Asthma constitutes a significant health & economic burden globally, afflicting 358 million people and responsible for over 400,000 deaths yearly. Many children and adults are suffering from asthma. It is predicted that by the year 2025, over 400 million people will be diagnosed with asthma. In Nigeria, anecdotal evidence suggests that 15- 20 million people suffer from asthma. However, asthma can be controlled!. Almost everyone with asthma can be symptom free. Adequate and proper long term management, avoidance of possible triggers and having a personalized self management plan go a long way to mitigate the effects of the disease and help to keep it well under control.
This information booklet will tell you how you can have your own self management plan and put it to good use in the control of your asthma.
Fig. 1: Comparison between a normal lung and an asthmatic lung.
This is an individualized information guide, developed in partnership with the health care giver or doctor, that instructs the patient or relatives on the prevention, management and control of asthma symptoms at various times. Your plan should help you to avoid your asthma triggers, recognize worsening asthma symptoms, start treatment quickly and seek the right medical assistance.
Taking control of asthma requires partnership of at least two people; the patient and the doctor. The partnership may also include relatives and other care givers. Having a self management plan helps the asthmatic cooperate with the doctor in the asthma treatment by understanding how the asthma medications work and playing his/her own roles in this treatment. Self management plans have been found to reduce frequent emergency visits, reduce absence from school or work, reduce attacks at night and improve the lung function. It ensures adequate control and more importantly minimizes delay in initiating appropriate anti-asthma therapy in the event of an acute attack.
One very important aspect of self management is keeping an asthma diary. This diary provides valuable information about a patients asthma and helps the doctor assess the severity of his asthma. An asthma diary contains a peak flow chart and some other columns where day to day information about daily symptoms, peak flow rate, the medications being taken and possible triggers of asthma are recorded. It helps to monitor response to treatment and helps the doctor to know when to step up or step down treatment. The diary should contain information on missed school or work because of symptoms, the frequency of use of reliever medications (bronchodilators), the times symptoms were severe enough to warrant report at the asthma clinic before clinic day, after hour treatments, emergency room visits and hospitalizations. Also, the treatment given at the hospital and the date of the events should be documented. Keeping an asthma diary will helps to plot the peak flow chart and to detect if the asthmatic is responding to treatment or not.
A peak flow is a measurement of how quickly you can blow air out of your lungs. It is measured using a peak flow meter. The Peak Flow meter is a simple device you blow into to measure the condition of your airways. It has a lot of advantages in that it is small, cheap, easy to use, portable and can be used at home. It is not only useful in diagnosing asthma but also essential in monitoring the progress of the disease. The peak flow reading on the chart can be used to plan asthma management. Normal peak flow scores vary according to age height and sex however, your own normal score should be within twenty percent of a person who is of your age, sex and height but who does not have asthma. Peak flow readings tell you whether your airways are wide open or narrow. Your peak flow score will be higher when you are well. Increasing asthma symptoms or a fall in peak flow readings suggest that your asthma is getting worse.
Fig. 2: Picture of a Peak Flow Meter.
An Asthma Action Plan is a written set of instructions prepared in partnership with your doctor that assists you to manage your asthma at different times. It always goes hand in hand with your Peak flow meter readings. The Action Plan is based on the Traffic Stoplight System. This system will be a guide to your treatment and help you to notice the changes in your Peak Flow Meter readings: are the Peak Flows gradually going up after you start a new treatment, or are they gradually going down?. Below is an example of a traffic stoplight system.
This is the "All Clear" Zone. There are no symptoms, you do your normal activities and have a sound sleep. It is where you should be every day. You should continue your usual treatments (bronchodilators when needed with or without your regular inhaled steroids).
Your asthma may be getting worse. You may be coughing, wheezing, sleeping poorly and having restricted activities. You should take action to gain control. Change your treatment, as recommended by your doctor (double dose of your inhaled steroids).
You may be coughing, short of breath and your sleep could be disturbed with frequent awakenings in one night and most nights in a week. You may also have difficulty walking or talking. You should take a reliever medication and start oral dose of your steroids, as recommended by your doctor. Call your doctor or go to the hospital right away if you start struggling to breath, has blue lips or fingers, has a Peak Flow still in the Red Zone 30 minutes later, or if 6 hours later, your Peak Flow is still less than 70% of your personal best, despite additional treatment with Reliever medications.
