Management Of Asthma Complete Guidelines
Asthma?
Asthma is considered a chronic inflammatory condition which affects the lungs. In this disorder, the constriction (reversible or at least partially reversible) of the bronchi occurs in the lung. Bronchi are the muscular tubes which are responsible for carrying air throughout the lungs. They transport the air to and from the smaller airway branches called bronchioles.
The walls of the bronchi get inflamed and swollen in this disease. When the airways become narrow, it is difficult for a person to breathe which lead to wheezing, breathlessness, and coughing. In the acute condition of disease, the bronchi muscles get more constricted and excess amounts of mucus are produced. The diameter of the bronchi gets reduced to the point that very little air can travel out or in. This condition causes affected person to wheeze and cough, feel tightness in chest, and difficulty in breathing. However, the reasons are not clear but asthma attack can occur at any time but especially at night and in the morning. Some of the severe asthma attacks are considered life-threatening and require quick medical attention.
About Asthma
Causes
It is the complex interaction of different types of factors that’s why the exact causes of this disorder are unknown. The various triggers and stimulator cause the release of inflammatory molecules by the cells present in the lining of bronchi which seems to be the underlying problem. The trigger responsible for the asthma attack can be different for each person. Some of them include:
Exposure to cold air
Some medicines like aspirin and beta blockers
Strong emotional responses and stress
Exercise (exercise-induced asthma)
Allergens, for example, pollen, dust/spores, animal allergens (hair, cells), and food etc.
Non-allergic (occupational) allergens like hairdressing products, cleaning agents, epoxy glues, chemicals, and smoke etc.
Signs and Symptoms
On the basis of the frequency and severity of the symptoms, it can be separated into four categories which include: intermittent, mild persistent, moderate persistent and severe persistent. In the case of mild intermittent only occasional episodes occur and no symptoms can be seen at other times. But in the case of severe persistent asthma, the multiple daily medications is required to control the condition.
The condition like emphysema, infection and other lung diseases may have symptoms which are similar to asthma and can exacerbate asthma or coexist with it. In some people, asthma attacks can be triggered and worsen by non-pulmonary conditions like Gastroesophageal Reflux Disease (GERD), also termed as acid reflux.
Test
The initial goals of testing are the diagnosis and evaluation of the severity of asthma. With the help of testing, asthma can be distinguished from other conditions which can cause similar symptoms and the presence of other conditions (like allergies which trigger or worsen the asthma attack) can also be identified. The monitoring of lung functions and asthma control, evaluation of attacks, identifying or addressing the raised complications and side effects, are the main goals of testing.
The Expert Panel Report 3 (Guidelines for the Diagnosis and Management of Asthma) was released by the National Heart, Lung, and Blood Institute (NHLBI) and National Asthma Education and prevention program (NAEPP) in August 2007. These guidelines were released to provide help for diagnosis and monitoring the individuals who are suffering from asthma. The main focus of the guidelines is assessing and monitoring asthma, educating the people and encouraging them to take part in the management of their condition and controlling the factors which can trigger the attacks of it.
Lung Function Tests and Imaging Studies
The primary tests which are used to assess, diagnose and monitor it, include:
Diagnosis
The NAEPP guideline recommends:
A detailed examination of physical and medical history, which focus on the respiratory tract and chest.
Spirometry which is used for the evaluation of the obstructed and narrowed airways (FEV1; Forced Expiratory volume in one second). The rate and amount of air exhalation are measured by this test as the person is made to blows out through a tube. It may be performed on the people of 5 years of age or older than 5, to evaluate the airway obstruction which is reversible or partially reversible (with a short-acting bronchodilator).
“Challenge” The tests which are used to provoke the constriction of bronchi (Bronchial Provocation test) for example exercise, cold air, methacholine, or histamine.
Chest X-ray or the study of other pulmonary functions.
Additional tests which are necessary to rule out the other possible causes of the symptoms such as, lung infection (including tuberculosis), cystic fibrosis, and gastrointestinal reflux.
Asthma assessment and monitoring
Spirometry – for the evaluation of lung function
Peak expiratory flow (PEF) determination – In this test, a small device called a peak flow meter is used to measure the capability to push air and how fast it is exhaled. This can be done at home by a person to monitor the lung function.
Pulse oximetry – this is the noninvasive way to monitor the O2 saturation and used in the hospitals or emergency department to estimate the oxygen status.
Chest X-ray
Exhaled nitric oxide test (FeNo; the fraction of exhaled No) – it measures the amount of nitric oxide in the exhaled breath; because of the level of NO increases due to inflammation of the airways. In the asthma patient, it may rise and fall depending upon the effects of inflammatory treatment which is given to the person. This test may provide help by giving guidelines about the management of the asthma patient. It is not widely used because it is not yet recommended by NAEPP.
Laboratory Tests for Asthma:
The lab testing is done to rule out the possible causes and symptoms which are similar to asthma, to evaluate the complications and to identify the allergies. In the case of severe asthma, the testing may be recommended to observe the organ function, oxygen level and the balance of acid and base in the body. These tests include:
Blood gases – For the evaluation of PH, oxygen and carbon dioxide in the blood, these tests can be ordered.
Blood testing for allergic sensitivity – To determine the triggers of asthma the blood tests are performed which are specific for allergens such as mold, mites, dust, pet, dander, and pollens.
CBC (Complete Blood Count) – this test helps in providing information about inflammation and infection. It also evaluates the blood cells.
CMP (Comprehensive metabolic panel) – For the evaluation of organ function.
Theophylline – It is therapeutic drug monitoring if an individual is taking this medication.
The results of medical history, general tests, family history, and risk factors for diseases as well as the physical history are considered by the health practitioners. On the basis of these findings some other additional lab tests are performed which include:
Tests to rule out cystic fibrosis, for example, sweat test or trypsin/ chymotrypsin
Sputum culture — for the diagnosis of the lung infection which is caused by bacteria.
AFB testing – for the diagnosis of tuberculosis and nontuberculous mycobacteria (NTM)
Lung biopsy – for the evaluation of damage which is done to the lung tissues and cancer.
Sputum cytology – it is ordered occasionally to evaluate cells which are found in the lungs; neutrophils and eosinophil (two types of white blood cells which are increased due to inflammation in some of the people (suffering from asthma).
Treatment of Asthma:
The goals for the treatment are:
Maintain and achieve good asthma control
Minimize or prevent the number of attacks a person is having
Treat asthma attack quickly and lessen the emergency room visits
Slow down the progression of damage to lungs
Treat, resolve, and minimize the possible conditions (which increase the severity of asthma) and the side effects of medication
Educate people
Encourage the healthy, active, and normal lifestyle.
By the combination of having great asthma control, avoiding the substances which can trigger the attacks, and recognizing the early signs, the asthma attacks can be prevented.
Management of Asthma complete guidelines
Depending upon the severity of the attacks, the treatment is tailored. Even the individuals having mild intermittent asthma can also suffer from acute asthma attacks. To make the breathing easier, some asthma medications are used which can reduce the airway inflammation and relax the muscles which surround the airways. Both of asthma (short-term and long-term) should be addressed carefully.
Long-acting medications are used on the daily basis which helps in preventing the attacks
Quick-acting medications are used when there is a need to provide the relief during the asthma attack.
If a person is suffering from it he should work with his healthcare provider and should become educated enough that he can monitor himself and the condition of his children and determine the best possible treatment of asthma. For the guidance of day to day control, they should together make a plan that what possible action can be taken when the attack occurs. For the determination of the best course of treatment the health practitioner will take the person’s whole clinical picture into account and also the detail of drugs (a person is taking).
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