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Pitfalls of Asthma Management

Pitfalls of Management

Pitfalls Remedies
Incorrect diagnosis Proper history taking, thorough (COPD, LVF, other differential diagnosis) relevant investigations.
Inappropriate management plan Evaluate scoring system for proper step care, proper step up/down.
Inadequate education Establish patient education program. Don't give excessive message at a time, educate at every visit.
Improper inhalation technique Demonstrate practically, observe patient performance repeatedly, give a handout describing the procedure.
Avoidance of spacer and nebulizer Use of spacer gives optimum result from every puff, use nebulizer whenever necessary to control acute attacks.
Non-compliance of treatment Drugs:antiinflammatory medicine works slowly, wait for at least 4-6 weeks for desired result before changing the drug. Dose: don't reduce or enhance the dose injudiciously.
Reluctance in using rescue therapy Encourage and ensure use of increased dose of reliever medicine and oral prednisolone if needed.
Environmental hazards Chalk out an effective trigger control plan.
Avoidance of spacer and nebulizer Use of spacer gives optimum result from every puff, use nebulizer whenever necessary to control acute attacks.
Non-compliance of treatment Drugs:antiinflammatory medicine works slowly, wait for at least 4-6 weeks for desired result before changing the drug. Dose: don't reduce or enhance the dose injudiciously.
Reluctance in using rescue therapy Encourage and ensure use of increased dose of reliever medicine and oral prednisolone if needed.
Environmental hazards Chalk out an effective trigger control plan.

See Also:

Home Management of Asthma

Step Care Management of Asthma

Emergency Management of Asthma

Hospital Based Care of Asthma

Concomitant Disease management of Asthma

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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

  • 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 ?

  • 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)
  • 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.

  • Definition of Asthma

    Why do we define asthma?

    We define asthma to identify the disease correctly and to differentiate it from other diseases. To fulfill this goal, definition of asthma has been changing over last 40 years. The clinician, physiologist, immunologist, pathologist or epidemiologist - all have different perspective of asthma.

    In the year 1997, the following working definition has been formulated by Expert Panel-2 of National Asthma Education and Prevention Program, USA.

    Asthma is a chronic inflammatory disorder of the airways:

  • Etiology of Asthma

    What Causes Asthma Episodes?

    The exact etiology or causes of asthma is still unknown. The airways of the asthmatics are found to be inflamed, red and hypersensitive. It is known that some triggers induce an asthma attack if exposed to the inflamed airways. Therefore, the management plan for asthma is directed towards prevention of inflammation of the airway and avoidance of triggers for the better control of symptoms.

    What is a trigger?

  • 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.