How to manage and treat chronic asthma symptoms?
The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function, and to reduce morbidity and prevent mortality. In order to achieve those aims the approach to management should include education of patient and family, avoidance of precipitating factors, use of the lowest effective dose of
convenient medications minimising short and long term side effects, and assessment of severity and response to treatment
Education of patient and family is important but often neglected aspect in the management of asthma. All patients should be taught how to monitor their symptoms so that they will know when an attack is starting, and those with moderate or severe asthma should know how to use a flow meter. They should also have a written "action plan" to follow if symptoms suddenly become worse, including how to adjust their medication and when to seek medical help. If more intense treatment is necessary, it should be continued for several days. Over-the-counter "remedies" should be avoided. When deciding whether a patient should be hospitalized, the past history of acute attacks, severity of symptoms, current medication, and whether good support is available at home all must be taken into account. Patient education should include nature of asthma, preventive measures/avoidance of triggers, drugs used and their side-effects, proper use of inhaled drugs, proper use of peak flow meter, knowledge of the difference between relieving and preventive medications, recognition of features of worsening asthma (increase in bronchodilator requirement, development of nocturnal symptoms, reducing peak flow rates), self management plan for selected, motivated patients or parent, and the danger of non prescribed self medication including certain traditional medicines.
Long-term asthma treatment is based on inhaling a beta-receptor agonist using a special inhaler that meters the dose. Patients must be instructed in proper use of an inhaler to be sure that it will deliver the right amount of drug. Once asthma has been controlled for several weeks or months, it is worth trying to cut down on drug treatment, but this must be done gradually. The last drug added should be the first to be reduced. Patients should be seen every one to six months, depending on the frequency of attacks. Treatment for chronic asthma is based on a stepwise approach. The initial objective is to abolish symptoms and normalize lung function, then adjust medication appropriately in response to changes. The outline below generally describes the stepwise approach, which is often modified to suit the patient. Mild intermittent: Take bronchodilator as needed, up to 3-4 times/day.
Mild persistent: Take low-dose inhaled corticosteroid (delivered by nebulizer or metered-dose inhaler with holding chamber, with or without a face mask, or by dry powder inhaler in children 5 years and younger).
Moderate persistent: For children 5 years and younger, low-dosage inhaled corticosteroid and long-acting beta2 agonist or medium-dosage inhaled corticosteroid should be taken. For adults and children older than 5 years, take low- to medium-dosage inhaled corticosteroid and long-acting inhaled beta2 agonist.
Severe persistent: High-dosage inhaled corticosteroid and long-acting beta2 agonist should be taken.
Patient treatment should be reviewed every 3-6 months; Step down rapidly from high dose oral steroids if PEFR responds promptly i.e. within a few days, otherwise need to be stable for 1-3 months before attempting more gradual step down.
More information on asthma
What is asthma? - Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest.
What types of asthma are there? - Types of asthma include child-onset asthma, adult-onset asthma, exercise-induced asthma, cough-variant asthma, occupational asthma, nocturnal asthma.
What's bronchial asthma? - Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath.
What is exercise-induced asthma? - Exercise-induced asthma is a form of asthma that some people have during or after physical activity. Exercise-induced asthma is common.
What is adult-onset asthma? - Adult onset asthma generally is the onset of asthma for the first time in someone of middle age or older. Adult-onset asthma develops after age 20.
What is status asthmaticus? - Status asthmaticus is a severe asthma episode that does not respond to standard treatment. Status asthmaticus is caused by severe bronchospasm.
What causes asthma? - Asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue changes leading to airway inflammation, bronchoconstriction, and wheezing.
What're the asthma triggers? - Many risk factors have been linked to triggering asthma attacks. There are two basic types of asthma triggers, allergic triggers, non-allergic triggers.
Asthma and allergy - Asthma attacks (worsening of asthma symptoms) can be triggered by allergies. Allergy is the leading cause of asthma.
What is an asthma attack? - An asthma attack occurs when the small and medium-sized airways become inflamed and constricted after being exposed to a trigger.
Asthma in children - Asthma is the most common chronic condition of childhood. Asthma symptoms can interfere with many school activities for children.
Asthma and pregnancy - During pregnancy, asthma or asthma episodes will become worse for an estimated one-third of pregnant women, particularly women who have severe asthma.
Asthma in adults and older people - Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases.
What're the complications of asthma? - Uncontrolled asthma in pregnant women puts them at higher risk for complications that can include early labor, hypertension, gestational diabetes.
What are the symptoms of asthma? - The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.
What're the warning signs of asthma? - Most people with asthma have warning signs before symptoms appear. There are many warning signs of an asthma episode.
How is asthma diagnosed? - The diagnosis of asthma is made on the basis of typical symptoms and signs. Positive allergy tests support a diagnosis of asthma.
What're the treatments for asthma? - Treatment of asthma is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.
What quick relief (rescue) medications cure asthma? - Short-acting beta-agonists are the most commonly used asthma rescue medications. Anticholinergics are another class of asthma drugs.
Long-term asthma control medications - Combinations of steroids and other medications are effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
What're asthma inhalers? - Most asthma drugs are inhaled using special devices or nebulizers. Two common types include dry powder asthma inhalers and metered-dose asthma inhalers.
What're asthma nebulizers? - Asthma nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
How to control acute asthma attacks? - Acute asthma is an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward.
How to manage chronic asthma symptoms? - The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function.
What asthma relievers are available? - Asthma reliever is a drug that provides relief from asthma symptoms and is the most commonly used asthma medication.
What asthma preventers are available? - Asthma preventers are to be used twice a day regardless of whether your child has symptoms of asthma.
What's the treatment for childhood asthma? - The goals of asthma therapy are to prevent child from having chronic and troublesome symptoms, to maintain child's lung function.
What's the treatment for asthma in the elderly? - Diagnosis and treatment of asthma can be more complicated in people age 65 and older than in those who are younger.
What can be done to prevent asthma? - Avoiding known allergens and respiratory irritants can reduce asthma symptoms. People with asthma should minimize risk for respiratory tract infections.