In this blog we will briefly review the asthma action plan or different techniques one may use to control and manage asthma, better understand one’s own health with goal of prevention of asthma attack thereby helping control of asthma, decreasing need for medications, and decreasing exacerbation of asthma.  This blog gives a general guideline and one may want to talk to their physician to better understand and coordinate the plan.

Also, different asthma action plans can be found on line for further developing your own plan and coordinate with the family member in case of an emergency on how it needs to be tackled.

  1. Understanding ones own asthma. Have a clear picture from a physician whether the asthma is mild, moderate or severe. Understand the use of medications an correct inhaler technique. Know the difference between a maintenance inhaler and rescue inhaler or nebulizer. How frequently it can be used and what is the maximum dose in 24 hours. Are there other associated conditions with asthma that have been triggered such as postnasal drip, heartburn, etc.
  1. Understand which inhalers your physician has recommended, and what is the regular dose. Is it twice a day? Is it once a day? Or, does it need to be used every 4 hours as needed? For example, Advair Diskus, Symbicort inhaler, Dulera inhaler are twice a day inhalers, but Albuterol inhaler as a rescue can be used every 4 to 6 hours if needed. Singular may be a once a day medication. Rinsing the mouth afte  the use of inhalers may help in preventing oral thrush.
  1. Family plan. Have a documented family plan with the family members if the asthma
    gets worse, and how it should be tackled. In mild situations, the primary care can be contacted.  How will moderate to severe asthma  situations be tackled? Through primary care or the Emergency Room?  Have this be clear with the primary care and family members, and what are the steps that can be taken to prevent an  Emergency Room visit.
  1. Prevention of exacerbation of asthma. Find out different triggers that have been exacerbating the symptoms like allergies, increasing the dripping and asthma symptoms, wheezing, smoking, smoke exposure directly or indirectly.  If one is smoking then he/she needs to quit and at the same time prevent second hand smoke exposure, perfumes, cologne, etc., one needs to avoid this contact.  If someone is working with dust or chemicals use a mask to prevent or to avoid symptoms altogether to avoid this kind of work exposure.
  1. Peak flow meter. One may want to have a peak flow meter, which may have a green, yellow and red zone.  Monitoring the peak flow may help to understand the severity of asthma and once there is  change in the color may contact primary care.  Example: A person with a peak flow in the green zone and if changes to
    yellow zone may be a sign to contact a primary care.
  1. Asthma education. Obtain asthma education through the primary care, other sources like the internet, and educational books and material that provide a basic
    education for asthma.  Also, there  are foods that may trigger bronchospasm like yogurt, dairy products, cold water,  cold drinks, cola, chocholate  etc., which may be avoided. Fruits like bananas may trigger asthma or nasal congestion symptoms  in many that may want to be avoided. Speak to your doctor about a change in diet before making any  dietary changes.
  1. Log of symptoms, inhalers. Keep a regular log of symptoms like wheezing, coughing, postnasal drip, gastroesophageal reflux disease, sleep symptoms one has and how frequent they are. Also, get input from the family members as many times the one coughing is not aware about the coughing, but the family member is aware. Also, keep a regular log of use of rescue inhaler and review with the primary care or  your lung doctor if you have one.
  1. Sleep symptoms. Are asthma symptoms waking you up at night? How frequent is
    it? Is there nighttime use of inhalers? Are you coughing and wheezing? As asthma improves, the symptoms should  resolve and one should be able to sleep regularly.
  1. Exercise. Regular exercise further helps to control asthma. If someone has exercise-induced asthma, may use a rescue inhaler prior to that. Before you start an  exercise program, check with your primary care.
  1. Pranayama / yoga. Many breathing exercises such as slow deep breathing, alternated nostril breathing if done correctly over a period or time may further
    decrease bronchospasm. If one is interested, he/she may learn many of the simple yoga exercises and by doing it may further help control asthma symptoms along with good sleep, regular exercise, avoiding the triggers of asthma, and remaining vigilant  about the symptoms and its prevention.

11.    Acute infection: In the event of an acute respiratory tract infection, see your primary           care on an urgent basis or if there is an increase in severe symptoms call 9-1-1 or go          to the nearest Emergency Room.

This is a general action plan or something similar one may develop. There are many different states which provide an asthma action plan or one may visit the Center of Disease Control Intervention website for different asthma plan and do ones own research.  This is a general guideline that we have seen that has helped our patients and have found
useful. Please contact your primary care or your pulmonologist and review the asthma plan with your healthcare provider and make appropriate changes as they recommend.
I hope some of these simple measures as stated above help your asthma or someone you may share this information.

Best wishes!

10 Helpful Tips For Bronchial Asthma Patients This Winter Season

In this blog we will see bronchial asthma and its management aspect of the disease with asthma prevention tips. Winter months for many bronchial asthma patients is the rough time of the year, as well as for some asthma patients the spring and or fall is a tough time.  A few helpful tips may help understand the asthma disease process, understanding your asthma symptoms; plan the asthma care to prevent exacerbation of asthma symptoms.

1. Update Doctor Visit: Have a Doctor visit if not done recently this fall, especially if you have moderate to severe bronchial asthma. Get checked by your physician if not done recently to adjust your inhalers, nebulizers and medications, flu vaccination and follow the recommendations of your physician. Make sure you have enough refills on your medication.

