Asthma Part 4: Treatment and Control

Asthma Part 4: Treatment and Control

There is no cure for asthma. The goal of management is to achieve control of the disease. This includes the following:

• Prevent chronic and recurring symptoms such as night cough

• Reduce the use of medications

• Maintaining lung function

• Maintaining regular activities

• Preventing severe asthma attacks that require hospitalization or emergency room visits

Practical Tips to Control Asthma:

• Control other conditions that may worsen asthma

• Avoid known allergens

• Maintain an active lifestyle

• Have an action plan in case of asthma attacks

The asthma action plan should include the medication regimen, avoidance of triggers, tracking of asthma attacks, and actions to take if asthmatic symptoms become more severe despite treatment. E.g. When do you have to go to the hospital emergency room for treatment?

Asthma medications

Asthmatic medications can be broadly divided into long-term control medications and medications for rapid relief of asthmatic symptoms.

Both types of medications aim to reduce airway inflammation to control asthma.

Initial treatment depends on how severe your asthma is. Follow-up treatment depends on how well the patient follows the asthma action plan and how effective the action plan is.

However, keep in mind that the asthma action plan varies with changes in your lifestyle and social environment, as different social pressures lead to exposure to different allergens in your environment.

Adjusting the medication dose should be at the discretion of your family doctor. If you have adjusted the medication dosage yourself, you should report this to your primary care physician immediately to facilitate proper titration of the medication dosage at each visit.

The doctor will always try to use the least amount of medication necessary to control your asthma. Therefore, it is imperative that the doctor is informed about how much medication you have taken.

Certain groups of patients require more intensive titration regimens - these include pregnant women, young children or patients with special needs.

Asthma Action Plan

Each asthma action plan should be designed for the individual patient. The plan should include medication regimen, avoidance of triggers, tracking of asthma attacks, and actions to take if asthma symptoms become increasingly severe.

It's best to work with your primary care doctor to create your asthma action plan. The plan should describe all of the above in detail.

For children, parents and caregivers should know the child's asthma action plan. This should include babysitters, daycare workers, parents, schools and organizers of children's outdoor activities.

Avoiding triggers

A number of allergens have been documented to be linked to asthma. The most important thing for the individual patient is to know what triggers asthma in you. Then, you should know what steps to take if asthma is triggered.

Simple common sense is important. For example, if you have a known allergy or sensitivity to pollen, please limit your exposure to pollen and stay indoors if necessary. If you are sensitive to pets or fur, please do not keep pets at home or allow pets into your bedroom.

It should be noted that physical activity can also trigger asthmatic attacks. However, it is recommended that asthmatics exercise regularly as exercise helps in controlling asthma in the long run. Talk to your doctor if asthma attacks occur during physical activity. There are medications to control asthma during exercise.

If your asthma is highly correlated with allergens that cannot be avoided (e.g. dust), your GP may recommend the use of allergy medication.

Asthma medications

Please consult your primary care physician for medications appropriate to control your asthma. Your GP will adjust the medication dosage as needed. If you have adjusted the dose yourself, you must inform your GP at your next visit.

In general, asthma medications can come in either the form of a pill, an injectable, or a nebulized medication that is consumed using an inhaler. Nebulized medications are inhaled directly into the lungs, where they take effect.

Please note that the use of inhalers requires specific technique and should be taught by a doctor or trained healthcare provider.

Long-term control medications

Chronic asthmatics need medication to keep their asthma under long-term control. These medications work slowly and reduce airway inflammation.

Inhaled corticosteroids

Inhaled corticosteroids are most commonly used for long-term control of asthma. They work by reducing inflammation in the airways of the lungs. Daily use of inhaled corticosteroids significantly reduces the severity and frequency of symptoms.

The most common side effect of inhaled corticosteroids is oral thrush. Using a spacer when using the inhaled corticosteroid may reduce the occurrence of oral thrush. If you are unsure about how to use a spacer, contact your primary care provider. Simply rinsing your mouth after inhaling inhaled corticosteroids may also reduce the occurrence of oral thrush.

Patients with severe asthma may need to consume oral corticosteroids instead of inhaled corticosteroids to achieve adequate control of their asthma. Unlike inhaled corticosteroids, which can be taken for years, oral corticosteroids have significant side effects with long-term use.

