Asthma Management Overview

Asthma Overview

• Asthma is characterized by recurrent wheezing, coughing, difficulty breathing, and chest tightness.

• Occasional cough may occur due to various factors like pneumonia, which leads to increased mucus, swelling, and bronchial constriction.

• Consistent symptoms warrant investigation into potential asthma, especially if they worsen at night or seasonally.

Identifying Symptoms

• Key indicators for asthma:

  • Recurrent wheezing

  • Constant difficulty breathing

  • Recurrent chest tightness

• Symptoms worsening at night or in specific seasons indicate underlying asthma triggers.

• Consider family history of asthma, eczema, or hay fever as risk factors.

Environmental Triggers

• Common asthma triggers include:

  • Animals with fur

  • Chemicals

  • Dust mites

  • Exercise

  • Pollen

  • Viral infections

  • Smoke

  • Emotional stress

• Understanding these triggers aids in diagnosis (intrinsic vs extrinsic asthma) and treatment planning.

Diagnosing Asthma

• FEV1 Test: Measures patient’s FEV1 before and after bronchodilator use.

  • Positive Response: FEV1 increases by >12% or 200 mL indicates reversible airway obstruction (asthma).

• Peak Flow Monitoring: Daily variability >10% suggests fluctuating airway constriction.

• COVID-19 Considerations: Diagnostic tests may include:

  • Bronchial provocation tests with methacholine or histamine.

  • Exhaled nitric oxide levels.

  • Allergy tests for indicated triggers.

Asthma Management Strategies

• Stepwise Management Approach:

  • Aim for symptom control and reduction of future exacerbations.

  • Use long-term controller medications (e.g., inhaled corticosteroids, [ICS], and long-acting beta agonists, [LABAs]).

  • Reliever medications (short-acting beta agonists) are used for immediate relief.

Treatment Guidelines by Steps

1. Step 1: Infrequent symptoms (less than 2 times a week) – Use low-dose ICS with a rapid onset LABA.

2. Step 2: Mild persistent asthma (more than twice a week) – Daily low-dose ICS and SABA as needed.

3. Step 3: Moderate persistent asthma (troublesome daily symptoms) – Low-dose ICS + LABA.

4. Step 4: Severe persistent asthma (frequent exacerbations) – Medium-dose ICS + LABA.

5. Step 5/6: Consider high-dose ICS or additional therapies for severe asthma.

Pharmacological Interventions

• Short-acting beta agonists (e.g., albuterol) and systemic corticosteroids (oral or IV) are first-line treatments during acute exacerbations.

• Combination therapy with short-acting muscarinic antagonist improves outcomes during acute treatment.

• Continuous treatments: Monitor for heliox therapy (oxygen + helium) to decrease air turbulence in severe cases.

Additional Considerations

• Magnesium sulfate and low-dose ketamine can provide bronchodilation in difficult cases.

• Physical therapy: Develop strategies to maintain physical activity and daily living activities, especially for patients with more severe asthmas.

Patient Education and Self-Management

• Regular use of an asthma action plan is crucial. Educate patients on:

  • Proper inhaler techniques (possibly using a spacer).

  • Recognizing and managing triggers by keeping an asthma journal.

  • Utilizing peak flow meters to monitor lung function and adjust treatments accordingly.

• Importance: Ensures adherence and better disease management.

Conclusion

• Assess for additional risks related to the workplace or home environment (e.g., chemical exposure, pets).

• Continual education and adjustment of treatment based on stepwise management ensure optimal asthma control.