case study aeba 2011
Post on 06-Apr-2016
292 Views
Preview:
DESCRIPTION
TRANSCRIPT
KOLEJ SAINS KESIHATAN BERSEKUTU KUCHINGPROGRAM ADVANCE EMERGENCY MEDICAL AND TRAUME CARE
BAHAGIAN 1 : Butir-butir peribadi pesakitNombor pendaftaran : 09 / 010125 Nombor K/P : 501021-13-5170Nama : SIM SHIP YEE Pekerjaan : SURIRUMAHBangsa : CINA Jantina : PEREMPUAN Umur : 59 TAHUNAlamat : NO.20A,TMN WEE WEE LRG 17E, STAPOK,KUCHING
Wad : Medical
Tarikh Masuk Hospital : 23 APRIL 2009 Tarikh Keluar Hospital : 28 APRIL 2009
Pengesahan Ketua Jururawat /Staf Klinikal mengenai kesahihan butir-butir yang tersebut di atas.
Betul / Tidak Betul * Tandatangan :………………………………… Nama & Cop :
BAHAGIAN 2 : Butir-butir mengenai pengkajian kes
Nombor Matrik : PB 1 / 2009 - 1327Nama pelatih : LIDIA BINTI MASILEKeputusan : Baik (70% ke atas), Memuaskan (50 – 69%), Tidak Memuaskan ( Kurang dari 50%)*Ulasan :
Tandatangan Pengajar :
Nama & Cop :
Tarikh Diterima : Tarikh Disemak :
Tarikh Dikembalikan :
----------------------------------------------------------------------------------------------------------------
Untuk Kegunaan PejabatNombor Matrik : PB 1 / 09 - 1327 No. Daftar PK : /KPP/PK/ ID PKNama Pelatih : LIDIA BINTI MASILE Diagnosis : ACUTE EXACERBATION
BRONCHIAL ASTHMAKeputusan : Baik (70% ke atas), Memuaskan (50 – 69%), Tidak Memuaskan ( Kurang dari 50%)*
Tandatangan Pengajar :
Nama & Cop :
Tarikh Diterima : Tarikh Disemak :
Tarikh Dikembalikan
( Bahgian ini harus dihantar kepada Pengajar PP Kanan Asas * Potong yang tidak berkenaan
Untuk Kegunaan Pejabat
KOLEJ SAINS KESIHATAN BERSEKUTU KUCHINGPROGRAM ADVANCE EMERGENCY MEDICAL AND TRAUME CARE
PENGKAJIAN KESBAHAGIAN 1
1.1. Nama Pelatih: LIDIA BINTI MASILE 1.4. No PengkajianKes:2
1.2. Tahun Pengambilan: JANUARI 2009 1.5. Wad: Medical
1.3. Tarikh: 23 APRIL 2009 1.6. Hospital: Sarawak General
BAHAGIAN 2: Butir-butir Peribadi Pesakit(i) 2.1. Nombor Pendaftaran: 09 / 010125
2.2. Nama: Bungkong ak Penguang 2.6.Nombor Kad Pengenalan: 390206-13-5071
2.3. Bangsa: IBAN 2.7. Umur: 70 Tahun
2.4. Pekerjaan: TIADA 2.8. Jantina: LELAKI
2.5. Alamat: Lot 113,RPR Landeh Jln Landeh Kuching 2.9. Agama: KRISTIAN
(ii) 2.10. Tarikh Masuk Hospital: 23.4.09 2.12. Tarikh Keluar Hospital:28.4.09
2.11. Waktu: 11 AM 2.13. Waktu: 12 MD
(iii) 2.14. Pengesahan Ketua Jururawat/Jururawat yang Menjaga Wad mengenai kesahihan butir-butir yang terkandung di Bahgian 2.
Betul/Tidak betul*
Tandatangan:………………………………………………………………..
Nama:………………………………………………………………………...
Tarikh Penyerahan / Penerimaan Pengkajian Kes :
Ulasan Pengajar: Baik / Memuasakan / Tidak Memuaskan *
* Potong yang tidak nerkenaan (Note: Your case study can also be witten in English)
2
BAHAGIAN 2 : RIWAYAT PESAKIT
ADUAN UTAMA :
Pesakit mengadu sesak nafas sejak awal pagi tadi.
SEJARAH PENYAKIT KINI :
Sebelum Kejadian
Pesakit mengalami kesukaran untuk bernafas sejak 3 hari yang
lalu. Pesakit juga dikatakan berbunyi semasa bernafas. Batuk yang
semakin teruk berserta kahak yang berwarna kuning. Pesakit mulai
demam dan diberi ubat yang dibeli dari kedai farmasi yang
berdekatan dengan rumahnya.
(ii) Semasa kejadian :
Pesakit semakin teruk dan dikatakan tidak sedarkan diri di rumah.
Sebelum itu, pesakit batuk sambil menggosok dadanya. Pesakit
juga berpeluh. Ahli keluarga membawa terus ke Hospital Umum
Sarawak.
3
Selepas Kejadian :
Setibanya di Hospital Umum, pesakit di masukan ke Red Zon.