Long-term use of oral corticosteroids increases the risk of diabetes, osteoporosis, cataracts, and abnormal metabolic activity.

Consult your primary care doctor to assess the risks and benefits before taking oral corticosteroids.

Other long-term medications:

These include:

• Cromolyn – This medication prevents airway inflammation and is used as a nebulized medication delivered through an inhaler.

• Omalizumab – This medication is a form of immunotherapy and works against immunoglobulin E (anti-IgE), which causes narrowing of the airways. This medication, usually given as an injection once or twice a month, prevents the immune system from responding to asthma triggers. However, it is not a first-line treatment for asthma and may not be offered in advance by your GP.

• Inhaled long-acting beta2 agonists - These drugs are usually taken together with inhaled corticosteroids to produce a synergistic effect on expanding the lumen of the pulmonary airways.

• Leukotriene modifiers – These are oral medications that reduce airway inflammation.

• Theophylline – Theophylline can be taken orally or via injection and opens the airways of the lungs.

Please note that there is a likelihood of symptoms returning if long-term medications are suddenly stopped. Additionally, all long-term medications have side effects. Please discuss this with your GP before starting long-term treatment

Fast-acting medications

Short-acting beta 2 agonists are usually the first-line drugs in this group. They are often delivered in nebulized form through an inhaler. They work by relaxing the muscles in the airways, allowing more air to pass through.

Fast-acting medications should be taken as soon as symptoms appear.

If the medication is needed for more than 2 days a week, you should inform your doctor to formulate further strategies for your asthma action plan.

Asthma sufferers are recommended to always carry their quick-relief inhaler with them.

It should be noted that these medications do not reduce airway inflammation and therefore cannot replace long-acting medications.

Documentation of asthma progress

Regular use of Peak Flow and regular visits to your primary care physician are the most important means of documenting asthma progression.

As a rule of thumb, asthma is well controlled when:

• Symptoms do not occur more than 2 days a week

• Symptoms do not disrupt sleep more than twice a month.

• There are no restrictions on your daily activities.

• Quick relief medications are needed less than 2 days a week.

• Less than one severe asthma attack per year requiring oral steroids

• The flow meter peak readings remain at 80% of the baseline level

Peak flow meters

Your GP will inform you about using the Peak Flow Meter.

When in use, the Peak Flow Meter measures the maximum rate of airflow from the lungs during exhalation. Regular measurements enable the progression of asthma to be documented. It is recommended that the patient record their peak flow every morning.

In the initial phase after diagnosis, it is important to establish baseline peak flow. This is often touted as the patient's “personal best” peak flow reading. Future control of asthma relies on this baseline. Good asthma control involves maintaining peak flow at least 80% of baseline.

Regular peak flow readings also help predict impending asthmatic attacks. Progressive worsening of peak flow values ​​often indicates an impending attack and should be included in the asthma action plan.

Medical reviews

In the initial stages of treatment, frequent 14-day medical check-ups with your GP are the norm. Once asthma is under control, your GP may decide to see you over a longer period of time.

Important information your primary care doctor will need during medical exams includes:

• Frequency of asthma attacks

• Changes in symptoms

• Changes in peak flow readings

• Changes in daily activities such as exercise tolerance

• Difficulty adhering to the asthma action plan

• Problems with current medications

Emergency situations

See a doctor if:

• Regular medication cannot treat an asthma attack.

• Peak flow values ​​fall to less than 50% of baseline

Go to the nearest hospital emergency room immediately if:

• You have severe shortness of breath to the point where walking becomes difficult

• Your lips and tongue turn bluish

Asthma – a lifelong problem

There is no cure for asthma. Successful treatment of asthma requires the patient to take an active role in controlling asthma by adhering to an asthma action plan.

Your primary care doctor is your best partner in developing your asthma action plan. The action plan will remind you of your medication regimen, triggers, and protocols to follow if asthmatic symptoms develop or worsen. Even children should be involved in creating their action plan, as it is the individual effort that counts in long-term asthma care.

Asthma won't go away. But it can be controlled.

Inspired by Tzun Hon Lau