/or peak flow, medication use, and restricted activity. You can monitor all of these factors at home. The diary is especially helpful if you are trying new treatments in an effort to control asthma, and if you need help identifying allergens and irritants that provoke your asthma.

    The periodic self-assessment sheet, which is filled out at during office visits, is designed to pinpoint your perception of asthma control, how well you are able to self-manage the condition, and overall satisfaction with treatment.

    Table 1.  Example of a Patient Diary

    ? Symptoms and Activities Medications Taken Peak Flow Comments
    Date Wheeze Cough Activity Sleep Inhaled Steroids Oral Steroids Cromolyn AM PM ?
    ? ? ? ? ? ? ? ? ? ?
    ? ? ? ? ? ? ? ? ? ?
    ? ? ? ? ? ? ? ? ? ?
    ? ? ? ? ? ? ? ? ? ?
    ? ? ? ? ? ? ? ? ? ?
    ? ? ? ? ? ? ? ? ? ?
    Wheeze: None = 0, Some = 1, Medium = 2, Severe = 3
    Cough: None = 0, Occasional = 1, Frequent = 2, Continuous = 3
    Activity: Normal = 0, Can run short distance or climb 3 flights of stairs = 1, Can Walk Only = 2, Missed school/work, or stayed indoors = 3
    Sleep: Fine = 0, Slept well, slight wheeze or cough = 1, Awake 2 or 3 times, wheeze and cough = 2, Bad night, awake most of time = 3

    Expert Panel for the National Institutes of Health, National Asthma Education of Prevention Program: Guidelines for the Diagnosis of Asthma. 1997 July; 97-4051:36.

    Table 2.  Sample Patient Self-Assessment Sheet

    Name Date
    How many days in the past week have you had chest tightness, cough, shortness of breath, or wheezing (whistling in your chest)? 0 1 2 3 4 5 6 7
    How many nights in the past week have you had chest tightness, cough, shortness of breath, or wheezing (whistling in your chest)? 0 1 2 3 4 5 6 7
    Do you perform peak flow readings at home? Yes No
    If yes, did you bring your peak flow chart? Yes No
    How many days in the past week has asthma restricted your physical activity? 0 1 2 3 4 5 6 7
    Have you had any asthma attacks since your last visit? Yes No
    Have you had any unscheduled visits to the doctor, including to the emergency department, since your last visit? Yes No
    How many puffs of your short-acting inhaled beta2-agonist (quick relief medicine) do you use per day? ?
    How many of your short acting inhaled beta2-agonist inhalers did you go through over the past month? ?
    What questions or concerns would you like to discuss with the doctor? ?
    How well controlled is your asthma in your opinion? ?
    How satisfied are you with your asthma care? ?

    Expert Panel for the National Institutes of Health, National Asthma Education of Prevention Program: Guidelines for the Diagnosis of Asthma. 1997 July; 97-4051:36.

    Know when to take prescribed medications and when to seek medical help. Be sure you understand your physician's instructions for performing self-monitoring, when to take medications, and when to call for medical assistance. Make certain you have and understand a written emergency management plan. Share this plan with members of your household so that they will know what to do in the event that you are unable to explain it yourself.

    Your doctor is the best source of information on the drug treatment choices available to you.

    If your asthma is triggered by a specific allergen, such as dust, immunotherapy shots may help you develop an immunity against the substance that causes the attack. Immunotherapy is a preventive treatment for allergic reactions to substances such as grass pollens and house dust mites. This treatment involves injecting small doses of the substance to which you are allergic. The dosage increases over time. This causes the immune system to build a tolerance to the allergen, so that when you are exposed to it in the future, you are less sensitive.

    Before starting treatment, you and your doctor will identify the factor that makes your asthma worse by discussing your case, and using skin or sometimes blood tests.

    Once the allergen has been identified, an extract of it is injected into the skin of the arm. An injection may be given once a week (sometimes more often) for about 30 weeks, after which injections can be reduced to every two weeks. Eventually, injections can be given every four weeks. The duration of therapy may be three to five years, sometimes longer.

    Strengthening the immune system through proper diet and nutrition can help you resist asthma, according to natural health practitioners. This may be achieved in part by eliminating allergens in foods, resolving digestive problems, establishing the right balance of essential fatty acids, and supplying other nutrients. Good dietary management includes eating a balanced diet, avoiding artificial colorings, caffeine, alcohol, tobacco, sugar, and additives and preservatives.

    You may want to take a multivitamin containing calcium if you are taking inhaled corticosteroids (ICCS), because they have a small potential to enhance osteoporosis.

    Many people with asthma have a family history of rhinitis, sinusitis, eczema, or migraine headaches.

    Uncontrolled asthma can lead to permanent lung damage. Although rare, in severe cases, an asthma attack can lead to lung failure. Once admitted to the emergency room, most people respond to treatment, but a few do not. Respiratory failure is a very serious condition, and can lead not only to lung damage, but damage to other organs as well.

    Uncontrolled asthma is especially serious in pregnant women. If you are pregnant, uncontrolled asthma poses a threat to both you and your child. Pregnant women are at risk for potentially stronger asthma symptoms. Strong coughing, for example, could possibly initiate premature labor.

    Although most asthma drugs are safe to take during pregnancy, the specific medications should be prescribed with care. Certain drugs are not recommended and some others should never be used if you are pregnant.

    About half of all children with chronic asthma will experience few or no problems for some time after adolescence. There is no known way, however, to predict which children may outgrow asthma and which will not. Additionally, although asthma symptoms may stop for a period of time, this does not guarantee that asthma will not return later. Treatment should never be withheld in the expectation that asthma will go away on its own.

    Asthma usually is a chronic condition, although in some cases it goes into long periods of remission. In patients with mild to moderate asthma, the condition can improve over time, and many adults eventually become free of symptoms.

    Asthma can be controlled through the daily use of long-term drug treatments, lifestyle recommendations, and as needed, use of bronchodilators or quick-relief medications.

    Patients with asthma should maintain regular follow-up visits with their physician. Uncontrolled asthma can be fatal. It is essential that you properly perform self-management by using peak flow meters and adjusting medications as required. You should keep a daily record of peak flow readings as well as asthma attacks, exposure to allergens or irritants, and other relevant factors to take with you to regularly scheduled physician visits.

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