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Manage your asthma

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No need to be afraid: An inhaler is the best way to prevent an attack.
No need to be afraid: An inhaler is the best way to prevent an attack.

DR. SANJIVA WIJESINHA

Asthma can be quite dangerous if mismanaged. But it can be controlled if adequate precautions are taken.

Telltale signs The American Academy of Paediatrics has given a list of warning signs that tell you an asthma attack is imminent.Breathing may be difficult and faster than usual. Wheezing, coughing and shortness of breath. Difficulty in breating may affect speech. Skin color may become paler than usual. A decrease in the level of awareness. When drawing in of the muscles between the ribs is necessary to breathe.

ASTHMA is such a common ailment in India but many people who have asthma treat their condition in an irresponsible and haphazard manner. In fact quite a few deny that they have asthma.This is unfortunate, because asthma should be viewed as simply a condition, not a major disease or stigma - and certainly not something of which to be ashamed. It is not a difficult condition to keep under control. However asthma can, if neglected or not managed properly, result in life-threatening situations or even death.

What happens?

When we say that a person has asthma, it means that that person has sensitive lungs or, to be more precise, sensitive bronchi. The bronchi are tubes that convey the air we breathe from the nose and windpipe to the lungs. They are like pipes made of smooth muscle. Like all muscles in the body, these muscle cells can contract when stimulated. Therefore these tubes are able to vary their diameter, thus allowing more (or less) air to flow in and out of the lungs as needed at various times.Unfortunately in a person who has asthma, these air passages are overly sensitive to certain stimuli referred to as allergens or substances present in the air we breathe, substances that get into the body through food or through the skin, and sometimes even emotional stimuli. When exposed to these stimuli, the air tubes suddenly become narrow making it difficult for air to flow into the lungs. The result is difficulty in breathing, with concomitant wheezing and air hunger.This is the simple explanation for asthma, although certain other factors (swelling of the lining of these air tubes as well as production of mucus, both of which can narrow the diameter of the tubes even more) can also contribute to the reduction in airflow.In practical terms, the management of asthma involves two basic steps:a) Preventing the action of allergens stimulating and narrowing the bronchi;b) Relieving this narrowing of the air tubes in case prevention fails.The simplest method of preventing an asthma attack is to keep away from known allergens. For example, if you are allergic to cat fur or cigarette smoke, it would obviously be sensible to keep away from cats and people who smoke. However, avoiding people and things that offend you is easier said than done!

Treatment

So to prevent allergens from causing a spasm and the inflammatory action that results in narrowing of the bronchi, we use certain types of drugs. Among the most effective are the steroids, and the modern management of asthma involves making optimum use of the preventive action of inhaled steroids.The word steroid is one that evokes fear in many because the drugs are associated with images of beefy muscle bound body-builders; masculinised women; of Olympic cheats who died young and obese moonfaced patients. While swallowing or injecting excess steroids into one's body is dangerous, the doses of inhaled steroids prescribed in modern asthma inhalers are too small to have these adverse effects. It is usually recommended that these drugs be taken once or twice a day through an inhaler (also called a puffer). Learning the proper technique of using these inhalers is vital to ensure that one sucks the right dose of drug correctly into the airways. It is important to always wash one's mouth with water after inhalation to make certain that any steroid particles, left in the mouth and throat, are not swallowed. If taken in the right way, inhaled steroids are most effective in minimising the frequency and severity of asthma attacks. In the event of an attack developing despite taking one's preventive medication regularly, a reliever medication is required. A common reliever drug in use worldwide is salbutamol, but there are several in the market today available in the form of inhalers that deliver a measured dose of the drug. These medications exert their effect by relieving the spasm in the bronchial muscles and widening the air tubes, thus allowing more air to flow into and out of the lungs.

Action plan

An important aspect of asthma management these days is to have a written Asthma Action Plan, a copy of which should be kept with the patient or with the parents and teacher if the patient is a child. The purpose of such a written plan is to educate the person with asthma so that he or she knows why they need to take the different medications, how they should take them and when they should take them. The "When" aspect is most important so that they do not neglect to take their preventive medication regularly, and that they know what symptoms indicate that it is time to take a dose of their reliever medication.Of course, having a plan and buying the correct medications prescribed by the doctor are only part of the solution. Far too many people with asthma forget to take their reliever puffers when they leave home or have the puffer in their pocket or handbag but feel embarrassed to take it out and use it even when they feel tightness in the chest.Managing asthma is not difficult if you make the effort to understand your condition, educate yourself about your medications, and ask your doctor to write out a practical Action Plan to follow. Just one more thing: Don't forget to take your medications. The writer is a senior lecturer in the faculty of medicine at Monash University, Melbourne.


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