Outpatient Treatment of Asthma

Outpatient Treatment of Asthma

Asthma is a disease of the airways characterized by three problems obstruction, inflammation and hyperresponsiveness. Asthma requires ongoing medical care.

According to the report of the Guidelines for the Management of Asthma Diagnosis y0 (for physicians) issued by the National Asthma Education, asthma has four phases:

The use of objective measures of lung function (spirometry, peak expiratory flow) to assess the severity of asthma and to monitor the course of treatment.

Drug treatment designed to reverse and prevent the inflammatory component of the airways in asthma treat bronchospasm addition of airways;

Environmental control measures to avoid or eliminate factors that induce or trigger asthma exacerbations, also considering as an alternative to immunotherapy in selected cases;

Truthful information to the patient on Asthma (Medical Education), which involves the doctor (as a promoter), the patient and his family.

According to these guidelines, there are five targets for effective asthma treatment:

•    To achieve and maintain levels (almost) optimal pulmonary function indices
•    Achieve and maintain normal activity levels, including exercise
•    Controlling chronic and troublesome symptoms (eg., Cough or shortness of breath at night, early in the morning or after exertion)
•    Preventing acute relapses (episodes) Recurring asthma;

Avoid adverse effects from asthma medications.

There are generally two groups of drugs to treat asthma: anti-inflammatory drugs and bronchodilators.
Anti-Inflammatory Drugs

Anti-inflammatory agents stop and help prevent the development of inflammation in the airways, these include corticosteroids, cromoglycate, the nedocromil, and, lately, the anti-leukotrienes.

Corticosteroids

Corticosteroids are anti-inflammatory drugs more effective for treating asthma. Corticosteroids may be administered orally or inhaled.

Generally the oral form is used for short periods of time when the patient's asthma is out of control. The likely effects of prolonged use very frequent or long-term effects include weight gain, elevated blood pressure, cataracts, bone weakness, muscle weakness and swelling (edema).
Inhaled corticosteroids are safe and effective for the treatment of asthma. Since this drug acts on the inflammatory phase of asthma, is used as first-line drug for moderate and severe asthma. Possible side effects include candidiasis (a type of fungus or "thrush") in the mouth and throat, and occasional cough caused by the aerosol device.

Cromolyn Sodium and Nedocromil

Sodium cromoglycate and nedocromil are drugs less anti-inflammatory effect than steroids. They serve as preventive inhaled directly into the lungs to prevent immediate and delayed symptoms. They work by stopping the effects of environmental allergens or irritants (including exercise and exposure to cold air and sulfur dioxide).

Not for oral use. Sodium cromoglycate is in the form of inhalable powder to be used with a rotary inhaler device, there is also a liquid for use with nebulizers and a form of metered dose aerosol. The nedocromil comes as a metered dose aerosol only. These two medications do not have serious side effects.

Anti-Leukotrienes

Is a relatively new group of drugs that act in one phase of the inflammatory process, inhibiting the production or blocking the effects of leukotrienes, which are highly potent chemical mediators of inflammation in asthma. It has already approved its use for mild to moderate asthmas as continuous use preventive medications.

Bronchodilators

The main role of bronchodilators is to open the airway relaxes the bronchial muscle. The two main types of bronchodilators are beta-adrenergic agonists (beta2-agonists) and methylxanthines (theophylline). Another group of minor anticholinergics are occasionally used for asthma.

Beta Adrenergic Agonists

Beta2 adrenergic agonists act by relaxing the muscle of the airway to assist in the control of persistent narrowing of the airways. They are adrenaline-like drugs that can be administered in oral (syrup or tablets), by nebulization, metered dose aerosol or by injection.
The injections are used primarily in emergency situations. Inhaled beta2 agonists are the drug of choice for treatment of acute asthma outbreaks and to prevent exercise-induced asthma.

Methylxanthines

Theophylline is the main methylxanthine used for the treatment of asthma. It serves as a bronchodilator in mild to moderate power. The sustained release formulation is useful for controlling nocturnal asthma. It is used sometimes associated with beta2 agonists for greater bronchodilation. It can also help reduce muscle fatigue and has some anti-inflammatory benefits. The main drawback is that theophyllines are common side effects, including abdominal pain, nausea, vomiting, nervousness and insomnia.

Immunotherapy

Immunotherapy (allergy shots) is a treatment method scientifically tested and approved for use in moderate or severe Allergic Asmas when the combined use of drugs and environmental control measures do not achieve the goals set out at the beginning. Comprises injection of small amounts of allergen to the patient. This helps create tolerance or resistance (permanent or temporary) to the allergens that cause asthma exacerbations. Allergen concentrations increase with the passage of time up to a limit, to reduce or eliminate the patient's allergy symptoms.

