Medical-Patient Report
Sensitize the patient to develop a close working relationship with the doctor
Asthma management requires the development of a close relationship between the asthmatic patient and the doctor.
Patients should learn to:
- Avoid exposure to risk factors.
- Take the medication correctly.
- Understanding the difference between "background" anti-asthmatic drugs, to be taken continuously, and "need" drugs, to be taken only before a real need.
- Monitor health status by interpreting symptoms and, if possible, measure peak expiratory flow (PEF).
- Recognize the warning signs of asthmatic crises and take appropriate action.
- Promptly contact your doctor if necessary.
The education of the asthmatic patient should therefore be an integral part of the doctor-patient relationship. With a series of methods - such as interviews (with the doctor and nurses), demonstrations and written material - it is possible to reinforce educational messages.
Healthcare professionals should prepare in writing, with the patient, an individual, correct and understandable treatment program that the asthmatic subject can actually perform.
Medications and Treatment
Needed Drugs
Symptomatic drugs are identified:
- in beta2-agonists
- in anticholinergics.
Based on the duration of the bronchodilating effect, beta2-agonists are divided into active ingredients
- short-acting: salbutamol and terbutaline
- long-acting: salmeterol and formoterol .
For this reason they are NOT considered bronchodilator drugs of first choice in the treatment of bronchial asthma.
Fund drugs
The purpose of the drugs used in underlying therapy is to keep the disease under control, that is, in the absence of symptoms. Their activity is aimed at reducing the bronchial inflammatory process, which starts very early, thus making the subject asymptomatic. The most effective drugs are:
- inhaled corticosteroids (beclometasone, budesonide, flunisolide, fluticasone, mometasone),
- cromoni (sodionedocromil, sodiochromoglycate),
- antileucotriene due to their ability to inhibit phlogogenic mediators and induce bronchial spasm.
Therapeutic setting
The therapeutic setting depends on the clinical-functional status.
Critical period
In the critical period, in order to reduce the particularly active inflammatory state and the bronchoconstriction, it is necessary to associate anti-inflammatory and beta2-agonist drugs, in order to bring back, in a short time, the bronchial patency to a level that allows the resumption of normal daily activity .
Serious Forms
In the more pronounced forms it is instead advisable to use high-dose corticosteroids, associated with salmeterol or formoterol for their long-lasting action.
Light forms
In milder forms, the use of chromones, or corticosteroids, at lower dosages, associated or not with salbutamol or terbutaline as needed, has proved very useful.
Treatment must be continued with both drugs (anti-inflammatory and bronchodilator) until the clinical-functional picture is stabilized at the level prior to the crisis. Once this goal is reached, it is necessary to continue with anti-inflammatory therapy only for a suitable period of time, as the inflammation of the airways can persist for long periods.
Intercritical period
In the intercritical period, when the subject is clinically asymptomatic, the need or otherwise of drug treatment is given by the functional condition detected with spirometry. If the data are normal, no therapy is required; if instead an obstructive (although asymptomatic) picture is present, it is necessary to set up a long-term therapy with inhaled corticosteroids and, possibly, beta2-agonists with long-acting action. In seasonal allergy sufferers it is advisable to start a pharmacoprophylaxis with anti-inflammatory a few weeks before the presumed critical period based on allergy tests.
Always in the intercritical period, it is essential to evaluate the state of bronchial hyperreactivity of the asthmatic patient with an exercise test, in order to verify the existence of bronchospasm for physical exercise - often limiting sports performance - therefore the need to establish an adequate pharmacoprophylaxis . This is based on beta2-agonist drugs in combination or as an alternative to Chromones (although these may be less effective), to be administered prior to performance
Also the antileucotrienis, used for the therapy of the acute episodes, but above all assumed for extended periods of time, have demonstrated an effective preventive action.
Prevention
To improve asthma control and reduce the need for medications when needed, patients should avoid exposure to risk factors that trigger asthmatic symptoms.
Physical activity is a stimulus that can trigger asthma symptoms, but patients should not avoid exercise. Symptoms can be prevented by taking a drug with rapid onset of action as needed, before starting intense physical activity (alternatives include antileukotriene or cromoni).
Patients with moderate severity asthma should undergo influenza vaccination every year, or at least until vaccination in the general population is recommended. Influenza vaccines with inactivated viruses are safe for adults and children over 3 years.
Conclusions
Bronchial asthma is responsible for a high consumption of health resources, both in terms of direct costs for the management of the disease - consisting of costs for drugs, health services and hospitalization of the most serious cases - and in terms of costs indirect, related to lack of productivity due to absences from work or school and poor quality of life.
The results of recent research show that there is still a diagnostic delay due to the patients' initial lack of motivation to go to the doctor - to report on the presence of symptoms, relying more on the transient nature of the problem and on self-medication - than on uncertainty the doctor to submit his client to a spirometry test to confirm the suspected asthma diagnosis.
This behavior causes a delay in the definition and regularity of anti-asthmatic therapy; in the meantime insufficient control of the illness is established and a continuation of limitations in the relational life of the patient, which are often unjustified, being the majority of asthma sufferers able to reach and maintain a physical well-being close if not equal to the non-asthmatic subjects .
It is therefore necessary to draw the attention of health personnel to the importance of a correct management of this so frequent disease.
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