विवरण
The management of bronchial asthma focuses on controlling and alleviating symptoms to improve a patient's quality of life. This involves two key components: long-term control and quick-relief (rescue) medications. Long-term control medications, often in the form of inhaled corticosteroids or leukotriene modifiers, are used to reduce airway inflammation and prevent asthma symptoms. Quick-relief medications, such as short-acting beta-agonists, provide immediate relief during asthma attacks. Patients also benefit from creating an asthma action plan, which includes monitoring symptoms, recognizing triggers, and knowing when to seek medical help. A collaborative approach between healthcare providers and patients is essential in tailoring the treatment plan to individual needs and ensuring optimal asthma management.
सारांश
- Bronchial asthma is on the rise due to environmental and lifestyle changes. Guidelines are updated annually by the Global Initiative for Asthma (GINA), established in 1993 by WHO and NHLBI, emphasizing prevention and management. Goals include minimal symptoms, no sleep disturbance or exercise limitation, normal lung function, preventing flare-ups and deaths, and minimizing side effects, particularly from oral corticosteroids.
- Patient management involves reviewing symptoms, exacerbations, side effects, lung function, and comorbidities. Assessing patient satisfaction is crucial for adherence to medication. After review, diagnosis is confirmed, symptom control assessed, modifiable risk factors identified, and inhaler technique evaluated. Therapy is tailored to each patient, including non-pharmacological strategies like yoga and physiotherapy.
- The GINA 2023 guidelines emphasize Track One, using a controller and reliever medicine. Mild asthmatics are managed with as-needed low-dose inhaled corticosteroid (ICS) and formoterol combination. For uncontrolled symptoms, the approach moves to a low-dose ICS formoterol maintenance dose twice daily, and further adjustments are made if needed.
- Track One uses a single inhaler for both maintenance and relief. This simplifies treatment, addressing issues with patients forgetting or not carrying separate inhalers. The shift away from short-acting beta-2 agonists (SABA) is due to observed adverse effects, including increased mortality, in long-term SABA-only therapy.
- Inhaler technique is crucial for effective asthma management. Metered-dose inhalers with spacers are generally preferred, but dry powder inhalers or nebulizers are alternatives. Regular reassessment of inhaler technique and patient adherence is necessary. Proper inhaler choice involves medicine type, availability, ease of use, and environmental impact.
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