Bantuan pernafasan segera diberikan dengan pemberian oksigen
High Flow Mask 15 liter. Sejarah pesakit diambil dari ahli
keluarganya. Hasil pemeriksaan mendapati pesakit mengalami
asma. Nebulizer diberi. Pesakit mulai sedar setelah mengambil
sedutan nebulizer selama setengah jam. Penyelidikan dilakukan
dengan menganbil spesimen darah dan x-ray. Setelah stabil,
pesakit di rujuk kepada pakar Perubatan. Pesakit dimasukan ke
wad Perubatan bagi rawatan lanjut.
SEJARAH PENYAKIT LALU :
Sejarah perubatan
Pesakit mempunyai sejarah perubatan yang lampau di antaranya
Cronic Obstruction Airway Disease, Hypertension, Benign
Prostate Hyperthropy dan Gastric Ulcer. Mendapat rawatan di
Hospital Umum dengan pakar Perubatan. Adakalnya pesakit
mendapat ubatan ulangan di Hospital Sentosa. Selalu masuk wad
di Hospital Umum kerana penyakit yang beliau hidapi di atas
semakin teruk.
4
(ii) Sejarah pembedahan
Pesakit tidak pernah menjalani apa-apa pembedahan
(iii) Alergi
oPesakit tiada sejarah alahan pada ubatan, makanan dan miniman.
SEJARAH KELUARGA :
Pesakit sudah berumah tangga dan mempunyai 3 orang anak.
Masing- masing sudah berumah tangga dan tinggal berasingan.
Pesakit juga mempunyai 2 orang cucu. Isteri pesakit juga mengidap
hypertension dan diabetes mellitus.
SEJARAH ALLERGI
Pesakit tiada alahan pada makanan dan minuman tetapi alahan
pada ubat Ponstan.
SEJARAH SOSIAL
o Pesakit seorang perokok sebanyak 20 batang satu hari. Pernah
cuba untuk berhenti. Pesakit juga ada mengambil alkohol.
Terutama musim perayaan. Semasa muda pesakit seorang ahli
sukan lumba perahu Regata. Minat berkebun dan menternak.
5
BAHAGIAN 3 :PEMERIKSAAN FIZIKAL
PEMERIKSAAN AM :
Pesakit dalam keadaan separuh sedar. Tiada keabnormalan fizikal. Berehat sepenuhnya di atas katil dalam posisi “fowler’s” dengan
menggunakan bantuan oksigen 10 Lt/min (High Flow Mask).
Pesakit berada dalam keadaan takipnea. Permukaan kulit yang sedikit pucat dan sejuk.
TANDA VITAL :
Suhu badan: 37,6 darjah celcius
Kadar nadi: 87 kali per minit
Kadar pernafasan: 25 kali per minit
Ritma nadi: Regular
Isipapadu nadi: Sederhana kuat
Tekanan darah: 160/90 mmHg
6
BAHAGIAN 4
PEMERIKSAAN KEPALA DAN SISTEM DERIA KHAS :
KEPALA:
Tiada luka atau parut.
Tiada hematoma.
Bentuk normal.
Tiada ketenderan.
Permukaan kulit sedikit pucat
MATA :
Bentuk normal, tiada luka .
Tiada papiloedema.
Sedikit palor.
Penglihatan jelas pada kedua-dua belah mata.
Tiada ketenderan.
Tiada discaj dan pendarahan kelihatan.
TELINGA :
Bentuk normal.
Tiada discaj dan pendarahan.
Tiada luka atau parut.
Tiada ketenderan ( palpasi dilakukan )
Pendengaran jelas di kedua – dua belah telinga.
7
HIDUNG :
Bentuk normal.
Tiada discaj dan pendarahan.
Tiada luka atau parut.
Tiada ketenderan.
Deria hidu yang baik.
Tiada sinusitis.
MULUT :
Bentuk normal.
Tiada discaj atau pendarahan pada gusi.
Tiada rekahan dan sianosis pada bibir.
Tiada ketenderan.
Tiada sebarang bendasing.
TEKAK:
Tidak terdapat kemerahan dan pembengkakan pada tonsil
Ada “Gag Reflex”.
Deria rasa yang baik.
LEHER :
Bentuk normal.
Tiada luka dan parut.
Tiada ketenderan.
8
Tiada pembesaran nodus limpa.
Tiada peralihan trakea.
Dapat menelan makanan dengan baik.
Tiada pembengkakan pada kelenjar tiroid.
Nadi karotid dapat dikesan dan dipalpat.
9
BAHAGIAN 5
SISTEM PERNAFASAN :
Inspeksi :
Tiada parut / luka pembedahan.
Bentuk dada semitrikal. (semasa pernafasan)
Tiada deformity.
Kadar pernafasan 26 kali per minit
Kedengaran wheezing yang jelas
Palpasi :
Pengembangan dada adalah yang sekata.
Kadar pernafasan regular.
Tiada ketenderen di kesan.
Trakea tidak beralih.
“Fremitus Vokal” yang normal.
Perkusi :
“Normoresonan” di setiap ruang interkostal di kedua-dua belah dada.
10
Auskultasi :
Kemasukan udara di kedua-dua belah paru-paru adalah jelas dan seimbang.
