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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 :

  1. Patient is almost asymptomatic.
  2. Patient can perform near normal activities.
  3. Use of reliever bronchodilator is once or less per day.
  4. Diurnal variability of peak flow is 10% or less.
  5. No nocturnal symptoms, if occurs, less than two times per month.
  6. No emergency visit to doctors or hospitals
  7. No or minimal side effects of medication.

What are the types of home management plan ?

Home management plan is of two types.

  1. Without Self Management Plan.
  2. 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

See Also:

Step Care Management of Asthma

Emergency Management of Asthma

Hospital Based Care of Asthma

Concomitant Disease management of Asthma

Pitfalls of Asthma Management

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  • Step Care Management of Asthma

    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

  • Use of Peak Flow Meter

    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:

  • Hospital Based Care of Asthma

    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)
  • Asthma Control Plan

    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.
  • Misconception about Asthma

    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.

  • Pitfalls of Asthma Management

    Pitfalls of Asthma Management - Incorrect diagnosis, Inappropriate management plan, Inadequate education, Improper inhalation technique

  • Medicines for Asthma

    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.