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Asthma

The control medications should be taken everyday to maintain the airways and prevent an attack of asthma. The medication used primarily, serves to maintain the normal diameter of the airways and control airway inflammation. The two major groups of medications used in controlling asthma are anti- inflammatories (corticosteroids) and bronchodilators.  Here a machine is used for helping with the inhalation and is reserved for patients who are unable to use MDI's because of difficulties with coordination, example small children or mentally retarded people. The machine helps in creating a mist out of the asthma drug, making it easy and pleasant to breath the drug into the lungs. A small compressor converts the drug into an aerosol mist, which travels through a hose with a mouthpiece attached. By taking deep breaths, the medicine is delivered into the lungs. Treatment to 'cure asthma' has been made by many alternative practitioners of medicine. How far these claims can be substantiated is unknown. Most doctors are a bit weary about these tall claims. 'Fish medicine' is one such claim. Similar claims are made by Chinese and Buddhist system of medicine. Normally one can try these medicines if they wish, however without stopping the inhalers and nebulizer as prescribed by the doctors. More integrated research is required between traditional and allopathic medicine before any conclusions can be safely made.

How can we diagnose Asthma ? Answer Below Given
Blood analysis may show increase in the number of eosinophils (Eosinophil is a specific type of white blood cell that increases in allergic reactions).
 Sputum examination may show increased eosinophils 
 The level of a certain antibodies can be elevated.
Arterial blood gas analysis shows decreased oxygen concentration in blood.
 
Pulmonary function tests (lung function tests) are helpful in judging severity of airway obstruction. To do this test a spirometer is used and the test is often called spirometery . A spirometer is an instrument that measures the maximum volume one can exhale after breathing in as much as one can .There are various values that are calculated and the interpretation of the test is done looking at a combination of values. Some of the common values looked at are as follows:

Forced Vital Capacity: or FVC: This is the total volume of air one can exhale after breathing in as much as one can inhale

Forced Expiratory Volume in One Second, or FEV1: This measures the volume of air one can exhale in the first second. In general, the more air you breath out during the first second of a full exhalation, the better.   

How can Asthma be treated
Remember asthma cannot be completely cured but can be prevented. Treatment of asthma can be divided into two broad categories:

1. Treatment of Acute attacks of asthma using quick-relief 
medications.
 
2. Long Term treatment strategies

Treating an Acute attack of asthma:
The quick-relief medications work by relaxing bronchial smooth muscle and are called broncho-dilators. These can reverse an acute attack in a short time. 

During an acute attack of Asthma the following should be done:

Always keep your blue inhaler with you.
Take a puff from the inhaler
Loosen any tight clothing and sit-up.
Open the windows of the room if room is warm and humid.
If no immediate improvement felt during an attack, continue to take one puff of inhaler every minute for 3 to 5 minutes or until symptoms improve. 
If your symptoms do not improve in five minutes or if you are in doubt, call your doctor or visit the nearest hospital

Spacer: This device works with MDI to deliver medication more easily and effectively. It also reduces side effects of MDI. When an MDI is used , some medicine is left in the mouth and throat. This results in some wastage of the dose and can cause an unpleasant aftertaste. Spacers hold the "puff" of medicine between the patient and the MDI, so that it can be inhaled slowly and more effectively. For small children a comfortable mask can be added to the spacer.

Anti-inflammatories - are used to reduce the risk of acute asthma attacks. These agents work by reducing the number of inflammatory cells in the airways. The drug prevents blood vessels from leaking fluid into the airway tissues and helps in reducing the spontaneous spasm of the airway muscle.

The most common drug is a corticosteroids. These are given in two ways - inhaled via a metered dose inhaler (MDI) or orally as a pill or tablet or in liquid form. The inhaled corticosteroids are usually a beclomethasone or flunisolide or triamcinolone preparation of steroids. The oral corticosteroids are usually prednisone group of steroid. Liquid forms are usually used for children with asthma. 
Other anti-inflammatory drugs that are useful include:
 
- Cromolyn sodium 
- Nedrocromil
A new class of anti-inflammatories called leukotriene inhibitors work by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle cells lining the airways. These drugs are intended for long-term use as they prevent rather than reduce symptoms of asthma. The Food and Drug Administration (FDA) approved two drugs called 
 
- Zafirlukast
- Zileuton

Bronchodilators: These drugs work by increasing the diameter of the air passages of the lungs and hence ease the free flow of gases to and from the lungs. They come in two basic forms ? short-acting and long-acting.

The short-acting bronchodilators drugs help to relieve symptoms during acute asthma attacks and include:

- Metaproterenol
- Ephedrine
- Terbutaline
- Albuterol.

The long-acting bronchodilators are used sometimes to control symptoms in special circumstances e.g. during spring when the pollen counts are likely to be high or during sleep to avoid an attack of asthma. 

These include:
 
- Salmeterol
- Metaproterenol 
- Theophylline
- Atropine

Theophylline is usually taken orally whereas others can be inhaled. 
Atropine sulfate is another highly effective bronchodilator. Immunotherapy (Anti-allergy shots) may also help some individuals. Immunotherapy involves the injection of extracts of allergens to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing.Monitoring Lung Function regularly
Monitoring Lung Infection Lung function decreases usually about two to three days? prior to an asthma attack - If the asthmatics learns how to use a peak flow meter to gauge their lung function, they can predict an attack themselves. If the meter indicates the peak flow to be down by 20 percent or more from the usual reading , an asthma attack may be on its way. 
Peak flow meters can be purchased and are easy to use. 
Regular follow-up visits (at least every six months) to the doctor are important to maintain asthma control and to reassess medication requirements.

Disclaimer - The contents of this site are for informational purposes only. Always seek the advice of a qualified physician for any doubts. 
 

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