Asthma – an overview of management

Asthma is condition of breathing difficulty caused due to spasm in the bronchi of lungs.

Asthma triggers

The asthma triggers include

  1. Inhaled allergens like molds, dander, mice and dust mites.
  2. Respiratory irritants like tobacco smoke, perfumes, air pollutants and chlorine based cleaning products.
  3. Comorbid conditions like COPD, gastroesophageal reflux, obesity, sleep disorders, vocal cord dysfunction, stress and rhinitis.
  4. Medications like non selective and beta – 1 selective blockers, aspirin and other NSAIDS.
  5. Complications of influenza and pneumococcal infection.

Classification of asthma severity

  • Intermittent :
  • Day time symptoms occurring less than two days per week
  • Less than two nocturnal awakenings per month
  • FEV1 ≥80 percent of normal
  • FEV1/ FVC ratio within normal
  • One or no exacerbation require an oral glucocorticoids per year

 

  • Mild persistent :
  • Day time symptoms occurring more than two days per week
  • Three to four nocturnal awakenings per month
  • FEV1 ≥80 percent of normal
  • FEV1/ FVC ratio within normal
  • Two or more exacerbation require an oral glucocorticoids per year

 

  • Moderate persistent :
  • Daily symptoms of asthma
  • More than one nocturnal awakenings per week
  • Limitation in normal activity
  • FEV1 – 60 to 80 percent of the normal
  • FEV1/FVC ratio below normal

 

  • Severe persistent :
  • Symptoms throughout the day
  • Nocturnal awakenings nightly
  • Extreme limitation in normal activity
  • FEV1 – < 60 percent of the normal
  • FEV1/FVC ratio below normal

 

The National Asthma Education and Prevention Program (NAEPP) report provides guidelines for the management of asthma in children and adults.

Goals of asthma treatment

  • Reduce the frequency and intensity of asthma symptoms by :
  1. Optimizing lung function
  2. Reduce cough, weakness and chest tightness
  3. Reducing the night time awakenings
  4. Maintenance of normal daily activities
  5. Minimize the need of beta agonists to relieve symptoms

 

  • Reduce the risk of asthma exacerbations by :
  1. Treating the abnormal lung growth in children
  2. Maintaining a proper lung function
  3. Optimizing the pharmacotherapy

Components of asthma management

Major components of asthma management include:

  • Monitoring lung function frequently
  • Educating the patient about the conditions and the triggering factors
  • Control the triggering factors and comorbid conditions
  • Pharmacotherapy

Monitoring pulmonary function

In adults and children older than five years pulmonary function is monitored by

  • Peak expiratory flow rate : used in patients with a well defined history of asthma
  • Spirometry : measures Forced Vital Capacity (FVC), Forced Expiratory Volume in One Second (FEV1) and FEV1/FVC ratio

Pharmacotherapy

Acute exacerbations: require systemic glucocorticoids

Intermittent: fast acting inhaled beta – 2 agonists

Mild persistent: low dose inhaled glucocorticoids

Moderate persistent: medium dose inhaled glucocorticoids or long acting beta agonist

Severe persistent: long acting beta agonist is used in combination with a high dose inhaled glucocorticoids

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