Asthma Treatment

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ASTHMA TREATMENT begins with prevention. This means avoiding things which make you wheeze, and using your preventative inhaler everyday - intal, becotide, pulmicort etc. If you haven't wheezed in six months then a trial off of inhalers can be made.

The next step is learning what your triggers are. When you come into contact with them or expect be near them you can take both your preventative and bronchodilator inhaler before the wheeze has a chance to start. This can completely abort or reduce the severity of a future attack. Common triggers are things like dust, smoke, colds, etc. So for example, if you know that smoke makes you wheeze and you were planning to attend a night club, before going you should take two puffs of both your preventative and bronchodilator inhalers.

Thirdly, is keeping away your triggers. This means keeping pets outside if allergic to furs, removing carpets and regular vacuuming if allergic to dust e.t.c.

Hospital

Most hospitals have a section specialized for asthma treatment. When you get there you typically are first assessed by an attendant listening to your chest, taking your vitals and by asking you to blow into a peak flow meter (PEFM).

After taking a deep breath you place your mouth over (1) a card cylinder and blow out as hard as you can which forces an arrow along a scale (2). How far you pushed it is compared to how far you should be able to for your age and height and helps to determine how bad your attack is, and when repeated after treatment, how well you have responded.

If you are a mild to moderate wheezer, you are placed on a nebulizer with oxygen to help your breathing, and a bronchodilator to open your airways. Periodically you are then reassessed by listening to your chest with a stethoscope and repeating the PEFM. In my center, after 9 nebulizations in an adult with unsatisfactory improvement, a chest xray is done to rule out other causes of wheezing that are treated differently to asthma and admission to the hospital for overnight nebulization and observation considered. In children after 6 nebulizations, we order a chest xray and refer to a pediatrician for admission where nebulizations will be continued at decreasing intervals overnight.

Severe cases are usually immediately obvious. These persons come in unable to carry on a conversation, their whole body shakes as they try to breathe, they can't pause to blow on the PEFM or score very poorly and their chest sounds like a tornado. These patients are treated much more aggressively.

If the person has reached the point that they are no longer able to breathe, a tube attached to an artificial lung is inserted through their mouth into their windpipe and the machine continues to breathe for them. In other cases nebulizations are carried out as before (1), blood tests are done (2) one of these being from an artery in the forearm to measure the levels of gases such as oxygen circulating (3). A drip is also set up and injectable bronchodilators such as aminophylline given (4). Oxygenation of the blood can also be determined with a finger probe (5). Periodic reviews are done as before, and if poorly responding these persons are admitted to hospital for longer observation and care.

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