Monday, September 16, 2019

Managing asthmatic attacks

Managing asthmatic attacks
Asthmatic patients need to understand how to use their medications and the difference between relief and control therapies. Education can improve membership, particularly with ICS. All patients should be instructed on how to properly use their inhalers. In particular, they need to understand how to recognize worsening asthma and how to intensify therapy accordingly. Written action plans have been shown to reduce hospitalizations and morbidity rates in adults and children and are particularly recommended in patients with unstable disease who have frequent exacerbations

Most patients with asthma respond well when the best treatment or combination of treatments is found and can lead relatively normal lives. Patients who take responsibility for their condition and experience various treatments are likely to keep symptoms to a minimum. Having urgent measures to control asthma attacks and continuing treatment to prevent attacks is also important

A severe asthma attack must be treated wich that can lead to death. It is very important that a patient with an acute attack receives additional oxygen. Rarely, a mechanical ventilator may be needed to help the patient breathe and frequent or continuous inhalation of beta receptor agonist. If the patient does not respond quickly and completely, a steroid is administered. A steroid therapy course, administered after the end of the attack, will make recurrence less likely. Long-term allopathic treatment for asthma is based on the inhalation of a beta receptor agonist using a special dose measuring inhaler

Patients should be educated on the correct use of an inhaler to ensure that they supply the right amount of medication. Once asthma has been controlled for several weeks or months, it is worth trying to reduce drug treatment, but this reduction should be done gradually

Guidelines should be followed whenever possible. Asthmatics of any severity should have immediate access to short-acting inhaled beta-agonists. In addition, there must be a plan to monitor asthma control and exacerbation treatment. Many doctors address this problem with an "asthma action plan," regulated by both asthma symptoms and serial peak flow measurements at home. If more intensive treatment is needed, it should be continued for several days. In deciding whether a patient should be hospitalized, the physician should take into account the patient's history of acute attacks, the severity of symptoms, current medications, and the availability of good support at home

Classification of Asthma Severity

Severe persistent (step 4): Continual daily symptoms Frequent nocturnal symptoms

PEF or FEV1 (%):≤ 60

Daily Medications:
• High-dose inhaled corticosteroids +long-acting β2-agonists
• Systemic corticosteroids if necessary, the therapy aims maintain control with inhaled corticosteroids and β2-agonists

Moderate persistent (step 3):Daytime symptoms daily Nocturnal symptoms  >1 night/wk

PEF or FEV1 (%): >60–80

Daily Medications:
• Low/medium-dose inhaled corticosteroids and ong-acting β2-agonists 
•  May use as adjunctive medications each of leukotriene modifier or theophylline

Mild persistent(step 2):> 2 d/wk but <1x/d >2 nights/mo but <1 night/wk 

PEF or FEV1 (%):≥80

Daily Medications:
• Low-dose inhaled corticosteroids
• Alternatively, may use leukotriene modifier,cromolyn, or nedocromil

Mild intermittent(step 1):t ≤2 d/wk ≤2 nights/wk

PEF or FEV1 (%):≥80

Daily Medications:
• No daily medications

Maintaining Asthma Control 

As with other chronic health problems, regular monitoring and control evaluation are critical to properly managing asthma. Asthma control problems need to be addressed at every office visit. In addition, follow-up visits should be scheduled at regular intervals, with the frequency determined by the severity of asthma. This should happen at least once a year for all asthmatics

Discussions about the use of drugs should not be limited to the frequency of use of rescue bronchodilators alone. It is important to ask if a patient has previously requested oral steroids (especially in the past year), hospitalization or intubation. The asthma follow-up visit should include periodic spirometry. This should be done at least once a year, particularly in patients receiving regular daily control therapies, and can be done more frequently if necessary

A small minority of patients will have progressively more difficulty breathing. Since they are at risk of respiratory failure, they should receive intensive treatment

Special Considerations in the Management of Adult Asthma 

Pregnancy and asthma

About a third of pregnant asthma patients improve during pregnancy, a third deteriorates and a third does not change. Maintaining good asthma control is important as poor control can have negative effects on fetal development. The drugs that have been used for many years in asthma therapy have now proven to be safe and without teratogenic potential. These drugs include SABA, ICS and theophylline; There is less information on the safety of new classes of drugs like LABA, anti-leukotrienes and anti-IgE. There is no contraindication to breastfeeding when patients use these drugs

The rate of complications of asthma for the maternal and fetal during pregnancy increases when the disease is poorly controlled. Therefore, although there is always a potential risk associated with any medical intervention during pregnancy, adequate medical management of asthma before and during pregnancy is considered essential

Heart disease and asthma

In addition to providing additional triggers for wheezing, heart disease largely complicates the management of asthma due to competing drug management goals. Β antagonists (β-blockers) are a standard component of treatment for most patients with heart disease, including coronary heart disease (CAD) and heart failure

Chronic obstructive pulmonary disease and asthma

Long-term asthma can lead to airway remodeling resulting in irreversible COPD-like obstruction. So, many asthmatics, especially older asthmatics who used tobacco, develop a significant component of COPD. The assessment of these patients is more complex


Prevention is extremely important in the treatment of asthma, which includes the removal of all possible allergens from the environment and from the diet. Homes and work areas should be as free of dust and contaminants as possible. The areas can be tested for allergens and high quality air filters can be installed to clean the air. If the patient is sensitive to a family pet, we recommend removing the animal or at least keeping it out of the room (with the room door closed). Keeping your pet away from carpets and upholstered furniture and removing all feathers also helps

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