Asthma Health Article

Managing asthmatic attacks

A severe asthma attack can be a medical emergency and should be treated as quickly as possible. It is most important for a patient suffering an acute attack to be given oxygen. Rarely, it may be necessary to use a mechanical ventilator to help the patient breathe. Under a doctor's care, a beta-receptor agonist is inhaled repeatedly or continuously. If the patient does not respond promptly and completely, a steroid is given. An additional course of steroid therapy, given after the attack is over, will make a recurrence less likely.

Once asthma has been controlled for several weeks or months, the dose may be gradually tapered. The last drug added to the regimen should be the first to be reduced. Patients should be evaluated every one to six months, depending on the frequency of attacks.

Long-term treatment

Long-term asthma treatment is based on inhaled medications that are a combination of beta-receptor agonists and steroids. The drugs are delivered to the lungs via special inhalers that meter each dose. While this regimen is usually quite successful in diminishing or preventing attacks, all patients should be taught how to monitor their symptoms so they will know when an attack is starting. Those with moderate or severe asthma can use a peak flow meter to determine if inflammation is increasing.

Asthmatics should also have a written action plan to follow if symptoms suddenly worsen, including how to adjust their medication and when to seek medical care. When deciding whether a patient should be hospitalized, the past history of acute attacks, severity of symptoms, current medication, and whether good support is available at home all must be taken into account.

Referral to an asthma specialist should be considered if:

• There has been a life-threatening asthma attack or severe, persistent asthma.
• Treatment for three to six months has been ineffective.
• Another condition, such as nasal polyps or chronic lung disease, is complicating asthma.
• Special tests, such as allergy skin testing or an allergen challenge are needed.
• Intensive steroid therapy has been necessary.

Special populations

INFANTS AND YOUNG CHILDREN. It is especially important to monitor the course of asthma in young patients so that treatment may be diminished or increased as necessary. The health care provider should write out an asthma treatment plan for the child's school. Although asthmatic children often need medication at school to control acute symptoms or to prevent exercise-induced attacks, proper management usually enables a child to take part in physical activities. Only as a last resort should activities be limited.

OLDER ADULTS. Side effects from beta-receptor agonist drugs (including rapid heart rate and tremor) may be more common in older patients. These patients may benefit from receiving an anti-cholinergic drug along with the beta-receptor agonist. If theophylline is given, the dose should be carefully monitored, as older patients may be less able to metabolize this drug. Asthma in older patients may also be complicated by other obstructive lung diseases such as chronic bronchitis or emphysema. It is important to know the extent the symptoms caused by the asthma. A two-to three-week course of steroids can help determine which symptoms are attributable to asthma.

Prognosis

Once the best drug or combination of drugs is found, most patients with asthma respond well and are able to lead relatively normal lives. More than half of affected children stop having attacks by the time they reach twenty-one. Many others have less frequent and less severe attacks as they grow older. In either case ongoing treatment to prevent attacks and urgent measures to control them if they occur are equally important. A small minority of patients will have progressive difficulties breathing. These patients are at risk for respiratory failure and must receive intensive treatment.

Health care team roles

Diagnosis and effective asthma management involve cooperation and collaboration between the patient, family, and an interdisciplinary team of health care professionals. These include the patient's primary health care provider, allergy and immunology specialists, nurses, laboratory technologists, respiratory therapists, pharmacists, pharmacy assistants, and health educators are involved in helping patients and families gain an understanding of how to manage this chronic disease.