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Initial Recognition and Treatment Of Bronchial Asthma In General Practice

M3 India Newsdesk Jan 19, 2023

In everyday clinical settings, the vast majority of Indian patients either go undetected or are given erroneous diagnoses. The purpose of this article is to evaluate the clinical predictors that help in identifying high-risk populations and making timely diagnoses of bronchial asthma.


Key takeaways

  1. Due to environmental and other extrinsic risk factors that are persistent and difficult to change, bronchial asthma in Indian clinical situations will continue to be a significant healthcare strain.
  2. Inhaled corticosteroids and inhaled salbutamol are widely used because of their quick-acting nature, and they may have therapeutic utility in the treatment and prevention of bronchospasm and exercise-induced bronchospasm in adults and children patients with reversible obstructive airway disease.

Indian perceptions of bronchial asthma

When a person suffers from asthma, their airways undergo remodelling, which increases the bulk of the airway's smooth muscles and ultimately causes fibrosis of the airway linings, a condition known as chronic inflammation. In India, asthma affects an estimated 38 million individuals. Households that use solid fuels, such as redwood and kerosene, have a disproportionate share of this burden.

The mental well-being of Indian children has been observed to be significantly impacted by asthma. The prevalence of obstructive pulmonary airway diseases and the need of developing effective maintenance medications both rise in response to these variables. Asthma is becoming more common across all age groups in India, yet it is inadequately treated.


Diagnosis

What to look for in order to identify asthma's early warning indicators?

Diagnosis of asthma, especially in its early stages, is based largely on symptoms; and management is based on prompt identification of the "treatable traits" to allow for targeted and personalised therapy, all because there is no gold standard test for asthma and because it is recognised as a disease with a wide range of aetiologies, phenotypes, and clinical manifestations.

 A few of the many asthma predictions highlighted by the research are:

  • Reversible arrow limitation
  • Airway inflammation
  • Hyper-responsiveness
  • Bronchial blockage
  • Airway eosinophilia
  • Symptoms of recurrent wheezing
  • Paired with dyspnoea and cough

Early eosinophilia and an asthma diagnosis throughout childhood, regardless of age, were independent significant risk factors for developing asthma.

Bronchial asthma risk factors in childhood 

Some of the early life variables linked with bronchial asthma include:

  • Positive family history
  • Exposure to secondhand smoke during pregnancy
  • Premature birth (including pulmonary infections
  • RDS
  • Early viral respiratory infections such as respiratory syncytial virus bronchiolitis)
  •  An atopic constitution

An inherent allergic constitution is the most important risk factor for chronic asthma.

Thus, a positive family history of allergy and the presence of early allergy symptoms, such as 'Allergic Progression' (allergies, eczema, allergic rhinitis, and asthma), could be considered important risk factors for the development of asthma.

Disease indicators

  1. In order to effectively manage asthma, it is crucial to be aware of the condition's symptoms. To promote early intervention and improved long-term results, it is important to recognise the occurrence of early warning signals or mild symptoms.
  2. Asthma episodes are typically preceded by early warning symptoms. Variability in the presentation of such symptoms is possible.

Asthma should be suspected in cases of:

  • Persistent cough
  • Wheezing
  • Chest tightness
  • And/or shortness of breath
  1. Asthma is highly suggestive of variable symptoms that worsen at night, occur when exposed to triggers like allergens or irritants, and react to appropriate asthma treatment.
  2. Some scientific literature also may describe symptoms such as a strange sensation in the chest, runny eyes, dry mouth, etc.
  3. When caring for a patient, it may be wise for the treating doctor to consider the patient's history and other pertinent clinical aspects in relation to these preclinical symptoms.

Treatment of bronchial asthma

Clinical guidance

Symptom presentation may have a role in the early diagnosis and therapy planning for adults and adolescents with asthma. Below is a synopsis of the Global Initiative for Asthma (GINArevised )'s 2022 guidelines for asthma management and prevention, the Global Strategy for Asthma Management and Prevention :

  1. ICS (inhaled corticosteroids)-formoterol: Low-dose ICS (inhaled corticosteroids)-formoterol may be an option for those with infrequent asthma symptoms (less than twice per month) and no risk factors for exacerbations. When using a combination or separate inhalers, short-acting beta2 agonists (SABA) may be administered with ICS for more flexibility. As required low-dose ICSformoterol or low-dose ICS plus as-needed SABA may be explored for the management of asthma symptoms and the requirement for relief >2 times per month.
  2. Corticosteroids: Low-dose inhaled corticosteroids - as maintenance and relief treatment - are to be centred on when asthma symptoms are bothersome on most days or awakening due to asthma more than once, particularly if any risk factors are present. Low-dose ICS, such as LABA or SABA as required, is an alternative treatment option.
  3. ICS-LABA: Initiate medium-dose ICS (as relief and maintenance treatment) or medium-to-high dosage ICS-LABA, with as-needed SABA, in situations when the first asthma presentation is with highly uncontrolled asthma or with an acute exacerbation. In addition, this group of patients may benefit from a brief course of oral corticosteroids.

Indian medical association advice for Salbutamol in bronchial asthma

Clinical evidence supporting the use of salbutamol for the treatment of bronchial asthma has been noted, namely, the guidelines established by the Indian Medical Associations for use in primary care. Inhaled salbutamol is suggested for the initial treatment of mild to moderate bronchial asthma exacerbations; 4 to 6 puffs of 100 g are delivered every 30 minutes.

Salbutamol's role in treating bronchial asthma: Indian recommendations 

The Joint ICS/NCCP guidelines for the therapy of bronchial asthma were produced as a joint effort by the Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP); for information on the clinical potential for using Salbutamol :

  1. Selected short-acting beta-agonists (SABAs) like salbutamol are among the choices prescribed for use as rescue therapy in patients with stable asthma.
  2. The most effective bronchodilators for the treatment of asthma are rapid-acting inhaled beta 2 agonists (salbutamol).
  3. In mild to moderate bronchial asthma exacerbations, inhaled short-acting beta-agonists are the first line of treatment (SABA). Four to six puffs of 100 micrograms of salbutamol every thirty minutes may be necessary.

 

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.

 

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