Bunyi krepitasi dan rhonki dikesan pada kedua-dua dasar paru-paru.
11
BAHAGIAN 6
SISTEM KARDIOVASKULAR
Inspeksi :
Tiada luka atau parut pembedahan.
Tiada denyutan abnormal.
Tiada bonjolan atau deformity.
Tiada pembengkakan dan hematoma.
Palpasi :
Terdapat peralihan sedikit pada kedudukan denyutan apeks (kardiomegali)
Nadi regular dan sederhana 76 per/min
Perkusi :
Tidak normal “cardiac dullness” pada sekitar kedudukan jantung.
Tiada kardiomegali dikesan.
Auskultasi :
Denyutan apeks dapat dikesan.
Bunyi denyutan apeks jelas kedengaran dan regular(DRNM).
Tiada murmur dikesan dan kadar denyutan apeks ialah 124/minit.
12
BAHAGIAN 7
SISTEM ALIMENTARI
Pesakit makan dan minum dengan baik sewaktu di wad. Pembuangan najis juga normal.
Inspeksi :
Tiada parut pembedahan dikesan.
Soft pada abdomen.
Umbilicus tiada pembonjolan.
Tiada hematoma dan parut dikesan.
Tiada sebarang luka dikesan.
Palpasi :
Superficial Dalam
Abdomen soft Abdomen soft
Tidak tender. Tiada mass.
Tiada mass. Hepar dapat di palpat.
Perkusi:
Pemeriksaan melalui ujian “Shifting Dullness” adalah positif.
Ujian “Fluid Thrill” juga positif.
13
Auskultasi :
Tiada kedengaran bunyi “Bruit” dikesan.
Normal “Bowel Sound” .
14
BAHAGIAN 8
SISTEM SARAF
Ekstrimiti atas
KANAN KIRI
Bahu
Abduksi 5/5 5/5
Adduksi 5/5 5/5
Siku
Fliksi 5/5 5/5
Eksteksi 5/5 5/5
Pergelangan jari
Fleksi 5/5 5/5
Ekstensi 5/5 5/5
Pergelangan tangan
Fleksi 5/5 5/5
Ekstensi 5/5 5/5
Refleks
Bisep ++ ++
Trisep ++ ++
Bronchioradialis ++ ++
Sensasi bertindak balas dengan baik pada bahagian sebelah kanan badan pesakit tetapi agak kurang tindakbalas pada sebelah kiri badan.
15
SISTEM SARAF
Ekstrimiti Bawah.
KANAN KIRI
Punggung 5/5 5/5
Paha
Abduksi 5/5 5/5
Adduksi 5/5 5/5
Ankle Reflex 5/5 5/5
Knee jerk ++ (Normal) ++
Ankle jerk ++ (Normal) ++
Plantar ( ) ( )
Pesakit adalah sedar sepenuhnya.
GCS pesakit adalah 15/15.( Di wad)
16
BAHAGIAN 9
SISTEM MUSKULOSKELETAL
Ekstrimiti Atas
Inspeksi
Tiada kebengkakan.
Tiada luka dan parut.
Tiada pendarahan dan hematoma.
Tiada”Clubbing Fingers”
Palpasi
Tiada ketenderan.
Nadi brahlocardialis dan radial dapat di kesan.
Tonus otot
Normatonia
Muscle power
5/5 pada sebelah kanan badan dan 5/5 pada sebelah kiri badan.
Sensasi
Merasa sakit terhadap cucukan.
Sirkulasi
Capilari refill pada jari tangan kurang dari 2 saat.
17
Ekstrimiti Bawah
Inspeksi
Tiada luka parut dan juga pendarahan.
Tiada “Pedal oedema “
Palpasi
Tiada ketenderan pada kedua-dua belah kaki.
Tiada sebarang kecacatan kelihatan.
Tonus
Normatonia
Mucles power
Kaki kanan- 5/5
Kaki kiri - 5/5
Sensasi
Merasa sakit terhadap cucukan.
Sirkulasi
“Capillary refill “ pada jari kaki kurang dari 2 saat.
18
BAHAGIAN 10
RINGKASAN PENEMUAN YANG PENTING DAN RELEVAN
Mata: Tiada pendarahan, bengkak, Kepala : Tiada luka atau pendarahan.
luka dan discaj. Tiada hematoma
Tiada tender
Sedikit palor Mulut : Tiada luka, parut dan
pendarahan
ENT : Tiada pendarahan Leher : Tiada luka.
Tiada discaj Tiada Pendarahan.
Tiada kebengkakan Nadi karotid dapat dipalpat.
Tiada luka. Vocal cord normal.
CVS : Abdomen :
S1S2 (Gallop Rythm)
Distensi pada abdomen.Peralihan pada
Fluid Thrill positif apeks jantung (kardioegali)
Agak keras, tiada luka, pendarahan Normal bowel sound
Genitalia :
normalEkstrimiti atas :
Tiada luka, parut, pendarahan
Tiada pembengkakan
Tiada kecacatan
19
Tiada clubbing finger
Nadi dapat dipalpat, capillary refill kurang 2 saat.
