Asthma is a chronic disease caused by inflammation of the airways. It is characterized by variable and recurring symptoms of breathlessness, coughing, and wheezing. A severe onset of such symptoms results in an asthma attack or acute asthma exacerbation. If a patient fails to receive appropriate treatment then it can further worsen the condition.
According to the Centers for Diseases Control and Prevention (CDC), it is the third leading cause of hospitalization among children under the age of 15 years. Goals of Therapy
Goals of Therapy Asthma
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma –2007 provide a new approach to help patients suffering from its symptoms. These guidelines focus on two major components:
Reducing Impairment Asthma
- To prevent chronic and bothersome symptoms experienced by patients, such as coughing, breathlessness in the daytime, at night, or after exertion
- In maintaining normal activity levels (including exercise and other physical activity and attendance at school or work)
- To maintain nearly normal lung (pulmonary) function
Reducing Risk Asthma
- To prevent the recurrent exacerbations of it and minimize the need for emergency visits or hospitalizations
- To prevent loss of lung function and side effects of drug therapy
According to EPR-3, there are four components, which should be considered for effective asthma control.
Step 1: Asthma Diagnosis
Based on the physical examination and medical history, your physician will determine if any of the following indicators are present or not:
- Dyspnea (shortness of breath) and coughing (worse at night or early in the morning, making it hard to sleep)
- Breathing problems or chest tightness or pain
- Nasal irritation
- Wheezing (wheezing is a whistling or shrill sound that occurs when you breathe, especially at night)
- Your doctor will check whether these symptoms occur or get worse with exercise, viral infection, exposure to allergens and irritants, changes in weather, stress, or any other factor
(Hyperlink to test and diagnosis section)
Step 2: Assessment and Monitoring
1. Initial visit:
- Before the initial treatment, your physician will assess the severity of your asthma and determine whether you are suffering from intermittent, mild persistent, moderate persistent, or severe persistent asthma
| Stage 1 | Intermittent (Irregular) | Symptoms occur not more than two times per week and night-time awakening occurs not more than twice per month |
| Stage 2 | Mild Persistent | Symptoms occur more than two days per week but not daily, and three to four night-time awakenings each month |
| Stage 3 | Moderate Persistent | Asthma symptoms appear once every day and night-time awakenings occur more than once per week |
| Stage 4 | Severe Persistent Asthma | Symptoms occur throughout the day, every day and night-time awakening may occur every night |
Step 3: Initiate the Drug Therapy
Based on the severity of the asthma attack, your physician will select an appropriate therapy to control your asthma symptoms.
- A short-acting beta agonist (SABA) is used as a preferred therapy for people suffering from intermittent asthma as they provide quick relief from its symptoms. Albuterol (SABA), a bronchodilator when inhaled produces bronchodilation within five minutes and the action lasts for two to four hours. However, frequent use of SABA may indicate that a patient has poorly controlled it and there is a need to step up the treatment. A short course of oral systemic corticosteroids is considered if asthma exacerbations/attack is severe or if a patient has a history of severe exacerbations/attacks
- Inhaled Corticosteroids (ICSs) are the preferred first-line treatment for patients suffering from persistent asthma (long-term control). ICSs are the most effective anti-inflammatory therapy for all age groups. They are given in combination with Long-Acting Beta Agonists (LABAs)
Caution:
LABAs should not be used as monotherapy for long-term control. Even though symptoms may improve significantly, it is better to use ICSs while taking LABA. The dose of ICSs and LABA depends on whether the patient is suffering from mild persistent, moderate persistent, or severe persistent asthma
- While selecting the medication, the patient’s history of response to the medication, willingness, and ability to use a particular therapy is also considered
Step 4: Patient Education for Self-Management:
Education plays a key role in the management of it and with adequate knowledge you can control your symptoms.
- You should monitor your symptoms regularly to check whether their symptoms are under control and to recognize the signs of worsening asthma. This may reduce the need for emergency visits or hospital admission
Develop an asthma action plan:
- Developing a written asthma action plan based on peak flow (hyperlink to peak flow) and/or symptom monitoring may assist you to manage your asthma symptoms. Make sure you update your asthma action plan at every visit (at least after every six months)
Step 5: Control of Environmental factors and Co-morbid Conditions
- Your physician may recommend multifaceted approaches to control the exposures to allergens and irritants (hyperlink) to which you are sensitive
- If you are suffering from other co-morbid conditions like gastroesophageal reflux disease (GERD), obesity, obstructive sleep apnea, rhinitis and sinusitis, stress, or depression, treating these conditions may help improve the symptoms of it.
Step 6: Follow-up visits:
If you need a dose adjustment, then your physician may schedule follow-up visits. During each visit:
- Its control, proper medication technique, and a written asthma action plan are assessed
- Lung function is measured with the help of spirometry (hyperlink to test and diagnosis section) at least once every one to two years (more frequently for asthma that is not well controlled)
- The need to adjust the therapy is determined.
