Asthma is an inflammation and obstruction of the bronchial tube passage that allows air to enter and leave the lungs. During an asthma attack, muscles surrounding the bronchial tubes constrict narrowing the air passage making it difficult to breathe. The duration of the attack may vary depending upon the course. At Medicircle, on the occasion of World Asthma Day, we are speaking to eminent Pulmonologist, Respiratory Therapists, Pediatricians to build awareness regarding respiratory-related diseases and their available treatments.

Dr. Narasimhan Rajgopal is a Specialist in Asthma and Allergy practices at Allergy Asthma and Chest Centre in Bangalore. He has been trained at the CMC, Vellore. He is in practice since the year 2000.

Asthma attack

Dr. Narasimhan speaks, “Sometimes the symptoms of Asthma patients suddenly become so bad that they have to change the current treatment to get relief and this is called an asthma attack or an exacerbation. There can be an increase in the cough, increase in the sputum or breathlessness that they face due to the spasm.”

Patients history is very important in Asthma

Dr. Narasimhan expresses, “History is very important in the diagnosis of asthma because there is usually a history of heredity. There might be some symptoms that they have suffered during childhood and would have been all right in between. And the problem starts again later with age, this can be repetitive. If a patient comes to the doctor with the symptoms of cough, repeated chest congestion, difficulty in breathing while doing normal activities, or with the change of season or in a particular kind of environment, this leads us to a suspicion that it could be an Asthma. We take the proper history of these kinds of patients. We do Lung Function Test or Spirometry. In spirometry, there are certain criteria by which we can make a diagnosis and find out that the airway obstruction is easily responding into a bronchodilator. So, reversibility is the factor, we should take into consideration when we do this objective assessment of the airway by Spirometry. That is the commonest thing. Most of asthma that we see is due to an allergic origin, we can also do additional tests in the form of allergy testing. This is to find out what is the triggering factor and then go ahead from there,” talks Dr. Narasimhan.

Asthma is not curable, but it is effectively treatable

Dr. Narasimhan informs, “once the diagnosis of Asthma is established, it is very important to convey certain things to the patient. Most of the patients ask for a complete cure. Unfortunately, asthma is not curable, but it is effectively treatable. Alternative therapies like Yoga, Ayurveda, and other things won't work here. But it is possible to effectively treat the condition, where one can sustain a normal life with minimal medication. This can be maintained throughout life. So, basically, it is correcting the present problem that the patient has and preventing future risk of problems that may occur. We try to achieve the situation where there are no symptoms or minimum symptoms, should not have sudden worsening attacks, should not be having any difficulty in doing day to day activities. Medicines should not be producing any side effects. Medicines should be minimum, and relief should be maximum. Asthma affects the lower airways, but many people also have problems in the upper airway that is the nose and structures around. Even that needs to be controlled well for effective asthma control. So, Asthma treatment and condition is controlled that will keep the patient going well at all times,” says Dr. Narasimhan.

Inhalers are the best form of treatment

Dr. Narasimhan emphasized, “asthma is a very common condition. Medicine that is given should be minimum so that it causes minimal side effects. Inhalers are the best form of management for Asthma. Similarly, for the upper airway, topically acting medicines like nasal sprays are recommended. And for the lower airway, we have two sets of Inhalers. One is the preventer, which controls the disease and prevents the attacks from coming. And the second one is for relief, when a patient suffers an attack, we have to give something for rescue and that is the rescue medication. Inhalers are invariably the best form of treatment.”

Counseling is very important

Dr. Narasimhan mentions, “We explain to them the importance of treatment and make them aware of the consequences if they don’t take timely treatment. They may land up in the hospital with a severe attack or in ICU. And sometimes even young lives are lost because of inadequate proper treatment. By explaining all this to the patient, we develop a level of comfort with them. We tell them that it is not the same medication that you will have to take for lifelong, sometimes the patient is absolutely under control with minimum medication for a reasonable length of time. This can be even stopped for some period if they are absolutely okay. 

Self Management plan

Dr. Narasimhan speaks, “WHO recommends a Self-Management plan for Asthma. So, we tell the patient, how to look for symptoms, how to see and recognize that things are going wrong. This strategy works with most of the patients. A lot of communication is done. Patients get confidence and takes the charge of themselves. We have to make them understand the need for continuing medications.”

(Edited by Renu Gupta)