Paru – paru :
Transmitted Sound pada kedua-dua paru-paru(Rhonci)
Bunyi krepitasi dan rhonci dikesan pada dasar kedua-dua belah paru-paru.
Kemasukan udara jelas dan seimbang.
Dada semitrikal.
Ekstremiti bawah (Kanan)
Tiada luka atau parut pembedahan.
Tiada deformiti.
Tiada pitting edema.
“Capillary Refill” kurang daripada 2 saat.
Ujian sensasi baik - merasa kesakitan pada rangsangan cucukan.
Ekstremiti bawah (Kiri)
Tiada luka atau parut pembedahan.
Tiada “Pedal oedema”
“Capillary Refill” kurang daripada 2 saat.
Ujian sensasi baik - merasa kesakitan pada rangsangan cucukan.
20
BAHAGIAN 11
DIAGNOSIS
Diagnosis sementara : Ac. Exerbaction Chronic Obstruction Airway Disease
Diagnosis perbezaan : Chronic Obstruction Pulmonary Disease Pneumonia Bronchiol Asthma
BAHAGIAN 12
PENYIASATAN YANG PENTING DAN RELEVAN
5. Ujian Darah:
(i) Full Blood Count
Total White Differential Count (TWDC)
Mengesan sebarang jangkitan dalam badan pesakit.
Hemoglobin (Hb)
Mengesan Anemia.
Platelet
Mengesan kadar atau pembekuan darah.
(ii) Blood Urea Serum Electrolit (BUSE)
Mengesan fungsi renal pesakit dan juga keseimbangan
elektrolit dalam badan.
2. Sinar-X dada
21
Mengesan hipertrofi atrium ataupun ventrikel kanan jantung.
Mengesan pembesaran arteri pulmonari dan juga efusi pleura.
3. Arterial Blood Gases (ABG)
Menilai pH dalam darah pesakit (kesan asidosis atau alkalosis).
KEPUTUSAN FULL BLOOD COUNT
WBC 17.1 H 4.1 – 10.9
GYM 2.0 0.6 – 4.1
GRAN 14.4 H 2.0 – 7.8
RBC 3.40 L 4.2 – 6.3
HGB 7.7 L 12.0 – 18.0
HCT 25.3 L 37 - 51
MCV 74.4 L 80 - 92
MCH 22.6 L 26 - 32
MCHC 30.4 L 31 - 36
RDW 15.7 H 11.5 – 14.5
PLT 592 H 14 - 44
22
BAHAGIAN 13 :
PENGURUSAN DI UNIT KECEMASAN
Sambut kehadiran pesakit. Tempatkan di zon merah.
Terangkan prosedur kepada ahli keluarganya untuk mendapatkan
kerjasama. Selain itu, beritahu tentang keadaan pesakit dan berikan
sokongan emosi untuk kurangkan keresahan.
Tentukan saluran pernafasan pesakit tiada kesekatan.
Tanda vital di ambil seperti tekanan darah, suhu, nadi, saturation oksigen.
Pesakit dalam posisi “fowlers” dan diikuti pemberian oksigen 10 hingga 12
liter per minit melalui “High Flow Mask” untuk kurangkan kesesakan nafas.
Lakukan pemeriksaan secara menyeluruh secara cepat dari kepala
hingga ke kaki.
Pemberian nebulizer A:V:N (2:2:2)
Monitor tanda-tanda vital pesakit secara regular setiap 15 minit. (kadar
pernafasan, nadi, suhu badan dan tekanan darah). Nilai juga Glasgow
Coma Scale (GCS) pesakit.
Setelah keadaan pesakit agak stabil, ambil sejarah dan juga riwayat
pesakit untuk tujuan untuk rancangan rawatan, diagnosis,mengenalpasti
penyakit-penyakit lain pesakit dan juga alergi.
23
Lakukan pemeriksaan fizikal (Inspeksi, Palpasi, Perkusi dan Auskultasi)
terhadap semua sistem badan pesakit (Sistem pernafasan,
kardiovaskular, alimentari,saraf dan muskuloskeletal) untuk mengesan
sebarang keabnormalan dan catatkan sebarang penemuan.
Rujuk pesakit kepada pakar kanak-kanak yang bertugas untuk
pemeriksaan lanjut dan juga untuk rawatan selanjutnya seperti rawatan
ubatan-ubatan.
Lakukan penyiasatan makmal yang relevan:
1. Ujian Darah:
a. Full Blood Count
i. Total White Differential Count (TWDC)
Mengesan sebarang jangkitan dalam badan pesakit.
ii. Hemoglobin (Hb)
Mengesan Anemia.
iii. Platelet
Mengesan kadar atau pembekuan darah.
b. Blood Urea Serum Electrolit (BUSE)
i. Mengesan fungsi renal pesakit dan juga keseimbangan
elektrolit dalam badan
2. Arterial Blood Gases (ABG)
Menilai pH dalam darah pesakit (kesan asidosis atau alkalosis)
3. Urinalysis
4. Chest X-Ray
24
Terangkan kepada pesakit dan juga ahli keluarganya yang pesakit perlu
dimasukkan ke hospital untuk penyiasatan, rawatan lanjut dan juga untuk
pemerhatian.