2. Emergency Prescription: Have a prescription of antibiotic and steroid handy if you have severe persistent bronchial asthma.  Based on the severity of underlying asthma, it may be good to have a prescription of an antibiotic and prednisone handy especially if you have an exacerbation of symptoms on the holiday or weekend and doctor may not be available right away.  In mild cases discuss such plan with your doctor for medication to be called in to the pharmacy.

3. Know your medication: Understand your medications, read about the inhalers you are taking.  Know the normal dose, frequency and maximum dose allowed in 24 hours.  Know the precautions which need to be taken, like with inhaled steroids, the need to rinse the mouth after use.  Understand the side effects of the medication. This is a key of asthma management.  Report side effects if you get to your health care provider. Know your treatments of asthma that you are getting from your health care provider. Similarly the treatments for asthma that you have received before. With this understanding will help you understand your disease process. Example once you needed the tapering steroids when you were sick was given for your asthma exacerbation. If you are taking long acting bronchodilator with the inhaled steroids and it is the ongoing treatment for your asthma to control asthma symptoms.

4. Peak flow meter: Get a pick flow meter if you don’t have and do peak flow meter reading and keep a log of your peek flow.  If there is a change in your peek flows inform your health care provider. Many peak flow meters will have green, yellow and red zone and keep track of it. With the change in the zone or change in peak flow by more than 100 inform your physician.

5. Simple Precautions to take: Wash your hands frequently; this will prevent germs from passing from one person to another person. Stay away from sick people.  If you know someone is sick avoid contact with them as much as possible, as this will prevent exposure and exacerbation of the symptoms.  Cover your face when coughing.  This prevents germs being spread through the air and other people being exposed if you are sick.

6. Urgent treatment for bronchial asthma: Get urgently treated with the onset of cold symptom, bronchitis, early pneumonia symptoms. Know your asthma symptoms and especially if someone in the family feels that it has changed don’t ignore it. It needs to be controlled.    If you get cold or respiratory symptoms contact your doctor to see if an antibiotic is needed or whether a change of inhalers may be needed would be adequate or if there is a need for steroids. See plan #2 and discuss with your doctor before you get sick.

7. Bronchial Asthma education.  Learn about the disease, exacerbation factors, and prevention and how to control.  Get familiar with asthma symptoms. Night time cough is a very common symptom of asthma not under control or its onset is a good of worsening asthma clue which most people don’t think. They think of wheezing which comes later and cough is a common symptom of asthma. Need for night time use of the inhaler means that the asthma symptoms are not under control. Post nasal drip and the GERD are two other exacerbation factors of asthma that one needs to look into if it starts suddenly. Smoking cessation if one is smoking is a key for asthma control. There are no specific cures for asthma but good education and understanding the disease and how to adjust medication, drugs, exercise, few foods to avoid, good life style, good sleep and relaxation, Yoga and Pranayama may work for many to control the asthma and allergy symptoms under control.

8. Bronchial asthma and food:    Learn about the food that causes the bronchospasm, increase mucus production, increase post nasal drip or sinus congestion or sinus headaches etc. Few foods to avoid is  cold water or ice water or  cold drinks or ice drinks or anything that is cold and not at room temperature as it produces slow bronchospasm and increase mucus formation and slows the digestion. Unfortunately chocolate which tastes so good is not good for asthma it increases bronchospasm. Foods like banana, milk products, tomatoes, potatoes, eggplant etc. increase mucus formation. Avoid them if possible.

9. Plan the emergency care: Think what you or your family will do if your asthma flares up? Make a plan now. What if the flare up is mild will you call your doctor and be seen? If it is moderate then will you go to the Emergency room to get treated right away? What if you cannot breath will you call 911? Who will call 911? Who will inform EMS or emergency medical service personal about the medical condition and the medication that you are taking. Plan the care and take care of asthma. By this there is no last minute panic in the family.

10. Learn Ayurveda and or other alternative medical prevention options:  Prevention is better than the cure is the old say in English. Many asthma patients are looking for a prevention aspect and cannot find that works. Ayurveda is the science of healthy living and is the traditional Indian medical science. Ayurveda is oldest medical science which has documented the asthma and its causes and prevention and treatment.  Bronchial asthma is a long term disease for many people.  If one is interested by slowly learning natural ways to control it may decrease long term use of medication and side effects of the drugs and improve quality of life. Use the medicines and inhalers under guidance of the doctor but as asthma improves the dose could be decreased or minimized or discontinued gradually. Or only need for the rescue inhaler is needed. One should know that if more than 2 albuterol inhaler canisters use in one calendar year means that asthma is not under control.  Make a short term and long term plan for asthma improvement.  By understanding your own body your mind and emotion is a key to improve health and Ayurveda helps to provide this insight.  Learn your body type, imbalance of the energy in the body, toxin built up, body type food, all this are referenced in Ayurveda. What we eat is what we are is the old say and it is true. As food has effect on our health and so is the effect on asthma symptoms. Ayurveda has a great insight for prevention of asthma. If one is interested in learning more than one may learn  appropriate Ayurveda diet based on the one’s Prakruti ( genetics) and Vikruti ( imbalance or toxins in the body). Good book to start is Ayurvedic Cooking for Self-Healing by Usha Lad, Vasant Lad.

Coordinate care with your physician and do regular follow up. No asthma care improves without multimodalities management like medication, inhalers, diet, exercise, sleep, relaxation, social support, and off course good guidance and monitoring of health care professional. Good luck and best wishes…