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post in: Lifestyle Date:05 Oct 2017, 06:35 views:2251
The current guidelines emphasize 4 important components of asthma care, as follows 2 : Assessment and monitoring, education, control of environmental factors and comorbid conditions. Pharmacologic treatment, assessment and monitoring, once the patient's condition is classified and therapy has been initiated, continual assessment is important for disease control.
Asthma control is defined as "the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met." 2, asthma can be classified as well controlled, not well controlled, or very poorly controlled; classification criteria vary by patient. In order to assess asthma control and adjust therapy, impairment and risk must be assessed. Assessment of impairment focuses on the frequency and intensity of symptoms and the functional limitations associated with these symptoms.
Risk assessment focuses on the likelihood of asthma exacerbations, adverse effects from medications, and the likelihood of the progression of lung function decline; spirometry should be measured every 1-2 years, or more frequently for uncontrolled asthma.
Because asthma varies over time, follow-up every 2-6 weeks is initially necessary (when gaining control of the disease) and then every 1-6 months thereafter. Patient education continues to be important in all children areas of medicine and is particularly important in asthma. Self-management education should focus on teaching patients the importance of recognizing their own their level of control and signs of progressively asthma worsening asthma symptoms.
Both peak flow monitoring and symptom monitoring have been shown to be equally effective; however, peak flow monitoring may be more helpful in cases in which patients have a history of difficulty in perceiving symptoms, a history of severe exacerbations, or moderate-to-severe asthma.
Educational strategies should also focus on environmental control and avoidance strategies and medication use and adherence (eg, correct inhaler techniques and use of other devices). Using a variety of methods to reinforce educational messages is crucial in patient understanding. Providing written asthma action plans in partnership with the patient (making sure to review the differences between long-term control and quick-relief medications education through the involvement of other members of the healthcare team (eg, nurses, pharmacists, physicians and education at all points of care (eg.
Control of environmental factors and comorbid conditions. As mentioned above, environmental exposures and irritants can play a strong role in symptom exacerbations. Therefore, in patients who have persistent asthma, the use of skin testing or in vitro testing to assess sensitivity to perennial indoor allergens is important.
Once the offending allergens are identified, counsel patients on avoidance from these exposures. In addition, education to avoid tobacco smoke (both first-hand and second-hand exposure) is important for patients with asthma. Lastly, comorbid conditions that may affect asthma must be diagnosed and appropriately managed.
These include the following: Bronchopulmonary aspergillosis, gastroesophageal reflux disease (gerd obesity. Obstructive sleep apnea, rhinitis, sinusitis, depression, stress.
Low vitamin D levels, based upon reports of an inverse correlation between low vitamin D levels and asthma control, vitamin D supplementation in children might enhance corticosteroid responses, control atopy, and improve asthma control.