MANAGING CHRONIC ILLNESS: ASTHMA

Managing Asthma

Asthma sufferers experience inflamed and hyperactive airways which cause temporary blockage and difficulty breathing. Asthma is a long-term disease which can progress over time. Asthmatics are sensitive to a number of "triggers" which lead to difficulty breathing. An estimated 17.3 million people suffer from asthma, with 4.8 million being children. Asthma costs exceed 14.5 billion dollars annually, including nearly 500,000 hospitalizations a year.

There is no cure for asthma, only maintaining control. To obtain and maintain control of asthma, members need to be encouraged and supported in their treatment plan. Q-elements' Asthma Disease Management program provides members with access to a Registered Nurse who maintains regular contact with the member and provides the following services:

  • education related to disease process and complications
  • compliance with treatment plan
  • access to community resources
  • creation of individualized goals
  • promotion of self management and problem solving skills
  • methods of stress reduction
  • coordination of care
  • focus on quality of life

The benefits of preventing and managing asthma include:

  • decreased emergency room visits and hospitalizations
  • increased work and school attendance
  • healthier environment
  • improved quality of life

Goals of Asthma Therapy

  • Prevent chronic and troublesome symptoms (i.e., coughing, morning or evening breathlessness or trouble after exercise).
  • Maintain (near) normal pulmonary function.
  • Maintain normal activity levels (including exercise).
  • Prevent recurrent worsening of the asthma and minimize the need for ER visits or hospitalization.
  • Use the best treatment for each patient and minimize side effects.
  • Meet patients’ and families’ expectations of and satisfaction with asthma care.

Monitoring Signs and Symptoms

Patients should monitor themselves by asking these questions:

  • Have you had problems with coughing, wheezing, shortness of breath, or chest tightness during the day?
  • Have you awakened at night because of coughing or other asthma symptoms?
  • Have you awakened with asthma symptoms that did not improve within 15 minutes of inhaling a short-acting beta2-agonist (such as Proventil, Ventolin , or Albuterol)?
  • Have you had symptoms while exercising or playing?

Monitoring Pulmonary Function

Peak Flow Meters are the preferred method of monitoring pulmonary function in asthma patients. Patients with moderate to severe asthma such as those who are on daily asthma medications or require frequent ER or hospital visits should be considered for Peak Flow Meter monitoring. The appropriate way to perform Peak Flow Meter monitoring is:

Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the numbered scale (0 or the lowest number on the scale).
Step 2: Stand up straight. Remove gum or food from your mouth. Take a deep breath (as deep as you can) and put the mouthpiece of the Peak Flow Meter into your mouth. Close your lips tightly around the mouthpiece keeping your tongue away from the mouthpiece. Blow as hard and as quickly as possible. Blow a “fast hard blast” rather than “ slow blowing” until you have emptied all the air you can from your lungs.
Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.
Step 4: Repeat the entire routine three times. (You know you have done the procedure correctly when the numbers from all three tries are very close together.)
Step 5: Record the highest of the three ratings. IMPORTANT: Do not calculate as average.
Step 6: Measure your Peak Flow Rate close to the same time each day. The most common times recommended are between 7:00 and 9:00 AM and 6:00 and 8:00 PM. You may measure before or after your medicine, but try to do it the same way each time.
Step 7: Keep a chart of your Peak Flow Rates and discuss them with your doctor.

Managing Peak Flow Rates

A “normal” Peak Flow Rate is based on a person’s age, height, sex and race. Each person’s own “normal” is best determined by using the Peak Flow Meter as described above. Once a person has determined his usual range, he can then monitor for change. A normal Peak Flow Rate can vary as much as 20 percent. Once you have learned your usual and expected Peak Flow Rate, you will be able to better recognize changes or trends. Three zones of measurement are commonly used to interpret Peak Flow Rates: Green, Yellow and Red.

GREEN ZONE: 80-100 percent of your normal Peak Flow Rate signals all clear. Stay on your current asthma regimen.

YELLOW ZONE: 50-80 percent of your normal Peak Flow Rate signals caution. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, and how or when you use your prescribed medications. To be safe, call your doctor

RED ZONE: Less than 50 percent of your normal Peak Flow Rates signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Contact your doctor now! The doctor can tell you what treatment to start.

The American Lung Association can also provide useful information. They may be contacted at 1-800-LUNG-USA (1-800-586-4872) or on their web site www.lungusa.org.

Asthma Medications and Use

Listed below are the recommendations for the drug treatment of asthma. These have been compiled from several sources. A short bibliography is included at the end. Future letters will address the evaluation of asthma including self-monitoring by patients.

In patients with only intermittent symptoms (requiring treatment 3 or fewer days a week) a beta agonist inhaler such as albuterol (Proventil or Ventolin) is the most appropriate treatment.

Patients who require treatment more than 3 days a week should begin on an inhaled steroid such as beclomethasone (Beclovent or Vanceril), flunisolide (Aerobid), fluticasone (Flovent) or triamcinolone (Azmacort). Each of these is best used with a spacer on the inhaler.

Patients requiring medications beyond inhaled steroids should add a short (albuterol) or long acting beta agonist such as salmeterol (Serevent). Serevent may be more effective in long term use and is particularly useful in exercise induced asthma.

The next addition should be a leukotriene antagonist such as montelukast (Singulair) or zarfirlukast (Accolate).

Theophylline is generally considered the next step. Levels should be carefully monitored. Many experts do not use theophylline in most patients.

Oral steroids such as prednisone are the final outpatient step. Patients requiring parenteral steroids should be considered for hospitalization.

References For Those With Asthma

AMERICAN LUNG ASSOCIATION
NATIONAL INSTITUTE OF HEALTH, NATIONAL HEART LUNG AND BLOOD INSTITUTE
NATIONAL INSTITUTES OF HEALTH, MEDLINEPLUS
ASTHMA AND ALLERGY FOUNDATION