Clues to Asthma Attacks and Managing Asthma Wisely

How could that happen? Are people using their medications improperly – their rescue medications too much – so that even though they’ve been given proper medicine, it’s not used right and they don’t get the full benefit from it?

Dr. Corsello:

There are number of factors involved. Whenever this happens, this is tragic because asthma is not only treatable, but it’s also controllable. Why this happens in most cases – most but not all – is because patients have not been adherent to their medical regimen or they have been unfortunate enough to come in contact with an allergen or an irritant that trips off the asthma.

If one is monitoring – and this is all a part of patient empowerment, which must be associated with the assumption of responsibility – if the patient or the parent, when it’s a child, is paying attention, there are almost always clues within 24 to 72 hours before a severe attack begins. The clues are there for them to pick up on and to seek medical advice.

Andrew:

Give us an idea of some of these clues.

Dr. Corsello:

There are a number of them. For adults, it would perhaps be increased cough, awareness of shortness of breath with activities that ordinarily are not associated with shortness of breath, sometimes a vague feeling of chest tightness. With children, one looks to other things, such as more rapid respiration; or even prior to that with children, they may become fussy or not be interested in eating. The clues are sometimes subtle, but in most instances, the clues will be respiratory.

For adults and for children over the age of 5, one of the clues that can be used is a determination of peak flows with a peak flow meter – a peak flow being a measure of how well, how rapidly, air flows through the airways. By measuring that, we’re able to get a sense of how constricted or open the airways are.

So in our program, we strongly recommend the use of peak flow meters, which are simple, inexpensive devices. Their use is quickly learned; the patients can use them and monitor their values. What we’re looking for is patients assuming responsibility for noting when peak flows are dropping, so they can contact the physician.

The other thing that’s being done is that peak flows are being monitored electronically in disease management programs so that the data from the peak flow can be transmitted telephonically or through the Web to those who will then note the trend and are in a position to take action.

Andrew:

Since asthma is so prevalent, probably all of us know somebody with asthma. But often I’ve found, particularly with adults or young people, that they’re pretty blasé about it. We used to work with someone who was a runner, and she’d talk about a running team going to an event, and they’d be in a van and the ones with asthma would be puffing on their inhalers to get ready to do the run.

But as far as maintenance medication, they weren’t doing it with any dedication. And you talked about responsibility, with this routine of a peak flow meter and looking for warning signs. You can’t expect your doctor to do that for you, can you?

Dr. Corsello:

No, you can’t. But what you can expect is that your doctor will discuss it with you. That the doctor will create an awareness of the risk that uncontrolled asthma poses, and the means by which that risk can be attenuated. And you’re right. When people aren’t having symptoms, it’s most difficult to get them interested in taking medication on a regular, daily basis.

One of the major problems we face is what’s referred to as non-compliance or non-adherence, and we all can be vulnerable to the feeling that “I feel fine, therefore I don’t need to take my medication.” One of the major things we need to do is to provide patients with the information they need about what asthma is, how it works, and especially why it’s necessary to continue taking your medication even on days when you feel terrific.