Asthma management

Asthma is very common and causes substantial morbidity. The aims of treatment are:

• to abolish the symptoms
• to re-establish normal or best possible long-term airway function
• to decrease the risk of severe attacks
• to facilitate normal growth occurring in children
• to reduce absence from school or employment.

This involves:

• patient and family instruction about asthma
• patient and family input in treatment
• prevention of identified causes where possible
• use of the lowest efficient doses of convenient medications to minimize short-term and long-term side-effects.

Control of extrinsic factors

Measures should be taken to avoid contributing allergens such as the house-dust mite, pets, moulds and certain foodstuffs, particularly in childhood.

Evasion of house-dust mites is now achievable with efficient and secure covers for bedding and changes to people’s living accommodation. Smoking should be avoided at all cost.

Other agents (e.g. preservatives and colouring materials such as tartrazine) should be avoided if shown to be a causative factor. Fifty per cent of those sensitized to work-related agents could be cured if they are kept permanently away from contact.

This emphasises:

• The significance of rapid identification of extrinsic causes of asthma and their removal wherever possible (e.g. occupational agents, family pets)
• Once extrinsic asthma is started, it can become self-perpetuating.

How to manage catastrophic sudden severe (brittle) asthma

This is an unusual variation of asthma in which patients are in danger of sudden death despite their asthma being well controlled between attacks. Severe life-threatening attacks can occur within hours or even minutes.

Brittle Asthmatics should ensure they have

• emergency supplies of medications at home, in the car and at work
• oxygen and resuscitation kit at home and at work
• nebulized β 2 agonists at home and at work
• self-injectable epinephrine (adrenaline): two Epipens of 0.3 mg epinephrine at home, at work and to be carried by the asthmatic at all times
• prednisolone 60 mg
• Medic Alert bracelet.

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