Managing Asthma: Asthma Management Goals Achieve and maintain control of symptoms Maintain normal activity levels, including exercise Maintain pulmonary function as close to normal levels as possible Prevent asthma exacerbations Avoid adverse effects from asthma medications Prevent asthma mortality
Six-Part Asthma Management Program1. Educate patients to develop a partnership in asthma management2. Assess and monitor asthma severity with symptom reports and measures of lung function as much as possible3. Avoid exposure to risk factors4. Establish medication plans for chronic management in children and adults5. Establish individual plans for managing exacerbations6. Provide regular follow-up care
Classifying severity in children who are not currently taking long-term control medication.
Classifying severity for patients who are not currently taking long-term control medications.
Classifying severity in patients after asthma becomes well controlled, by lowest level of treatment required to maintain control
Peak flow meter The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR) is a persons maximum speed of expiration, Peak flow meter, a small, hand-held device used to monitor a persons ability to breathe out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.
An easy to remember approximation is: PEFR (L/min) = [Height (cm) - 80] x 5
Managing Asthma: Peak Flow Chart People with moderate or severe asthma should take readings: – Every morning – Every evening – After an exacerbation – Before inhaling certain medicationsSource: “What You and Your Family Can Do About Asthma” by the Global Initiative ForAsthma Created and funded by NIH/NHLBI
Spirometry Spirometry (meaning the measuring of breath) Measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important tool used for assessing conditions such as asthma cystic fibrosis & COPD.
A volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the X-axis A flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total volume inspired or expired on the X-axis Procedure
Typical Spirometric (FEV1) Tracings Volume FEV1 Normal Subject Asthmatic (After Bronchodilator)Asthmatic (Before Bronchodilator) 1 2 3 4 5 Time (sec)Note: Each FEV1 curve represents the highest of three repeat measurements
Limitations of test Spirometry can only be used on children old enough to comprehend and follow the instructions given (6 years old or more), and only on patients who are able to understand and follow instructions Many intermittent or mild asthmatics have normal spirometry between acute exacerbation, limiting spirometrys usefulness as a diagnostic. It is more useful as a monitoring tool.
STEPWISE APPROACH FOR MANAGING ASTHMA I N CHI LDREN 0–4 Y EARS OF AGE
STEPWISE APPROACH FOR MANAGING ASTHMA I N CHI L DREN 5–11 YEARS OF AGE
Inhalation devices you can use Dry Powder Spacer Inhaler Metered Dose inhaler
Advantages of Spacer No co-ordination required No cold - freon effect Reduced oropharyngeal deposition Increased drug deposition in thelungs
The Zerostat advantage Non - static spacer made up of polyamide material Increased respirable fraction → Increased deposition of drug in the airways Increased aerosol half - life → Plenty of time for the patient to inhale after actuation of the drug No valve → No dead space → Less wastage of the drug Small, portable, easy to carry → Child friendly
Rotahaler - The dry powder advantage Overcomes hand-lung Overcomes hand-lung coordination problems that are encountered with MDIs. Can be easily used by children, elderly and arthritic patients. Can take multiple inhalations if the entire drug has not been inhaled in one inhalation.
Call for first follow up at 1-2 weeks after initiating therapy and subsequent follow up 2-8 weekly. Review regime prescribed and diary of events since the past visit. Enquire specifically regarding bronchodilator usage, school absenteeism, limitation of activity and sleep disturbance. Assess if symptoms and signs of asthma are present at the time of visit and monitor weight and height. Check for adverse effects (relevant especially, if on oral drugs e.g. steroids, theophylline). Re-emphasize the need for continued compliance and clarify any doubts regarding asthma and its management (page 7). Assess whether goals of treatment (page 6) have been achieved.
Immunosuppresive drugs - Methotrexate and gold salts. Other modalities - Ketotifen Yoga Acupuncture