Sediakan borang rujukan ke wad yang lengkap dan maklumkan kepada
staf yang bertugas dalam wad tersebut.
25
BAHAGIAN 14
PENGURUSAN DI WAD HOSPITAL
Sambut kedatangan pesakit dan lakukan prosidur kemasukan pesakit ke wad
Rehatkan pesakit di atas katil. Mulakan kesinambungan rawatan dari
jabatan kecemasan
Lakukan orientasi wad kepada pesakit atau ahli keluarganya untuk
memudahkan pesakit menjalani kehidupan harian pesakit di wad. Selain
itu, terangkan tentang peraturan-peraturan di wad, contohnya tentang
masa melawat yang ditetapkan.
Monitor tanda-tanda vital pesakit secara regular setiap 4 jam. (kadar
pernafasan, nadi, suhu badan dan tekanan darah).
Ambil sejarah dan juga riwayat pesakit untuk tujuan untuk rancangan
rawatan, diagnosis,mengenalpasti penyakit-penyakit lain pesakit dan juga
alergi.
Lakukan pemeriksaan fizikal (Inspeksi, Palpasi, Perkusi dan Auskultasi)
terhadap semua sistem badan pesakit (Sistem pernafasan,
kardiovaskular, alimentari,saraf dan muskuloskeletal) untuk mengesan
sebarang keabnormalan dan catatkan sebarang penemuan.
Ambil spesimen darah untuk ujian darah:
a. Full Blood Count
i. Total White Differential Count (TWDC)
26
Mengesan sebarang jangkitan dalam badan pesakit.
ii. Hemoglobin (Hb)
Mengesan Anemia.
iii. Platelet
Mengesan kadar atau pembekuan darah.
b. Blood Urea Serum Electrolit (BUSE)
i. Mengesan fungsi renal pesakit dan juga keseimbangan
elektrolit dalam badan.
Ubatan
Penjagaan kejururawatan:
i. Kebersihan pesakit semasa di wad.
ii. Permakanan yang seimbang.
iii. Monitor tanda vital setiap 4 jam.
iv. Monitor intake / output chart.
v. Fit chart.
27
BAHAGIAN 15
Kemajuan Pesakit Semasa Di Hospital
Hari Pertama (23 APRIL 2009) – 11AM
Pesakit kelihatan lemah dan sesak nafas.
Pesakit diberikan bantuan terapi oksigen dengan menggunakan “high flow mask”
dengan kadar 12 liter/minit.
Pesakit berehat di katil dalam posisi “fowler”
Pemberian nebulizer A:V:N (2:2:2).
Chart PEAK
Chest physiotherapy
Tanda – tanda vital:
Tekanan darah 160/80 mmHg
Nadi 84 per minit
Suhu badan 37.3 darjah celcius
Kadar pernafasan 24 per minit
Ubat – ubatan:
Tab atenolol 50-100mg BD
Tab prednisolone 30mg/day
Iv aminophyline 250 mg
28
Penyiasatan
Pengambilan Electrocardiogram (ECG)
Hipertrofi ventrikel
Kompleks QRS lebar
Gelombang T tinggi
Sinar X-dada
BUSE ( Blood Urea Serum Electrolyte )
FBC ( Full Blood Count )
TWDC ( Total White Differiential Count ) – 10.6 (H)
Hb ( Hemoglobin ) - Normal
PTT ( Platelet Trombin Time) – 454 (H)
Lain-lain perancangan perawatan
Pesakit dirujuk kepada pakar kardiak untuk pemeriksaan dan mendapatkan
pengesahan untuk menjalani ekokardiogram.
Pengambilan ubat Tab Atenolol diberhentikan.
Pengawalan carta ( I/O ) – penghadan pengambilan cecair < 800 mi /day.
29
Hari Kedua (24 APRIL 2009) – 08.00 pagi
Pesakit masih kelihatan lemah dan sukar atau sesak nafas.
Pesakit diberikan bantuan terapi oksigen dengan menggunakan nasal prong
dengan kadar 2 liter/minit.
Pesakit berehat di katil dalam posisi “fowler”.
Jumlah pengambilan cecair yang direkodkan di carta I/O adalah 750/1000 ml.
Pesakit mengadu tidak dapat tidur malam akibat sesak nafas.
Chest physioteraphy
Tanda – tanda vital:
Tekanan darah 130/80 mmHg
Nadi 90 per minit
Suhu badan 37.0 darjah celcius
Kadar pernafasan 18 per minit
Ubat – ubatan:
Salbutamol 2.5 mg QID
Continue nebulizer.
Tab prednisolone 30 mg/day
Penyiasatan
Pengambilan Electrocardiogram (ECG) – Daily ECG
Hipertrofi ventrikel
30
Kompleks QRS masih lebar
Gelombang T masih tinggi
Cretinin – Normal
Liver Function Test
Daripada ujian yang dilakukan, didapati fungsi hepar pesakit agak menurun.
Lain-lain perancangan perawatan
Pesakit dirujuk kepada pakar kardiak untuk pemeriksaan dan
mendapatkan pengesahan untuk menjalani ekokardiogram.
Pengambilan ubat Tab Atenolol diberhentikan.