Environmental Measures

Between 75% and 85% of patients with asthma have varying types and degrees of allergies. This reinforces the concept that the control of allergies will be beneficial for allergic asthma patient. To prevent allergic reactions, are essential environmental control measures to reduce exposure to allergens and irritants (chemical or physical) indoors and outdoors.

For outdoor allergens

Reduce exposure to outdoor allergens staying indoors when the pollen count and humidity levels are high, especially on windy days it spread dust and pollen. Minimize early morning activity when pollen is issued more frequently. Keep windows closed, especially at night and preferably use air conditioning, which cleans, cools and dries the air.

For indoor allergens

House dust Components: House dust itself is not an allergen, but what is in it can cause allergic reactions. House dust can be formed of animal allergens (if you are allergic, get rid of all warm-blooded animals in the house), house dust mites (found in mattresses, pillows, carpets, furniture, carpets, blankets, clothing and toys soft) and cockroach allergens.

Mold (fungi) Interior: The interior mold can be found in bathrooms, carpets, basements, kitchens and other wet areas. Allow adequate ventilation and frequent cleaning of these areas. Dehumidifiers shall be fixed in less than 50 percent but 25 percent.

Air Control Devices: There are several devices that help control indoor allergens indoors. These include air conditioners, air cleaning units inside, humidifiers and vacuum cleaners.

The apparatus for cleaning indoor air can be helpful, but even more important is to control the source of allergens. The particulate air filter high efficiency HEPA is the most effective and can be used in central heating and cooling systems (cooling) or independent power.

Vacuums can spread allergens during use, therefore allergic patients should wear a mask when vacuuming. There HEPA filters that can adapt to some brands of vacuum cleaner.

Humidifiers are important sources of mold growth if not cleaned properly. Placing the high moisture level, promotes growth of fungi. Put the unit level between 25 and 50 percent humidity.

Other irritants: There are other irritants that can cause exacerbations in patients with asthma. These include snuff smoke, smoke from wood stoves, strong smells, aerosols and air pollutants, including ozone and sulfur dioxide.

It is essential that all patients with Asthma dagnóstico perform these environmental measures as the most important part of their treatment regimen, which will result in better control, and consequently, in a reduced need for other treatments (drugs or vaccines) .

School Asthma in Children

School Asthma in Children

Since the school is the other child's house, is one of the most important environments to protect children. The school boards should be aware to understand asthma and its impact on the child with asthma. It shall take appropriate steps to meet the needs of these children. Since there are nearly five million children with asthma under 18 years of age in the United States, is a real problem.

So the normally unfold asthmatic child at school, everyone involved (child, family, physician, and school staff) must work together to prevent and / or manage asthma at school. It is important for the child to have a positive and healthy learning environment.

What Should Parents Do?

1.    Parents should alert the school staff about the child's asthma. To do so they must meet with the teacher, the nurse, and perhaps the director, at the beginning of the school year.

2.    Explain that your child has asthma, what medicines should he / she take and the side effects they can have. The asthmatic child should be treated "normal" as that given to other children.

3.    Encourage teachers to allow the child to take their medicine when required without giving too much importance.

Raising Asthma Symptoms

There are common problems facing the child with asthma. One problem is the high absenteeism due to increased asthma symptoms or doctor visits. Rarely teachers send a child home because they think that cough, wheezing, difficulty breathing or colds are "contagious".

A knowledgeable teacher reduces these problems. In some cases, you will need additional tutoring for children with asthma. But at any cost the child should stay in school. Daily activities should be carried out as usual, parents should try to send the child to school even mild symptoms of asthma.

Good communication between parents and school officials allow the child with mild attend school. In order to do this it is necessary that the child can take medicine at school and parents can easily be reached in case of an emergency.

Sometimes, children with asthma use their illness as an excuse for not going to school or participate in school activities specific. Parents and teachers need to recognize this and discourage this behavior.

Medication at School

Take the medication at school can be very difficult since most children with asthma want to hide the need for medications. School authorities also misinformed sometimes make it impossible for the child with asthma take medicines. In other cases some children refuse to go to another school site (school nurse or secretary) to take their medications.

The school officials and parents should create an environment that shows the child with asthma that is acceptable to take your medication at school. With the approval of the physician and parents, the child with asthma can take your dose inhalers (MDI) and use them properly. It should establish the needs of each child with asthma.

Side Effects of Drugs

The side effects of medication can be a real problem. These effects may include headache and tremors, stomach pain, or sleep (also by an attack at midnight, etc..), And these can affect a child's learning ability.

