Prevention of Asthma

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?

"What we mean by primary prevention is intervening even before we can see any form of sensitization in the individual we are investigating". The four key areas in primary prevention are: -

-Timing of hyperresponsiveness

- The level to which allergen concentrations must be reduced to prevent the development of hyperresponsiveness

- The necessary duration of allergen avoidance

- Adjunct factors involved in triggering the disease

for these, following two things are to be done:

- Identification of the asthma prone persons
- Well defined prevention program for the asthma prone persons

How to identify asthma prone persons?

Period before and immediately after birth is very important for the future development of allergic diseases, such as asthma. Identification of the high-risk newborns can be done by a family allergy scoring system (FAS). FAS is based on the number of immediate (first degree) family members (mother, father, brothers and sisters only) who suffer or who have suffered from one or other allergic condition.

Scoring system:

Two points are scored for each immediate family member who has definite, medically confirmed allergic disease. (Positive history along with clinical evidence).

One point is scored for each family member who has possible or suspected allergic disease but which has not been medically confirmed. (Positive history without clinical evidence).

One point is scored for persons exposed to occupational hazards (occupational asthma).

No point is scored for the members with no allergic disease.

Interpretation of the score:

0 - 1 : No prevention is necessary.

2 - 3 : Serum IgE estimation, raised value indicates preventive program.

4 or more : Strongly advocate preventive program.

Program for primary prevention

Program for primary prevention of asthma vary from person to person. It is difficult to chalk out an universal program. However on the basis of recent knowledge asthma prone persons, that is, persons who have more e chance of developing asthma, may be given the following advice in the form of DOs and DON’Ts :

DOs	DON’Ts

• Babies should be exclusively breast-fed until the age of six month.	• Lactating mother should not eat or drink any allergy producing food or beverage.
• Weaning should be delayed, if possible until six month of age, particularly allergy producing solids.	• Prevent high risk babies being exposed to high allergic foods and inhaled substances during first year of life.
• Encourage low salt diet .	• Avoid carpeting, stuffed furnishing, household pets, stuffed toys (teddy bears) and furry dresses.
• Encourage more fish and less meat in diet.	• Try to avoid broad-spectrum antibiotics for viral R.T.I.
• Encourage outdoor sports in summer and indoor sports in winter. Swimming is best exercise for asthmatics.	• Try to avoid outdoor air pollution - pollen, dusts, smoke etc.
• Try to establish proper ventilation at home.	• Quit active smoking and avoid indoor passive smoking.
• Try to change the job if occupational asthma is suspected.	• Try to avoid spending 3 hours or more at a stretch in a day in front of the television or computer.

Topics:
Disease and Treatment

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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.
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:
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.
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)
Use and Care of Nebulizer
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
Investigation of Asthma
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 :
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 ?