Pengawalan carta ( I/O ) – penghadan pengambilan cecair tidak melebihi
800 ml/sehari
Pastikan pesakit dalam keadaan atau posisi fowler.
“Keep In View”
31
Hari Ketiga (25 APRIL 2009) – 09.00 pagi
Pesakit berehat di atas katil dan kelihatan dalam keadaan yang agak selesa
dalam posisi semifowler.
Pesakit masih diberikan bantuan terapi oksigen dengan menggunakan nasal
prong dengan kadar 2 liter/minit. (Jika perlu sahaja)
Jumlah pengambilan cecair yang direkodkan di carta I/O adalah 500/950 ml.
Tanda – tanda vital:
Tekanan darah 140/80 mmHg
Nadi 80 per minit
Suhu badan 36.7 darjah celcius
Kadar pernafasan 20 per minit
Penyiasatan
Tiada sebarang penyiasatan makmal yang dilakukan pada hari tersebut.
Lain-lain perancangan perawatan
Pesakit diperiksa oleh pakar kardiak untuk menilai perkembangan pesakit.
Pengawalan carta ( I/O ) – penghadan pengambilan cecair tidak melebihi
800 ml/sehari
32
. Hari Keempat (26 APRIL 2009) – 08.30 pagi
Pesakit berehat di atas katil dan kelihatan dalam keadaan yang agak selesa
tanpa bantuan oksigen.
Jumlah pengambilan cecair yang direkodkan di carta I/O adalah 550/950 ml.
Pesakit menyatakan yang beliau tidak lagi mengalami masalah untuk tidur pada
waktu malam.
Selain itu, percakapan pesakit lancar dan tidak tersekat-sekat.
Tanda – tanda vital:
Tekanan darah 130/85 mmHg
Nadi 78 per minit
Suhu badan 36.7 darjah celcius
Kadar pernafasan 22 per minit
Penyiasatan
Pemeriksaan fizikal dilakukan oleh doktor yang bertugas. Hasil daripada
pemeriksaan yang dilakukan, didapati:
Bunyi krepitasi di dasar kedua-dua paru-paru pesakit semakin
berkurangan.
Pengambilan Electrocardiogram (ECG) – Daily ECG
Hipertrofi ventrikel
Kompleks QRS kelihatan semakin normal (tidak begitu lebar)
33
Gelombang T semakin rendah.
Lain-lain perancangan perawatan
Pesakit diperiksa oleh pakar kardiak untuk menilai perkembangan pesakit.
Pengawalan carta ( I/O ) – penghadan pengambilan cecair tidak melebihi
800 ml/sehari
. Hari Kelima (27 APRIL 2009) – 09.30 pagi
Pesakit berehat di atas katil dan kelihatan dalam keadaan yang agak selesa
tanpa bantuan oksigen.
Jumlah pengambilan cecair yang direkodkan di carta I/O adalah 660/950 ml.
Tanda – tanda vital:
Tekanan darah 140/90 mmHg
Nadi 75 per minit
Suhu badan 36.5 darjah celcius
Kadar pernafasan 21 per minit
Penyiasatan
Tiada sebarang penyiasatan makmal yang dilakukan pada hari tersebut.
Lain-lain perancangan perawatan
Pesakit diperiksa oleh pakar kardiak untuk menilai perkembangan pesakit.
Penambahan ubat pesakit – Tab Metoprolol 50 mg BD ( Anti Hipertensi)
34
. Hari Keenam (28 APRIL 2009) – 11.45 pagi
Pesakit kelihatan cergas dan bertenaga.
Tidak mengalami kesukaran untuk bernafas.
Setelah diperiksa oleh pakar kardiak, pesakit dibenarkan pulang pada hari
tersebut dan disahkan dalam keadaan yang stabil dan sihat.
Hasil pemeriksaan, paru-paru pesakit adalah “clear”
Tanda – tanda vital:
Tekanan darah 130/80 mmHg
Nadi 70 per minit
Suhu badan 37.0 darjah celcius
Kadar pernafasan 20 per minit
Ubat – ubatan yang dibekalkan kepada pesakit:
Tab prednisolone 30mg/day
Tab Metoprolol 50 mg BD
Nebulizer bronchodilators by metered dose aerosol or dry.
*Ubat-ubatan ini dibekalkan untuk tempoh sebulan.
Penyiasatan
Tiada sebarang penyiasatan makmal yang dilakukan pada hari tersebut.
35
Nasihat dan pendidikan kesihatan kepada pesakit sebelum discaj:.
Jumpa dengan doktor tepat pada masanya sekiranya ada temujanji.
Makan ubat yang dibekalkan oleh doktor mengikut masa, dos dan
jenis yang telah ditetapkan.
Mengajar cara-cara penggunaan aerosol inhaler
Permakanan yang seimbang dan kurangkan pengambilan makanan
berlemak dan yang mengandungi garam yang tinggi.
Jaga kebersihan diri.
Elak dari tempet yang berhabuk dan kotor
Jangan merokok dan tidak berada di tempat orang merokok
Segera laporkan jika terdapat sebarang komplikasi daripada
pengambilan ubat yang dibekalkan untuk tindakan selanjutnya.
