INTRODUCTION In 1991 the National Institutes of Health (NIH) first released their expert guidelines for asthma care. Few physicians properly follow these guidelines (or their updates) in fact even many "asthma specialists" do a less than perfect job of delivering appropriate care to control asthma. In a family care setting the situation usually becomes even worse. This might be due to a number of factors, the physician: may not know the guidelines, may not understand the guidelines or may feel the guidelines do not apply to their patients. Problems with asthma control result in over one million U.S. emergency room visits every year and the situation is not improving!
THE PROBLEM Appropriate asthma management involves a number of components primarily: preventing/controlling airway inflammation and preventing/controlling airway constriction. Historically only the second component was considered but since 1991 it has been well documented that controlling the inflammation within the respiratory system is equally important in slowing the progression of the disease. In fact, the idea of asthma causing progressive changes to the lungs known as airway remodeling is foreign to many physicians.
GET INVOLVED Although short acting inhalers such as albuterol are needed by all levels of asthma patients for occasional symptomatic relief, patients that are only being treated with an albuterol inhaler probably are not receiving adequate therapy, an exception to this might be exercise induced asthma that often can be controlled with a short acting inhaler. The concept of "no wheeze means no disease" needs to be discarded once and for all! There are a variety of medications that can be used in many combinations for asthma control. A physician properly following the guidelines will be able to correctly identify the appropriate combination of asthma medications for you or your family member. Medications may need to be both increased and decreased over time to maximize asthma control and minimize side effects. Drug therapy for asthma is definitely not 'one size fits all' in fact it needs to be very specifically tailored to your specific condition at any given time. There may not be just one correct therapy choice for you but on the other hand there are certainly a lot of wrong choices that your health care provider can make. Learn as much as you can about what is currently considered 'state of the art' asthma care and don't be afraid to share what you learn with your physician. Be your own health advocate silence can cost you your health! You have nothing to lose and much to gain be becoming involved in your own care plan. Knowledge is power!
PEAK FLOW METERS Every asthmatic should have and know how to properly use a peak flow meter. Peak flow meters are very much underused! Changes in the results when using a peak flow meter can occur many days prior to a patient being able to detect a worsening condition thereby allowing time to adjust the therapy to possibly prevent an exacerbation or attack. You may be able to set up a program with your physician whereby you will adjust your medications based on peak flow reading and even begin a short course of steroids such as prednisone if the readings warrant this (you would report starting the medication to your doctor but you would not wait for the physicians OK before beginning it- thereby saving precious time in getting your attack under control). One problem that we have seen with peak flow meter training is very simple but critical: you must be standing (unless unable) to properly do the test. A peak flow reading taken while seated is going to be inaccurate!
Although as current and accurate as possible, the information contained in this article or provided to you by the author in an email or other manner, may not relate to your particular medical condition and is not intended to be used in the diagnosis or treatment of any specific medical condition. Always refer to your healthcare provider before making any changes in your medications or any other aspect of your treatment plan.
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