Asthma: Diagnosis and Management ____________________________________________________________
notice symptoms. Such awareness can help patients address changes earlier in the course of possible illness (using their action plan) and avoid medical intervention or hospitalization. COMPLIANCE The main problem seen in both the adult and pediatric asthma populations is compliance with a prescribed treatment plan and control of asthma symptoms. It is important that, as a part of patient education, adherence to the treatment plan is stressed. As noted, much of the treatment and management responsibili- ties associated with controlling asthma and asthma symptoms falls on the patient. The more patients understand their treat- ment and the value of each aspect, the more likely they will be to adhere to the established treatment plan. Healthcare providers should take into account the possible barriers to care, such as income level, education, language, and cultural beliefs. When a child is seen frequently for uncontrolled asthma, it may also be a parenting and caretaking issue. Education of patients regarding proper administration of medi- cations can be time consuming, and healthcare providers are often limited in the amount of time they can spend with patients or their families. Managed care has caused many hospitals, pri- vate offices, and clinics to reduce the number of staff members while increasing the patient loads to cover basic costs. However, patient education is one of the most vital steps in effectively managing and treating asthma and should not be ignored. TRIGGER AVOIDANCE In addition to the importance of treatment plan adherence, trigger avoidance should be covered in detail. If a patient has known asthma triggers, avoidance of these items, substances, or situations may greatly improve, or even eliminate, asthma symptoms. Information regarding these asthmagens, where they may occur, and ways to avoid triggering an attack should be incorporated into initial patient education. Asthma symptoms begin when lungs react to a stimulus, referred to as a trigger or asthmagen. It is important for patients with asthma to discover what triggers their asthma symptoms in order to prevent episodes and more serious lung damage. Asthma symptoms may appear slowly over several years, become noticeable only in specific environments or conditions, or result from the accumulation of repeated exposure to irritants in the environment [2; 13]. While any stimulus that induces an asthma attack is considered a trigger, the most common of these agents may generally be grouped into either the allergen or irritant categories. Allergens are specific—either pollen is an allergen for a patient or it is not, depending on the response of the patient’s immune system. In many cases, allergens are a basic cause of asthma. Allergy has attained this prominent role in the study of asthma not only due to the frequency with which it produces asthmatic episodes and the number of patients with asthma affected with it, but also because the allergic reaction serves as a model for the pathophysiology of asthma. However, numerous other asthma triggers exist as well [13; 48].
PSYCHOSOCIAL MANAGEMENT Asthma does not just affect the lungs. It is a condition that touches all aspects of life. As such, treatment of the patient with asthma should include treatment of the whole person. Because so much of the success of treatment depends on the individual’s adherence to the prescribed management plan, patients and caregivers may be stressed by the added responsi- bility. By managing these and any other stresses, patients may experience increased quality of life and, by extension, may be more compliant to treatment plans. Successful adaptation to this chronic, cyclical, sometimes unpredictable condition demands attention to emotional, mental, and social issues as well as to the physical pulmonary problems. The biopsychosocial approach to treating asthma appears to be one of the most successful; healthcare practitio- ners have found that clearing away psychological and social obstacles positively affects treatment compliance and improves the patient’s experience of asthma. Additionally, as discussed, ADHD and other learning and behavioral disorders commonly co-occur with asthma. Most would agree that managing and treating asthma emotionally and mentally, as well as physically, leads to a happier, healthier lifestyle. Referring a patient with asthma to a counselor or psychologist may help alleviate some of the stresses of managing the illness. Connection with others with asthma, through support groups or community involve- ment, may also be helpful. PATIENT EDUCATION As stressed throughout this course, patient education and com- munication are imperative to the treatment and management of asthma symptoms. It is important that healthcare providers are able to discuss the different aspects of asthma symptoms as well as treatment and management to ensure that patients are able to understand and follow the established plan. In addi- tion to the treatment plan and common symptoms associated with asthma episodes, patient education should outline the importance of compliance, trigger avoidance, and the continu- ous monitoring of their condition. CONDITION MONITORING Continuing with follow-up consultations and symptom moni- toring allows for better treatment of asthma. Peak flow meters may be used by the patient to monitor FEV 1 levels and have been useful for some in determining when and if asthma is exacerbated. Peak flow and FEV 1 readings may also be useful in determining the efficacy of an established treatment plan. If possible, encourage patients to keep asthma diaries, in which they may record occurrences of symptoms and attacks. These diaries have been useful in identifying possible asthmagens and in determining the extent and severity of asthma in certain patients. It also helps patients feel more in control, as they will begin to see changes in their lung function even before they
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