bronchial asthma management plan

1. Asthma Management in current era

2. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

3. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

4. Challenges In Diagnosis
Listening (time constraints)
Understanding Patient Fears
Explaining Airway Inflammation
Using Breathing Tube Models

5. Managing The Diagnosis
Children with asthma
Listening to the parent
Observing the child, both at rest and exercise
Adults with asthma
Listening to the patient
More time with the patient

6. What Do You Tell The Patient
Use the 3 tube model
Explain structure and airway
Explain bronchoconstriction & Inflammation of
airway during asthma
Explain how treatment helps

8. Questions to Ask
Recurrent attacks of wheezing?
Troublesome cough, worse at night, or on awakening?
Cough or wheeze after physical activity?
Seasonal breathing problems during a particular season?
Wheeze, chest tightness, or cough post-exposure to allergens or pollutants?
Do colds ‘go to the chest’ or take more than 10 days to clear up?

9. 9
Diagnosing Asthma
History
Spirometry
Recurrence, family history, childhood-onset, rhinitis or
skin allergy history
Triggered by weather change/ environment, dust, odours,
smoke, emotions, occupation
Response to trial of treatment

10. Key Issues In Asthma
Bronchitis
Recurrence
Inflammation

11. 11
The Story Of Asthma Treatment
Normal
Regular
Inhaled
Steroid
Partly
Treated
Inflamed (untreated)

12. Communicating the Diagnosis
Bronchitis
Recurrence
Inflammation

13. Communicating the Diagnosis
Bronchitis (with tube models)
Recurrence
Inflammation

14. Communicating the Diagnosis
Bronchitis
Recurrence (genetic and environmental)
Inflammation

15. Communicating the Diagnosis
Bronchitis
Recurrence
Inflammation (swelling, mucus and short-
tempered airway – use tube models)

16. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

17. Managing The Patient’s Mind
The word ‘asthma’ is hard to accept - denial
Can I just take some tablets ?
Inhalers are strong medicine
Steroids regularly ! – you must be kidding
I feel normal so often – how can I have a chronic disease ?

18. Tackling Mental Blocks
Asthma is just a ‘word’
Your problem is a persistent bronchitis. We just need to give it a
label at times
Take your lungs seriously. Don’t neglect them – that’s why people
suffer from asthma
Why would you want a tablet – 20 times the dose, goes to your
stomach, then blood, all over your body, then reaches your
airway ??

19. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

20. 20

21. Advantages of Inhaled Therapy
Parameters Inhaled Oral Parenteral
Dose Low (mcg) High High
Onset of Action Rapid Slow Rapid
Site of Action Direct Indirect Indirect
Systemic side effects Few Many Many

22. If your patient needs to use a reliever medication
every day, or even more than three or four times a
week, preventive medication must be added to the
treatment plan
GINA Workshop Report, 2020

23. GINA Guideline 2020

25. GINA Guideline 2020

26. Role of
nebulization in
different settings
1. In acute care
settings/ED
2. Hospitalized/
inpatient
3. At home
Very
young/old
Inadequately
controlled on
current
therapy
Patients
prefer
nebulization
Physically/co-
gnitively
impaired
Unable to
appropriately
use
MDIs/DPIs

27. Acute asthma
• Moderate to Severe respiratory distress
• Increase in cough
• Increased night time awakening

28. Redefining Relief Medication
BECLO + LEVOSALB
BUD + FORM
BUD+LEVOSALB
The Anti-Inflammatory Relievers !

29. Key Messages
Quick-Relief in Adults and Children > 12 – Always use inhaled
steroid whenever you use SABA
Mild Asthma (Step 1) Symptoms less than 2 x/month – FORM and
BUD need-based is all you need
Mild Asthma (Step 2) – FORM + BUD need-based as good as low
dose regular ICS with SOS SABA
In Adults and Children > 12 – At every stage the reliever is
Salbutamol/Levosalbutamol/ Formeterol along with ICS
No role or mention of theophylline in entire recommendations
Use and prescribe more peak flow meters, moving forward

30. OCS therapy in severe cases
Prednisolone
0.5 mg/kg daily for 5 to 7 days (Adults)
1 – 2 mg/kg daily for 5 to 7 days (Children)
Action plans for patients

31. Good nebulization practices
The need of the hour!
•In hospital /clinic settings
•Home settings

32. Precautionary measures during COVID-19
Pre-neb
• Washing hands
• Ensure the device
is clean
• Ensure adequate
protection for
Health care
workers (HCWs)
During neb
• Mouthpiece
preferred over
face mask
• Separate room
(home
nebulization) or
negative pressure
room
(hospital/clinic)
Post- neb
• Cleaning and
disinfection of
nebulizer.
• Cleaning of the
surface and areas
of nebulization.

33. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

34. Handling Non-Adherence
A great prescription is never enough
Once daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

35. Before and After Prescription
Communicate Diagnosis
Communicate Treatment
Use Breathing Tube Models
Invest a Bit of Time – it always pays off

36. Handling Non-Adherence
A great prescription is never enough
Once daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

37. Adherence With Inhaler Medication
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
twice a day three times a
day
four times a
day
Dosing Frequency
%
of
Patient
Adhering
Arch Dis Child 1992; 67: 332-3

38. Handling Non-Adherence
A great prescription is never enough
Once/twice daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

39. Comorbidities
Hypertension
Hypothyroidism
Diabetes
Hypercholesterolaemia

40. Handling Non-Adherence
A great prescription is never enough
Once daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

41. Monitoring of Asthma
Hypertension BP apparatus
Diabetes Glucometer
IHD Stress test/ CAG
Bronchial asthma ??

43. Handling Non-Adherence
A great prescription is never enough
Once daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

44. Handling Non-Adherence
A great prescription is never enough
Once daily dosing
Examples of co-morbidities taken more seriously
Peak flow meters
Dose Counters

45. ffffffffffffffffff
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Dose Counter on
MDI

46. Tackling Mental Blocks
Ask the patient before he leaves – will he really follow the
prescription ? (check body language)
Did I leave you confused or unclear ?
Did I leave you with any words you didn’t understand ?
This is a course I need you to take. We meet after 2
months and talk again then

47. Issues In Asthma Management
Managing The Diagnosis
Managing The Patient’s Mind
Managing The Treatment
Handling Non-Adherence
The Difficult Asthmatic

48. Helping You Deliver In Your Asthma Practice
Communicate the diagnosis well
Always address mental blocks the patient could have
A prescription is incomplete without describing the
airways (breathing tube models mandatory)

49. Helping You Deliver In Your Asthma Practice
Your ‘steroid’ communication should be strong
Keep a peak flow meter in your clinic with disposable
mouth-pieces
Truly difficult asthma is uncommon. Most such patients
just need simple re-education.

50. Thank You