Name of Patient ........................................ Prepared by Dr. .........................................

This plan will help a patient control his asthma and know what to do if he has an asthma episode. Keeping a patient’s asthma under control will help to :

Be active without having asthma symptoms. This includes being active in exercise and sports. Sleep through the night without having asthma symptoms. Prevent asthma episodes (attacks). Have the best possible peak flow number - lungs that work well.

For Adults

Airways of an asthmatic are very sensitive. They may react to some stimuli that can cause asthma episodes. These stimuli are called as “triggers” . The airways may become swollen, tighten up, and produce excess mucus in the presence of one or more of the triggers below. These triggers may make asthma symptoms worse or keep the patient from getting better. It is important to find out what a patient’s asthma triggers are. They should learn ways to avoid them.

Advice for Patients :

Ask your doctor to help you find out what your triggers are.

Asthma episodes rarely occur without warning. Most people with asthma have warning signs (physical changes) that occur hours before symptoms appear. Warning signs are not the same for everyone. Same patient may have different signs at different times. By knowing their warning signs and acting on them, patients may be able to avoid a serious episode of asthma.

Think back on your last asthma episode. Did you have any of the signs below? Check your warning. Show them to your doctor and family.

A peak flow meter is a device that measures how well air moves out of a patient's lungs. During an asthma episode, the airways of the lungs begin to narrow slowly. The peak flow meter can be used to find out if there is narrowing in the airways, hours - even days - before the patient has any symptoms of asthma. By taking the medicine early (before symptoms), your patient may be able to stop the episode quickly and avoid a serious episode of asthma. So its role in preventing severe asthma attack is very important.

The peak flow meter can also be used to help you:

A nebulizer is a device driven by a compressed air machine. It allows your patient to take asthma medicine in the form of a mist (wet aerosol). It consists of a cup, a mouthpiece attached to a T-shaped part or a mask, and thin plastic tubing to connect to the compressed air machine. It is used mostly by three types of patients:

Young children under age 5. Patients who have problems using metered dose inhalers. Patients with severe asthma

A nebulizer helps make sure that patients get the required amount of medicine

A spacer or holding chamber is a device that attaches to a metered dose inhaler. It holds the medicine in its chamber long enough for the patient to inhale it in slow deep breaths. The spacer makes it easy to use the medicines the right way (especially if a child is young or patient can not coordinate between pressing the inhaler and breathing). A spacer helps prevent coughing while using an inhaler. It will also help protect the patient from getting a fungal infection in mouth (thrush) when taking inhaled corticosteroids.

Using a metered dose inhaler (MDI) is a good way to take asthma medicines. There are few side effects because the medicine goes right to the lungs and not to other parts of the body. It takes only 5 to 10 minutes for the medicine to have an effect compared to oral asthma medicines, which can take 1 to 3 hours. Inhalers can easily be used by all asthma patients of age 5 and older. A spacer or holding chamber attached to the inhaler can help make taking the medicine easier for even younger children.

Do I have to use my preventer inhaler all the time, even when I am well?

There are some common concerns about Asthma prevailing in the society. In majority of cases, these are misconceptions or baseless fears. For optimum control of asthma, these points should be dealt with proper care. Otherwise the management plan may go in vain. It the physicians responsibility to eradicate such worries, if present, from the patient’s mind. Some common concerns and suggested clinicians responses are listed below. Model answers to some frequently asked questions (FAQs) are also given. These will help the physician to deal with such situations more confidently.

How to prevent asthma?

Development of asthma has two distinct bases: Hereditary and Environmental. For the prevention of the development of asthma we should manipulate these two factors. Regarding hereditary factors, we have yet nothing to do practically. Genetic engineering is a future probability. What we can do is to manipulate the environmental factors. Effort should be concentrated on primary prevention of asthma.

What is primary prevention?

Pitfalls of Management

Pitfalls

Remedies

 

 

Incorrect diagnosis

Proper history taking, thorough (COPD, LVF, other differential diagnosis) relevant investigations.

Allergic Rhinitis:

Definition: Rhinitis is characterized by inflammation of the lining of the nose. Clinical diagnosis is made on the basis of recognizing a symptom complex of two or more of the following:

- Nasal blockage - Nasal discharge - Sneezing - Nasal itching

Classification:

1) Intermittent Rhinitis :

Acute form of rhinitis persists from few hours to maximum 14 days.

Management of Asthma Attacks :

Hospital-Based Care

Initial Assessment:

History, Physical examination (auscultation, use of accessory muscles, heart rate, respiratory rate) and Investigations (PEF or FEV1, Oxygen saturation SaO2, arterial blood gas analysis and other tests)

Initial Treatment:

Inhaled short-acting b2-agonist, usually by nebulization, one dose every 20 minutes for 1 hour Oxygen to achieve O2 saturation >90% (95% in children)

What is emergency management of asthma?

Emergency management is the management plan for acute exacerbation of asthma. Severe acute asthma should always be dealt on emergency basis. Acute exacerbation of asthma may appear in any class or variant of asthma.

What are the protocols of emergency management ?

Emergency management consists of the following protocols:

Management at Home Management at Physicians chamber Management at Emergency department Management at Hospital and ICU

What is step care management?

Step Care Management is like a staircase. We start treatment at the appropriate step. Then we shall step up along the stairs if asthma is not controlled or becomes more severe and shall step down when patient's asthma is fully controlled for 3 months or more.

We have divided the asthma management plan into five steps. At first, we should understand basic principles of five steps. Then we can construct any step by combining available drugs.

Basic Principles of Step Care Management

Why management at home ?

Since asthma is a chronic disease, it can be and should be managed at home up to a certain level. If home management plan is applied intelligently and skillfully, most asthmatics can lead symptom free normal life, avoid hospitalization thereby cutting down the financial expenditure significantly. All patients of asthma, except those with acute exacerbation, should be treated at home.

What are the components of home management plan ?

What are the medicines used to treat asthma?

There are basically three kinds of medicines:

Relievers (Bronchodilators) are medicines that relax smooth muscles that have tightened around the airways. They relieve asthma symptoms. Short acting b2-agonists, short acting aminophylline, and ipratropium are bronchodilators or relievers.

Why we investigate asthma patients?

For classification and assessment of severity For diagnosis of concomitant illness For exclusion of other causes of cough, wheeze dyspnoea or chest tightness

What are the investigations for asthma?

We should do four basic investigations of all patients.

1. Blood for TC, DC, ESR, Hb% and : 

What are the Diagnostic Criteria of Asthma?

There are four diagnostic criteria of asthma:

1. Cardinal features of asthma

Paroxysmal respiratory distress Recurrent cough Wheeze Chest tightness

2. Recurrent attack due to multiple stimuli

3. Features of Eosinophilic inflammation: Sputum Eosinophilia

4. PFT: obstructive defects, at least partially reversible by drug