Surviving
Asthma Season
By: Dr.
Stefanie Kelley
September 2002
It's asthma season! But for some
people with asthma - it may seem like it is always asthma season. Asthma
patients with increasing use of short-acting inhalers (beta2-agonist) or
increasing asthma exacerbations signal the need to review medication techniques
and use, and evaluate environmental triggers. In fact, using greater than
two canisters a month of short-acting inhalers or experiencing three or
more emergency care visits for asthma in the past 12 months are two potentially
fatal risk factors (National Asthma Education and Prevention Program). For
children with asthma, the National Asthma Education and Prevention Program
(1997) recommends a follow-up appointment with a primary care provider within
3-5 days after an emergency room visit for an exacerbation of asthma. However,
recent studies show that less than half of these patients follow-up with
their providers and remain in jeopardy of morbidity and mortality due to
poor asthma management (Asthma: The Continuing Problem).
Asthma severity classifications (mild intermittent, mild persistent, moderate
persistent, severe persistent) and a stepwise approach to managing asthma
help health care providers diagnose and treat persons with the disease.
There are 6 goals of therapy for the asthma patient (NAEPP):
 |
Prevent chronic
and troublesome asthma symptoms (for example, coughing or breathlessness
at night, in the early morning or after exertion). |
|
Maintain pulmonary
function that is "normal" or near normal. |
|
Maintain normal
activity levels (including exercise, physical activity, and activities
of daily living). |
|
Minimize the
need for emergency department visits or hospitalizations by preventing
recurrent exacerbations of asthma. |
|
Provide optimal
medication therapy with minimal or no adverse effects. |
|
Develop a plan
of asthma care that meets the patient's and family's expectations.
|
Asthma is not an emotional or episodic illness, but rather a physical
and chronic disease. All patients with asthma should be managed with a
short-acting inhaled beta2-agonist for acute symptoms. Over-the-counter
meter-dosed inhalers are not as effective as prescriptive short-acting
inhaled beta2-agonists and may inhibit a person from seeking prompt, appropriate
medical care. Patients with persistent asthma need to have a daily management
plan, which includes regular medications to keep asthma controlled, and
an action plan for worsening asthma symptoms (AAAAI). The AAAAI has asthma
action plans available on their website: http://www.aaaai.org.
Asthma exacerbations need to be treated promptly and aggressively. All
health care facilities that treat or have the potential to treat an acute
asthma exacerbation need to be prepared for emergency airway management.
These facilities should have a peak
flow meter, a power driven nebulizer,
oxygen,
bag and mask devices to deliver oxygen, and medications such as epinephrine
and antihistamines. (Click
here for School Health Corporation's entire line of Asthma and Allergy
Products)
When worsening asthma symptoms occur at increasing rates, patients and
providers need to assess peak expiratory flow, identify asthma triggers,
and adjust medications to meet the goals of asthma therapy. Peak expiratory
flow monitoring requires effort and skill and is an important part of
daily asthma care. Regular peak flow monitoring should be done in the
morning upon awakening and before using a short-acting bronchodilator.
Patients can also monitor their asthma by comparing morning and late afternoon
peak flow measurements. A greater than 20% difference between morning
measurements or morning and afternoon measurements suggest inadequate
asthma control (AAAAI). Short-term peak flow monitoring, over a 2-3 week
period, is recommended to evaluate asthma patients that do not have consistent
asthma symptom control. Identifying triggers may be as simple as identifying
the projected pollen count, or adjusting exposure to animals and insects.
However, when triggers are difficult to identify or avoid, a referral
to an allergist may assist the control of asthma exacerbations.
Asthma patients that survive "asthma season" without an exacerbation
may ask why they have to take all their medications when they feel fine.
Chances are they feel fine because they are correctly adhering to their
medication plan. The stepwise approach may allow patients to step down
their medication routine if asthma symptoms are controlled for 1-6 months
(AAAAI). If a step down results in an increase in asthma exacerbations,
patients and providers will need to reassess the medication technique
and use, and evaluate the environmental triggers.
Additional information is available from the National
Heart, Lung, and Blood Institute; the American
Academy of Allergy, Asthma, and Immunology.
National Asthma Prevention and
Education Program. (1997). Expert Panel 2: Guidelines for the Diagnosis
and Management of Asthma. (NIH Publication No. 97-4051), Retrieved August
1, 2002, from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
American Academy of Allergy, Asthma, and Immunology. (2000). The Allergy
Report. Retrieved August 1, 2002, from http://www.allergyeducation.org/pdf/volume1.pdf.
Asthma: The continuing problem. (2002). The Nurse Practitioner, 24 (Suppl.6),
2.
Stefanie J. Kelley, ND, RN, CS has been in
the nursing field for over 10 years. She has clinical expertise in general
pediatrics and pediatric hematology, oncology, and bone marrow transplantation.
As a family nurse practitioner she has advanced practice expertise in
internal medicine, urban health care, and general pediatrics. As a faculty
member at Texas A&M University and Case Western Reserve University,
she has taught in the undergraduate and graduate didactic and clinical
portions of nursing. Dr. Kelley's interest in web-based instruction and
health care has been a part of her academic, clinical, and research practice.
|