Elakkan mengambil sebarang jenis ubat lain tanpa mendapatkan
nasihat daripada doktor.
Jumpa doktor dengan segera jika ada tanda-tanda sesak nafas atau
mengalami pening kepala ataupun komplikasi-komplikasi lain.
Pastikan mendapat rehat dan tidur yang cukup.
Jangan minum minuman beralkohol dan merokok.
Jangan melakukan aktiviti berat atau melebihi keupayaan diri.
36
What is asthma?
Asthma causes swelling and inflammation in the airways that lead to
your lungs. When asthma flares up, the airways tighten and become
narrower. This keeps the air from passing through easily and makes
it hard for you to breathe. These flare-ups are also called asthma
attacks or exacerbations.
Asthma affects people in different ways. Some people only have
asthma attacks during allergy season, or when they breathe in cold
air, or when they exercise. Others have many bad attacks that send
them to the doctor often.
Even if you have few asthma attacks, you still need to treat your
asthma. The swelling and inflammation in your airways can lead to
permanent changes in your airways and harm your lungs.
Many people with asthma live active, full lives. Even though asthma
is a lifelong disease, treatment can control it and keep you healthy.
What causes asthma?
Experts do not know exactly what causes asthma. But there are some
things we do know:
Asthma runs in families.
37
Asthma is much more common in people with allergies, though not
everyone with allergies gets asthma. And not everyone with asthma has
allergies.
Pollution may cause asthma or make it worse.
What are the symptoms?
Symptoms of asthma can be mild or severe. You may have mild attacks
now and then, or you may have severe symptoms every day, or you may
have something in between. How often you have symptoms can also
change. When you have asthma, you may:
Wheeze, making a loud or soft whistling noise that occurs when you
breathe in and out.
Cough a lot.
Feel tightness in your chest.
Feel short of breath.
Have trouble sleeping because of coughing or having a hard time
breathing.
Quickly get tired during exercise.
Your symptoms may be worse at night.
Severe asthma attacks can be life-threatening and need emergency
treatment
38
How is asthma diagnosed?
Along with doing a physical exam and asking about your health, your
doctor may order lung function tests. These tests include:
Spirometry. Doctors use this test to diagnose and keep track of asthma.
It measures how quickly you can move air in and out of your lungs and
how much air you move.
Peak expiratory flow (PEF). This shows how fast you can breathe out
when you try your hardest.
An exercise or inhalation challenge. This test measures how quickly
you can breathe after exercise or after taking a medicine.
A chest X-ray, to see if another disease is causing your symptoms.
Allergy tests, if your doctor thinks your symptoms may be caused by
allergies.
You will need routine checkups with your doctor to keep track of your
asthma and decide on treatment.
How is it treated?
There are two parts to treating asthma. The goals are to:
Control asthma over the long term. To do this, use a daily asthma
treatment plan. This is a written plan that tells you which medicine to
take. It also helps you track your symptoms and know how well the
treatment is working. Many people take controller medicine—usually an
inhaled corticosteroid—every day. Taking controller medicine every day
39
helps to reduce the swelling of the airways and prevent attacks. Your
doctor will show you how to use your inhaler correctly. This is very
important so you get the right amount of medicine to help you breathe
better.
Treat asthma attacks when they occur. Use an asthma action plan,
which tells you what to do when you have an asthma attack. It helps
you identify triggers that can cause your attacks. You use quick-relief
medicine, such as albuterol, during an attack.
If you need to use the quick-relief inhaler more often than usual, talk to
your doctor. This is a sign that your asthma is not controlled and can
cause problems.
Asthma attacks can be life-threatening, but you may be able to prevent
them if you follow a plan. Your doctor can teach you the skills you need
to use your asthma treatment and action plans.
How can you prevent asthma attacks?
You can prevent some asthma attacks by avoiding those things that cause
them. These are called triggers. A trigger can be:
Irritants in the air, such as cigarette smoke or other air pollution.
Don't smoke, and try to avoid being around others when they
smoke.
40
Things you are allergic to, such as pet dander, dust mites,
cockroaches, or pollen. When you can, avoid those things you are
allergic to. It may also help to take certain kinds of allergy medicine.
Exercise. Ask your doctor about using an inhaler before you
exercise if this is a trigger for you.
Other things like dry, cold air; an infection; or some medicines, such
as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).
Try not to exercise outside when it is cold and dry. Talk to your
doctor about vaccines to prevent some infections, and ask about
what medicines you should avoid.
Sometimes you don't know what triggers an asthma attack. This is
why it is important to have an asthma action plan that tells you what
to do during an attack.
Cause
The cause of asthma is not known. Health experts believe that inherited,
environmental, and immune system factors combine to cause
inflammation of the bronchial tubes, which carry air to the lungs. This can
lead to asthma and asthma attacks.
Asthma may run in families (be inherited). If this is the case in your family,
you may be more likely than other people to develop long-lasting (chronic)
inflammation in the bronchial tubes.
