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Asthma Education – Myths and Milestones

Asthma Education – Myths and Milestones. Dr. Narayan Mishra, M.D., F.I.A.B, F.N.C.C.P, F.I.C.S, F.C.C.P (USA). Former Prof. & HOD Pulmonary Medicine MKCG Medical College Berhampur Odisha, India. President Indian Chest Society 2012. Asthma Education at. Health

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Asthma Education – Myths and Milestones

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  1. Asthma Education – Myths and Milestones Dr. Narayan Mishra, M.D., F.I.A.B, F.N.C.C.P, F.I.C.S, F.C.C.P (USA) Former Prof. & HOD Pulmonary Medicine MKCG Medical College Berhampur Odisha, India President Indian Chest Society 2012

  2. Asthma Education at Health Professional Level Patients Level Society Level The message is same for all but the level of communication and skill to be titrated

  3. The common messages for all. • Asthma is due to genetic and environmental factor. • It is not curable but can be well controlled. • Inflammation is the hall mark of Asthma. • Inhaler is the best root for therapy. • Inhaled Corticosteroid is the corner stone of treatment. • Needs prolonged treatment. • Clarification regarding local believes and misbelieve .

  4. Asthma Education at Health Professional Level Not only for doctors but for all paramedical staffs involved in Asthma management. Is it really needed ? …

  5. WRONG INFORMATION TO THE SOCIETY TO BE STOPPED Asthma disease is a Sleeping volcano. Asthma is a social disease. Asthma patients has to take medicine for whole life. Use of Inhaler in Asthma patients is dangerous because once it is started the patients has to take it for life long and the Inhaler contains steroid which is very bad for health. Sources: SAMAJA (Odia News paper), 1st May 2012, Page 12.

  6. Asthma Education at Need for Reorientation on Health Professional Level • Patho physiology • Diagnosis • Management • Asthma education to pt.

  7. Asthma Education at Need for Reorientation on Health Professional Level • Patho physiology • Diagnosis • Management • Asthma education to pt.

  8. The traditional view of asthma Allergen IgE Mast Cell Mediator Release Histamine, SRS-A etc. Airway Smooth Muscle Bronchoconstrinction

  9. THE MODERN VIEW OF ASTHMA Source: Peter J. Barnes, MD

  10. ASTHMA Inflammation Airway hyper- responsiveness Airway smooth muscle contraction Asthma symptoms

  11. To define ASTHMA…. Asthma is an obstructive pulmonary disease with the following characteristics • Airway obstruction that is reversible (in most patients) • Airway inflammation • Increased airway responsiveness

  12. Asthma Education at Need for Reorientation on Health Professional Level • Patho physiology • Diagnosis • Management • Asthma education to pt.

  13. Apart from history, clinical examination and radiology PFT (Pulmonary Function Test) Diagnosis of asthma can be confirmed by demonstrating the presence of reversible airway obstruction using Peak flow meter. Spirometer Peak Flow Meter ALLERGY TEST Skin test Serological test

  14. Classification of Severity CLASSIFY SEVERITY Clinical Features Before Treatment Nocturnal Symptoms FEV1 or PEF Symptoms Continuous Limited physical activity STEP 4 Severe Persistent  60% predicted Variability > 30% Frequent 60 - 80% predicted Variability > 30% STEP 3 Moderate Persistent Daily Attacks affect activity > 1 time week STEP 2 Mild Persistent  80% predicted Variability 20 - 30% > 2 times a month > 1 time a week but < 1 time a day < 1 time a week Asymptomatic and normal PEF between attacks  80% predicted Variability < 20% STEP 1 Intermittent  2 times a month The presence of one feature of severity is sufficient to place patient in that category.

  15. Asthma Education at Need for Reorientation on Health Professional Level • Patho physiology • Diagnosis • Management • Asthma education to pt.

  16. Armaments in Asthma Management  Preventive  Pharmaco therapy  Immunotherapy  Pt’s Education & compliance

  17. Quick Relief Short-acting b2 -agonists Salbutamol Terbutaline Anticholinergics Ipratropium Bromide Tiotropium Short-acting theophylline Aminophylline Long Term Control Corticosteroids Beclomethasone Budesonide Fluticasone Memetasone Ciclosenide  Leukotriene modifiers  Long-acting b2-agonists Salmeterol Formoterol Bambuterol Current Available Drugs

  18. PROPER SELECTION AS PER ACTION

  19. PROVED BEYOND DOUBT Prolonged & High dose of Short acting B2 Agonist increases Hyper responsiveness. • Kran J. et al., 1985 • Kerrbetijn K.F. et al., 1987. • Van Schayck et al., 1990 and • Many other studies.