Several of these drugs can also affect the concentration level of the child and can also affect your handwriting. Teachers should be aware that asthma drugs can affect a child's ability to act and / or behave properly. They should inform parents of any problems so they can treat it with appropriate changes in asthma management program of the child (eg drug dose changes, medication changes).

Physical Education and Sports

Participating in physical education and organized sports teams sometimes creates problems in the child with asthma. Proper education of everyone involved should help avoid embarrassment and / or unwillingness to exercise.

By reluctance to separate from their peers, children often avoid going to the school office to use their MDIs before exercise. Allowing children to carry their IDM avoids this problem, and improves participation.

Some environmental conditions (cold, dry air, wind, pollution, high levels of allergens) can cause more asthma symptoms with exercise. The child and teacher / coach should know what medications administered to prevent exercise-induced asthma. It is important to continue an exercise program to prevent or adequately reduce the symptoms of exercise-induced asthma.

Before you start an asthmatic child physical education class at school, the child's doctor must write a letter to the teacher / physical education coach specifying the nature of exercise-induced asthma, prevention techniques, and explain warning signs the asthma management program of the child.
The school must help the asthmatic child to participate in sports and physical education and hope that each one knows his own limitations.

Other Problems

There are other problems that a child with asthma or allergy can be found in school. Sometimes the classroom can be allergens and irritants as pets, dusty carpets, old blackboards or mold. The presence of any allergenic pet in the classroom (hamsters, guinea pigs, mice, rabbits, etc..) Should be discarded.

Adequate ventilation of the classroom is essential, especially when children are working with chemicals for art projects, scientists, etc.. Sometimes, to avoid these scents is necessary for the child changes classrooms.

Some children with nasal allergies are associated ear problems which may interfere with your hearing. It should teach the teachers to find evidence of hearing loss, including inattention, trouble following directions, behavioral changes and signs of deteriorating job performance.

Some children with asthma and allergies who have severe sensitivity or allergy to food or food preservatives. These children need their parents to discuss any problems expected with the cafeteria staff. Some days the cafeteria will have to give some alternative food or the child will need to bring your own food.

It takes teamwork to function normally asthmatic children in school. The family, the school staff and the child with asthma should work together. This team effort will help create a positive and healthy environment for the child.

What will confirm the diagnosis of asthma in children?

What will confirm the diagnosis of asthma in children?

Medical history

The doctor will seriously consider a diagnosis of asthma if the child has a history of periodic attacks of breathlessness, coughing and wheezing, perhaps accompanied by chest tightness. Parents should describe the pattern of symptoms and possible precipitation factors, including whether the episodes often occur at night, if they are more frequent during spring or fall (common allergy seasons), and if the exercise , a respiratory infection or exposure to cold air has ever triggered an attack. The doctor should be informed about any family member have a history of allergic disorders such as eczema, urticaria or rhinitis (inflammation of the nasal passages).

Pulmonary function tests

If asthma is suspected, the doctor will usually perform pulmonary function tests to confirm the diagnosis and determine the severity of the disease. Using a spirometer, an instrument that measures the air taken in and exhaled through the lungs, the doctor will determine several values: (1) vital capacity (VC acronym in English), which is the maximum volume of air that can be inhaled or exhaled , (2) the rate of peak expiratory flow rate (PEFR, by acronym in English), which is the maximum flow rate that can be generated during a forced exhalation, (3) and forced expiratory volume (FEV1 acronym English), which is the maximum volume of air expired in one second. During an attack. reducing airway FEV1 and PEFR decrease.

If these measurements indicate that a degree of airway obstruction is present, the doctor may administer a bronchodilator (a drug that opens the airways) and then measure lung function again - revocation of obstruction confirms a diagnosis of asthma . If there are no signs of airflow obstruction when the patient is examined, the doctor may perform a challenge test by administering a drug (histamine or methacholine) to induce an increase in airway resistance. A positive response to this test indicates that the child has asthma.

Diagnosis of exercise-induced asthma

A simple test can be used to examine the exercise-induced asthma in a school or medical office. After breathing into a spirometer, the child up and down a step until a heart rate of 150-200 beats per minute is maintained, detected with a monitor attached to the child's chest. After three and ten minutes, the child is breathing into the spirometer, if FEV1 has fallen over 15%, asthma is suspected and the child is referred to an asthma specialist.

Laboratory tests

The doctor may also perform additional tests to rule out other diseases or for more information about the causes of asthma in children. Such tests may include chest X-rays and sinus, complete blood count, sputum examination for the presence of eosinophils (white blood cells that are highly characteristic of asthma) and skin tests to measure the child's response to inhaled allergens common.