Asthma Medicines

Having a Treatment Plan

The drop in peak flow to 50 percent of the patient’s best identifies a serious attack. The patient should repeat the maneuver to determine if it is reproducible. Each patient should have a plan of treatment that has been worked out with the physician. This will typically call for immediate use of rapidly acting bronchodilator medication delivered as an aerosol. The plan should contain instructions on the use of corticosteroids and notification of the patient’s physician.

The physician’s knowledge of the patient’s history will prove invaluable at this time. Patients who have required hospitalization and especially those who have required respirator support for treatment of asthmatic attacks in the past will be advised not to delay treatment decisions. This patient group may require emergency room treatment as will patients with severe attacks who do not rapidly increase their peak flows with bronchodilator medication administered as directed (and not overused).

In treatment of bronchial asthma it is necessary to be aggressive early in treatment of severe attacks, including the possible use of an emergency room. With early recognition of a severe attack and aggressive treatment at its onset, fatal or near-fatal episodes can be avoided.

In the patient group with severe attacks who respond promptly to treatment, the patient’s treatment plan may often be continued in the home. With severe attacks this will most certainly require corticosteroids. Communication with the physician is essential and will be more accurate with serial peak flow measurements. Increasing airflows will confirm the effectiveness of treatment and can be used to adjust medication dosage and frequency of administration.

Following a severe attack that has been successfully treated it is important for the physician and patient to reassess maintenance medication and the treatment plan. The diary of peak flows will be extremely helpful since it may identify a downward trend that began before a severe attack was recognized. Emphasis on earlier recognition may prove helpful in avoiding future attacks.

With each significant attack the physician will look for a “trigger” mechanism that might be prevented in the future. An example would be raking moldy leaves or dusting without a face mask. Avoiding allergens will be stressed in sensitive patients who suffer serious attacks on exposure to these substances. Often the trigger for an asthmatic attack is the common cold. Although this infection cannot be prevented, the patient should be alerted to the possible adverse effects that might result and be prepared to institute the treatment plan.

In many instances the trigger for a severe asthmatic attack cannot be identified. If attacks are frequent, a review of the medical evaluation should be made. Additional allergy tests may be indicated and another careful examination of the home and work environment made. The patient’s administration of medication should also be examined and the maintenance medication program reviewed.

What If Avoidance Doesn’t Work?

Despite measures to avoid asthma triggers, the patient may still experience asthmatic attacks. These attacks may be frequent and severe and at times require hospitalization. In a small number of patients these attacks may prove fatal.

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Peak Flow Meter

In bronchial asthma it is extremely important to recognize the presence of an attack before it becomes severe and requires emergency measures. Each patient should have a means of assessing the degree of asthma that is present from day to day. In this manner severe episodes and often the use of oral or injectable corticosteroids necessary for such emergencies can be avoided. As an extension of this home monitoring the patient should be instructed how to respond to the presence of increased asthma. In this way a contingency plan can be in place and ready before severe attacks occur and require emergency room care. The cornerstone of this home monitoring is the peak flow meter. In essence it is an “early warning” device for individuals with asthma.

What the Peak Flow Meter Measures

The peak flow meter is a simple and inexpensive device that can be used in and out of the home to monitor bronchial asthma and similar conditions. This compact device determines the maximal expiratory flow rate that the patient is capable of producing. Similar to the office spirometry, the patient inhales fully and then exhales fully and forcefully into the flow meter device. A simple scale registers the peak flow. If done as instructed this flow rate correlates well with other measurement of airflow through the large airways of the lung. With a diary to record readings the patient can maintain an accurate assessment of the degree of asthma from day to day. This is not unlike the diabetic who records blood sugar readings. This information can be invaluable to the physician in managing patients with bronchial asthma since it gives an objective measurement to go by instead of trying to assess asthma by the degree of shortness of breath or wheezing. Communication with the physician can be much more meaningful with a record of the patient’s peak flows, resulting in earlier and better treatment. With earlier recognition of an attack through peak flow measurements, severe and potentially fatal asthma attacks may be avoided.

An electronic peak flow meter is now available in the form of Air-Watch which is made by Enact. This more sophisticated and expensive device is capable of storing several hundred peak flow measurements. Patients may also download their readings by phone to a central computer which then faxes the results to the physician.

Asthma with Normal Peak Flows

Remember that peak flow measurements reflect primarily large airways and therefore do not totally assess the asthmatic condition. Normal peak flows may occur in the presence of significant small airway disease that requires continued and effective treatment. This explains why patients may continue to be symptomatic even with normal peak flow rates.

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