Attacks By John F. Freiler, MD

Key Ashtma Management Strategies to Prevent Asthma Attacks

By John F. Freiler, MD

Asthma Fast Facts • More than 26 million Americans have asthma (1 in 12 children and 1 in 13 adults).1 • Each year, asthma accounts for more than 439,000 hospitalizations, 1.7 million emergency department (ED) visits and 13.8 million missed school days.1 • Asthma costs about $50 billion each year in healthcare costs.1 • Every day, about 10 people die of asthma. Black Americans are 2-3 times more likely to die from asthma than any other racial or ethnic group.1 • More than 60% of adults and 50% of children with current asthma have uncontrolled asthma.2,3

Asthma is a chronic respiratory disease requiring ongoing medical management. When controlled, asthma has a minimal impact on everyday living. Uncontrolled asthma with frequent and intense episodes of symptoms can have a significant cost to families and society because it may relate to an increased risk of an emergency department visit, hospitalization, and work and school absenteeism.2,3

Most people with asthma should be able to control their disease with proper care. Asthma education and self-management are essential components of successful asthma management. When healthcare providers deliver asthma care based on evidence-based asthma guidelines, patients can experience better health outcomes and quality of life.4

Asthma attack prevention

Important strategies in asthma attack prevention include routine visits, recognition of symptoms, understanding the use of medications, proper inhalation technique, avoidance of triggers, monitoring and the use of premedication in certain situations.

Routine follow-up care: Scheduling office visits every 6-12 months or more often if indicated is an essential part of caring for patients with asthma.4 • Assessing control should be incorporated into every routine asthma visit and is the basis for stepwise management of asthma medications. This can be done using a questionnaire that the patient completes prior to their visit. Standardized questionnaires, such as the

Asthma Control Test and Asthma Control Questionnaire are informative and easy to use. • Periodic spirometry can also help assess progressive loss of lung function over time. • Incorporation of a written asthma action plan into routine visits can serve several functions such as daily asthma care, attack management and indications for emergency care.

Read the American Lung Association: Create an Asthma Action Plan at https://www.lung.org/lung-health-diseases/lung-diseaselookup/ asthma/living-with-asthma/managing-asthma/create-anasthma-action-plan.

Asthma symptoms:

Patients should understand how to recognize early symptoms of a potential asthma attack, such as shortness of breath, wheezing, chest tightness and recurrent coughing.

Role of medications: The differences between quick-relief medication and long-term controller medications should be discussed.

Single Maintenance and Reliever Therapy (SMART) can be considered for select patients. Rather than an inhaled corticosteroid for daily

maintenance and an inhaled bronchodilator for exacerbations, SMART uses the same inhaler for both prevention and rescue therapy. This strategy, delivering a corticosteroid and long-acting beta agonist together, allows for a lower regular steroid dose, with additional doses as patients use the inhaler to relieve asthma symptoms. Only formoterol-containing formulations should be used, as it has a rapid onset bronchodilator effect, like albuterol.

Correct inhaler use: Provide skills training in using each type of inhaler prescribed. It may be helpful to have pictures of commonly-used inhalers to confirm which inhaler the patient is using. Also discuss spacer devices and nebulizers if used.

Identification of triggers: Explain how to identify, avoid, eliminate or control asthma "triggers." It is important to stress that treatment measures without environmental control may be ineffective.

Common asthma triggers:5

• Common allergens include house dust mites, animal dander, molds, pollen and cockroach droppings; • Tobacco smoke; • Air pollution, strong odors or fumes; • Exercise-induced bronchoconstriction; • Medications such as aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen and beta-blockers; • Emotional anxiety and stress; • Viral and bacterial infections such as the common cold and sinusitis; • Exposure to cold, dry air or weather changes; • Acid reflux, with or without heartburn.

Monitoring: Patients should understand the importance of monitoring their asthma daily, recognition of early asthma symptoms and in treating their symptoms quickly. Encourage keeping diaries of medication use, peak flow rates, environmental exposures, symptoms and actions taken, as these can be used in planning attack prevention and management strategies.

Premedicating to prevent onset of symptoms: Instruct patients on medication measures to take when triggers cannot be avoided. For example, premedication with beta-agonist agents prior to exercise, irritants or exposure to known allergens, such as animal dander, may prevent onset of asthma symptoms.

Conclusion: While it can be challenging to incorporate patient-focused asthma education into routine care visits, busy clinicians can identify the most important points to discuss with each patient. Collaboration with an asthma specialist, such as an Allergist or Pulmonologist, can use useful to develop a comprehensive plan for incorporation of asthma management strategies based on evidencebased guidelines for asthma attack prevention.

Recommended patient education resources

Allergy & Asthma Network: https://allergyasthmanetwork.org

American Lung Association: Asthma https://www.lung.org/lunghealth-diseases/lung-disease-lookup/asthma.

References 1. Control Asthma, 6|18 Initiative, Centers for Disease Control and

Prevention: https://www.cdc.gov/sixeighteen/asthma/index.htm accessed 4/9/2022 2. AsthmaStats: Uncontrolled Asthma among Adults, 2016, Centers for Disease Control and Prevention: https://www.cdc.gov/asthma/ asthma_stats/uncontrolled-asthma-adults.htm accessed 4/9/2022 3. AsthmaStats: Uncontrolled Asthma among Children, 2012–2014,

Centers for Disease Control and Prevention: https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthmachildren.htm accessed 4/9/2022 4. Strategies for Addressing Asthma for Healthcare Providers, American Lung Association: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/str ategies-for-addressing accessed 4/9/2022 5. Asthma Triggers and Management, American Academy of Allergy,

Asthma and Immunology: https://www.aaaai.org/Tools-for-the-

Public/Conditions-Library/Asthma/Asthma-Triggers-and-Management-TTR accessed 4/9/2022

John F. Freiler, MD is the founder of Premier Allergy of Texas. A decorated Air Force Allergist-Immunologist, Dr. John F. Freiler retired from the military in the grade of Colonel in 2021 with 22 years of active-duty military service to serve the San Antonio community. Dr. Freiler’s distinguished military career is notable for having served as the Chief Consultant to the USAF Surgeon General for both Allergy & Immunology and Internal Medicine. Additionally, he was selected to serve as core teaching faculty for the Air Force’s sole Allergy and Immunology Fellowship Program. Dr. Freiler has published numerous peer-reviewed manuscripts and has been active in the mentorship and education of healthcare professionals throughout his career. He is board certified by both the American Board of Allergy and Immunology and the American Board of Internal Medicine. Dr. Freiler is a member of the Bexar County Medical Society.

To learn more about Premier Allergy of Texas, please scan the QR code above, or visit their Facebook page at https://www.facebook.com /profile.php?id=100069842199659.