Treatment of Asthma
Remember asthma cannot be completely cured but can be prevented. Treatment of asthma can be divided into two broad categories:
- Treatment of Acute attacks of asthma using quick-relief medications.
- Long Term treatment strategies.
1. Treating an Acute attack of asthma:
The quick-relief medications work by relaxing bronchial smooth muscle and are called broncho-dilators. These can reverse an acute attack in a short time.
During an acute attack of Asthma the following should be done:
- Always keep your blue inhaler with you.
- Take a puff from the inhaler.
- Loosen any tight clothing and sit-up.
- Open the windows of the room if room is warm and humid.
- If no immediate improvement felt during an attack, continue to take one puff of inhaler every minute for 3 to 5 minutes or until symptoms improve.
- If your symptoms do not improve in five minutes or if you are in doubt, call your doctor or visit the nearest hospital.
It is important to recognize a life threatening attacks of asthma. This situation should be suspected if:
- The reliever (blue) inhaler does not help.
- The symptoms get worse (cough, breathless, wheeze, tight chest).
- If you are too breathless to even speak.
2. Long-term treatment strategies:
There are three broad strategies to follow:
1. Controlling the Environmental Impact on Asthma
The first step in long-term asthma management is trying to control the environment in which you live. Although the environment cannot be changed totally but one can control its impact on our health.
The following measures would lessen asthma attacks:
- Wash the bedding used weekly in hot water (included sheets, pillow cases and mattress pads)
- Use dust-proof covers for mattress and pillows
- Avoid pets with fur or feathers inside the house
- Avoid using bedding made of foam rubber with synthetic materials
- If house is carpeted consider replacing it with hardwood floors or tile
- Use air-conditioners for rooms
- The humidity of the house should be kept low
2. Controlling Asthma Attacks by taking Regular Medications
The control medications should be taken everyday to maintain the airways and prevent an attack of asthma. The medication used primarily, serves to maintain the normal diameter of the airways and control airway inflammation. The two major groups of medications used in controlling asthma are anti-inflammatories (corticosteroids) and bronchodilators.
The most popular asthma medications are administered orally or by inhalation. Metered-dose inhalers (MDI's) and dry powder inhaler (Rotacaps) are the most widely used method. Dry powder inhalers do not require the coordination that is necessary with MDIs Currently the metered-dose inhalers are changing from the type propelled by liquefied chlorofluorocarbons (CFCs) to a new, CFC-free delivery system.
After using MDI it is advised to have a warm drink or water, so that unpleasant aftertaste of the medicine is not felt.
Nebulizer therapy: Here a machine is used for helping with the inhalation and is reserved for patients who are unable to use MDI's because of difficulties with coordination, example small children or mentally retarded people. The machine helps in creating a mist out of the asthma drug, making it easy and pleasant to breath the drug into the lungs. A small compressor converts the drug into an aerosol mist, which travels through a hose with a mouthpiece attached. By taking deep breaths, the medicine is delivered into the lungs.
Spacer: This device works with MDI to deliver medication more easily and effectively. It also reduces side effects of MDI. When an MDI is used , some medicine is left in the mouth and throat. This results in some wastage of the dose and can cause an unpleasant aftertaste. Spacers hold the "puff" of medicine between the patient and the MDI, so that it can be inhaled slowly and more effectively. For small children a comfortable mask can be added to the spacer.
Anti-inflammatories - are used to reduce the risk of acute asthma attacks. These agents work by reducing the number of inflammatory cells in the airways. The drug prevents blood vessels from leaking fluid into the airway tissues and helps in reducing the spontaneous spasm of the airway muscle.
The most common drug is a corticosteroids. These are given in two ways - inhaled via a metered dose inhaler (MDI) or orally as a pill or tablet or in liquid form. The inhaled corticosteroids are usually a beclomethasone or flunisolide or triamcinolone preparation of steroids. The oral corticosteroids are usually prednisone group of steroid. Liquid forms are usually used for children with asthma.
Other anti-inflammatory drugs that are useful include:
- Cromolyn sodium
A new class of anti-inflammatories called leukotriene inhibitors work by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle cells lining the airways. These drugs are intended for long-term use as they prevent rather than reduce symptoms of asthma. The Food and Drug Administration (FDA) approved two drugs called.
Bronchodilators: These drugs work by increasing the diameter of the air passages of the lungs and hence ease the free flow of gases to and from the lungs. They come in two basic forms ? short-acting and long-acting.
The short-acting bronchodilators drugs help to relieve symptoms during acute asthma attacks and include:
The long-acting bronchodilators are used sometimes to control symptoms in special circumstances e.g. during spring when the pollen counts are likely to be high or during sleep to avoid an attack of asthma.
Theophylline is usually taken orally whereas others can be inhaled.
Atropine sulfate is another highly effective bronchodilator.
Immunotherapy (Anti-allergy shots) may also help some individuals. Immunotherapy involves the injection of extracts of allergens to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing.
Vitamin D Supplements and Asthma
The potential role of vitamin D in asthma management has been of much interest, as low vitamin D levels have been linked to increased asthma attacks. Role of vitamin D supplementation and its effect on severe asthma attacks was published in the Cochrane Library. The study revealed that an oral vitamin D supplementation in addition to standard asthma treatment reduced the risk of severe asthma attacks requiring hospital admission or emergency department attendance from 6% to around 3%.
3. Monitoring Lung Function regularly
Monitoring Lung Infection Lung function decreases usually about two to three days? prior to an asthma attack - If the asthmatics learns how to use a peak flow meter to gauge their lung function, they can predict an attack themselves. If the meter indicates the peak flow to be down by 20 percent or more from the usual reading , an asthma attack may be on its way.
Peak flow meters can be purchased and are easy to use.
Regular follow-up visits (at least every six months) to the doctor are important to maintain asthma control and to reassess medication requirements.