The goal of asthma therapy is to control it so that patients can live active lives while minimizing their risk of asthma exacerbations and subsequent mortality. There is a consensus that a stepped-up approach with anti-inflammatory drugs based on severity forms the cornerstone of treatment. However, the importance of prevention of an acute attack should be emphasized.
There are many guidelines on diagnosis and management of asthma and allergic rhinitis emphasizing the importance of long-term regular anti-inflammatory therapy with inhaled corticosteroids which are safe and effective, and short-term therapy with relievers or bronchodilators. It is important to teach patients the skills to self-monitor and manage asthma and to use a written action plan, which should include instructions for daily treatment and ways to recognize asthma.
Salient features for treatment with limited resources in India:
Inhaled drugs to be taken as first line of therapy.
Reliever inhaled drugs to be taken on an SOS basis.
Prevent inhaled drugs to be taken regularly.
Treat exacerbations aggressively and prevent future exacerbations with regular controller options (inhaled and oral).
Avoid the use of antibiotics, except to control bacterial infections.
Regular use of antitussives which only mask symptoms (cough) and offer no relief in the pathogenesis, should be discouraged in asthma.
Advise proper dietary intake and avoid tobacco and other triggers.
The duration of anti-inflammatory drugs for asthma and allergic rhinitis should be for a minimum of three months to extend the prophylaxis and protection of the airways against all the triggers for the entire duration of any one season.
Yoga, deep breathing exercises, pranayam and swimming have been listed by both asthma specialists and patients themselves as the most useful set of activities which tend to improve the exercise tolerance. Identifying the most useful and productive exercise protocol is as essential as the therapy itself.
