HOW TO CONTROL ASTHMA ?

It is easy to put the blame on the patient for non-compliance in the use of steroid inhalers. The causes for this lie both with the patient and those managing the disease — the physician, hospitals and the policy makers.

Patient's attitude

The first is the attitude of the patient. Many think that asthma is a serious one-time disease, which if treated well will not recur. This attitude is so deep-rooted that it will take time to change it. Most awareness campaigns on asthma are directed towards increasing compliance in using steroid inhalers rather than stressing that asthma is a problem whose management depends on long-term strategies rather than short-term gains. By short-term gains, I mean rapid cure for asthma, alternative therapies, complementary therapies and so on. Surprisingly some people are not aware that they have asthma and are not averse to taking regular treatment if advised. Many times asthma that was undiagnosed is picked up when the patient is admitted for some other problem or for surgery.

The idea of a long-term strategy for asthma control is to make the patient understand that asthma, like diabetes or hypertension, needs regular and long-term management. The symptom-free periods do not mean complete cure but only control of asthma, which needs to be maintained. The symptom-free periods are possibly the biggest disadvantage of asthma management. For example, when a patient is discharged after an asthma attack with discharge advice and a follow up, it is hardly followed because neither the patient nor the physician thinks about long-term management. Nor is there a discussion about the disease during discharge.

In this situation, a self-management plan is considered the best. The usual argument in our country about this strategy is that our country is poor, literacy rate is poor and comprehension capacity is poor. All this has been proved wrong by one study.

Study results

The Respiratory Research Foundation of India and Glaxo Smith Kline distributed a questionnaire called the Asthma Control Test to patients suffering from asthma. The study results came as a surprise, as many people were enthusiastic and clear about the disease and could understand the disease better and plan their treatment accordingly. The reassuring aspect was the interest shown by participants and also the regularity of use of steroid inhalers.

So it is clear that self-management strategies would work if the patient were given details about the disease. This should be done in the first sitting. The ACT forms can be translated into languages other than English and distributed to people who cannot follow English. Illustrations in the form can help people who are not educated understand the problem than didactic lectures.

The need of the hour is to educate the patient about asthma, the consequences of non-control and also help the patient create a self-management plan that teaches control without frequent visits to the physician's office.