  20. INHALATION IS THE BEST WAY

  21. IMMUNOTHERAPY ALLERGAN SPECIFIC IMMUNOTHERAPY SCIT( Subcutaneous immunotherapy) SLIT(Sublingual immunotherapy) Oral tablets NON SPECIFIC IMMUNOTHERAPY Omalizumab VACCINES • Influenza vaccine: every year • Poly valent pneumoccocal vaccine: 5 yrs

  22. Treatment should be based on Guidelines

  23. LEVEL OF CONTROL TREATMENT OF ACTION REDUCE maintain and find lowest controlling step controlled consider stepping up to gain control partly controlled uncontrolled step up until controlled INCREASE exacerbation treat as exacerbation REDUCE TREATMENT STEPS INCREASE STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 GINA Guideline

  24. STEP CARE APPROACH IN MANAGEMENT ASTHMA Addition of regular oral steroids Step-5 Step-4 High-dose ICS + LABA / LTRAs Severe Persistent Step-3 High-dose ICS or low dose ICS + LABA / LTRAs Mod. Persistent Step-2 Low dose ICS / LTRAs Mild Persistent Step-1 Occasional use of relief bronchodilators Intermittent High Dose ICS BDP/BUD : 800-2000 mcg/day FP : 400-1000 mcg/day Low Dose ICS BDP/BUD : 200-800 mcg/day FP : 400 mcg/day

  25. PEF as percentage of predicted or personal best PEF >80% 60-80% <60% Zone severity Mild Moderate Severe Zone Colour Green Yellow Red Management It PEF <80%, initiate 2-agonist treatment upto 3 times in first hour, then recheck PEF to determine new zone and next step listed below. High risk patients should contact physician promptly after starting treatment. Inhaled 2-agonist use Continue every 3-4 hours for 24-48 hours Continue every 3-4 hours for 24-48 hours Repeat immediately Oral Corticosteroid None Add Add Follow-up instructions Discuss with physician Consult clinician promptly Immediate transport to emergency department for failure to respond SELF MANAGEMENT PLAN

  26. LOCAL BELIEVES FACTS OR MYTH

  27. EAR-PIERCING IN ASTHMA Dr. N. Mishra et al : NAPCON-2005, 16 – 20th Nov. 2005, Calcutta, ICAAI-CON2005, 15 – 17 Oct. 2005, Jaipur, Rajsthan

  28. 104 Mild Persistent Asthma ICS - 1 Month (Run in period) Asthma under Control 69 Wanted themselves ear-piercing Group-C (n-35) I.C.S. Group-A (n-34) Ear Piercing Group-B (n-35) Ear-Piercing+I.C.S. + All patients were followed up for 12 weeks with regular check-up at the interval of 2 weeks and as and when required if there was any exacerbation.

  29. SOME OF OUR EAR PIERCING PATIENTS

  30. Ear-piercing has got no role in asthma Management and this message should be propagated in the community. Dr. N. Mishra et al : NAPCON-2005, 16 – 20th Nov. 2005, Calcutta, ICAAI-CON2005, 15 – 17 Oct. 2005, Jaipur, Rajsthan

  31. FISH THERAPY OF HYDERABAD

  32. COW URINE THERAPY

  33. Asthma Education at Need for Reorientation on Health Professional Level • Patho physiology • Diagnosis • Management • Asthma education to pt.

  34. Asthma Education at Society Level Through Press Electronic Media

  35. Asthma Education at Patients Level • Non compliance is due to • No knowledge of Pathophysiology • Non acceptance of diagnosis • Lack of knowledge in using devices • Embarrassment to use in pubic. • Inability to judge the severity • Lack of conception of prophylaxis • Steroid phobia

  36. How can compliance be enhanced ? Only Through PATIENTS EDUCATION.

  37. Our Experience 240 Mild persistent Asthma patients. Educational session in a special room with devices for 30 minutes. Prescription on the table With general instruction. Educated Group (EDG) 120 Pt. Non Educated Group (NEDG) 120 Pt.

  38. 6 Armaments in our Asthma Education (In a special room for 30 minutes) • Asthma can not be cured but can be controlled. • Inflammation is the hall mark of the disease. • Information and knowledge about reliever and preventer drugs. • Inhaler technique. • Necessity of prolonged treatment. • Cost efficacy of treatment in long run.

  39. Asthma Education 1 Asthma CAN NOT BE CURED But Can be fully controlled… Even one can join in OLYMPICS

  40. Asthma Education Normal 2 Inflamed INFLAMMATION is the hallmark of Asthma

  41. Asthma Education 3 Pollen Dander Food Smoke Avoidance of Triggering Factors Perfume Paint Exercise Stress Ajinomoto Medicine

  42. Asthma Education 4 KNOWLEDGE Reliever Preventer 2 Agn. Theo. Etc. Steroid Inhaler Steroid Phobia: Inhaled Steroid is the Best.

  43. Asthma Education 5 INHALER TECHNIQUE

  44. Pressurized metered dose inhaler (pMDI) 7 – 20%

  45. Spacer devices 10 – 30%

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