Home Management of Asthma
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 ?
Education, Caution and Medication are the three fundamental components of an effective management plan for asthma.
What is the goal of a management plan ?
Effortless easy breathing is our goal.
This means with effective and appropriate management, we should achieve the following points :
- Patient is almost asymptomatic.
- Patient can perform near normal activities.
- Use of reliever bronchodilator is once or less per day.
- Diurnal variability of peak flow is 10% or less.
- No nocturnal symptoms, if occurs, less than two times per month.
- No emergency visit to doctors or hospitals
- No or minimal side effects of medication.
What are the types of home management plan ?
Home management plan is of two types.
- Without Self Management Plan.
- With Self Management Plan.
Home Management without Self Management Plan:
It includes the three fundamental components (education, caution and medication) of home management plan. That is -
a) Patient education.
b) Precautionary measures to be taken by the patient.
c) Step care management.
Although step care management is employed here, the prescription is quite inflexible. Whatever the condition of the patients, they will not increase their drugs except short acting b2-agonists (Salbutamol) inhaler. Patients can take Salbutamol inhaler as per need up to 4-6 times daily.
Home Management with Self Management Plan:
In this system patient education is more time consuming and laborious but chances of mortality and morbidity is reduced considerably.
Here patient is advised to maintain a peak flow chart. With the help of this chart, patient's best peak flow result is determined. On the basis of "Personal Best result" peak flow results are placed in three zones - Green, Yellow and Red. Patient will try to be in the green zone. He/she can modify the medication up to a certain limit without physician consultation.
|Green Zone =||(Safe zone) Peak flow result is 80% - 100% of personal best. Green Zone means patient will continue his prescription.|
|Yellow Zone =||(Zone of alert) Peak flow result is < 80% to >50% of personal best. Yellow Zone means Patient will double his preventer drug (anti-inflammatory corticoisteriod inhaler) and one or two oral protector drugs like Theophyllin SR, Salbutamol SR may be added.|
|Red Zone =||(Zone of emergency) Peak flow result is < 50% of personal best. Red Zone means along with prescription of yellow Zone, patient will start rescue oral steroid and should contact a physician immediately.|
Education, Caution and Medication - of these three components of “ Home Management Plan” - , only “Medication” will be discussed here. Caution and Education is described in a separate section.
What to know about medication?
We must know four points regarding medication of asthma.
i. Step care management
ii. Which step is appropriate for a specific patient
iii. Self management plan
iv. Rescue steroid therapy
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