In some people, immune system cells release chemicals that cause
inflammation in response to certain substances (allergens) that cause
allergic reactions. Studies show that exposure to allergens such as dust
mites, cockroaches, and animal dander may influence asthma’s
41
development. 1 Asthma is much more common in people with allergies,
although not all those with allergies develop asthma. And not all people
with asthma have allergies.
Environmental factors and today's germ-conscious lifestyle may play a
role in the development of asthma. Some experts believe that there are
more cases of asthma because of pollution and less exposure to certain
types of bacteria or infections. 2 As a result, children's immune systems
may develop in a way that makes it more likely they will also develop
allergies and asthma.
Asthma in adults also can be related to work (occupational asthma). Being
around animals, plastic resin, wood dust, grain dust, insecticides, and
metals can cause asthma, usually because your immune system reacts to
the material. Some people continue to have asthma symptoms even after
they are no longer exposed to what caused the symptoms. But for many
people, symptoms will get better or go away when they are away from the
asthma trigger.
Symptoms
Symptoms of asthma can be mild or severe. You may have no symptoms;
severe, daily symptoms; or something in between. How often you have
symptoms can also change. Symptoms of asthma may include:
Wheezing, which is a whistling noise of varying loudness that occurs when
the airways of the lungs (bronchial tubes) narrow.
Coughing, which is the only symptom for some people.
Chest tightness.
Shortness of breath, which is rapid, shallow breathing or difficulty
breathing.
Sleep disturbance because of coughing or having a hard time breathing.
Tiring quickly during exercise.
An asthma attack occurs when your symptoms suddenly increase. Factors
that can lead to an asthma attack or make it worse include:
42
Having a cold or another type of respiratory illness, especially one caused
by a virus, such as influenza.
Exercising (exercise-induced asthma), especially if the air is cold and dry.
Exposure to triggers, such as cigarette smoke, air pollution, dust mites, or
animal dander.
Being around chemicals or other substances at work (occupational
asthma).
Changes in hormones, such as during the start of a woman's menstrual
blood flow or pregnancy.
Taking medicines, such as aspirin (aspirin-induced asthma) or
nonsteroidal anti-inflammatory drugs.
Many people have symptoms that become worse at night (nocturnal
asthma). In all people, lung function changes throughout the day and
night. In people with asthma, this often is very noticeable, especially at
night, and nighttime cough and shortness of breath frequently occur. In
general, waking at night because of shortness of breath or cough indicates
poorly controlled asthma.
Symptoms are used to classify asthma by severity. They are also used
along with peak expiratory flow to help define the green, yellow, and red
zones of your asthma action plan. You use this plan to decide on
treatment during an asthma attack.
Other conditions with symptoms similar to asthma include heart failure,
chronic obstructive pulmonary disease (COPD), and vocal cord
dysfunction.
What Happens
Asthma often begins during infancy or childhood but may start at any age
and last throughout your life. It can increase your risk for complications
from lung and airway infections, such as acute bronchitis and pneumonia.
43
At times, the inflammation from asthma causes a narrowing of your
airways and mucus production, resulting in asthma symptoms such as
shortness of breath.
The airways narrow when they overreact to certain substances. These are
known as asthma triggers and may include:
Substances you are allergic to (allergens, such as dust mites or animal
dander). Allergens cause long-term (chronic) inflammation and may cause
asthma symptoms.
Environmental factors, such as smoke or cold air. Environmental factors
may lead to a tightening of the muscles that line the bronchial tubes
(bronchospasm), which can trigger asthma symptoms.
What triggers asthma symptoms varies from person to person. When
asthma is triggered by an allergen, it is called allergic asthma.
When asthma symptoms suddenly occur, it is called an asthma attack
(also called a flare-up or exacerbation). Asthma attacks can occur rarely
or frequently and may be mild to severe. Although some asthma attacks
occur very suddenly, many become worse gradually over a period of
several days. Generally, you can take care of symptoms at home with an
asthma action plan, although a severe attack may require emergency
treatment and on rare occasions can be fatal.
Asthma is classified as intermittent, mild persistent, moderate persistent,
and severe persistent.
People with intermittent asthma often have symptoms only after being
around a trigger.
People with intermittent asthma usually need medications only during an
asthma attack.
People with mild persistent or moderate persistent asthma may not always
have noticeable symptoms, but they need to take medications daily to
control the long-term inflammation in their airways.
People with severe persistent asthma have symptoms almost all of the
time. Their symptoms need to be treated daily. These people are at
44
increased risk for severe, life-threatening asthma attacks known as status
asthmaticus.
Asthma—even mild asthma—may result in changes to the airway system
(airway remodeling) and may speed up and make worse the natural
decrease in lung function that occurs as we age. 3 Asthma may raise your
risk for developing chronic obstructive pulmonary disease (COPD). 4
Sometimes asthma does not respond to treatment because people are not
taking their medications, not taking them correctly, not avoiding triggers, or
otherwise not following their daily treatment plans or asthma action plans.
Follow your asthma plans so you can prevent worsening asthma and an
increased risk of death.
Asthma during pregnancy
Asthma can affect your pregnancy. It may occur for the first time during
pregnancy, or it may change during pregnancy.
When asthma is properly controlled, a pregnant woman with asthma can
have a normal pregnancy with little or no increased risk to herself or her
fetus. But if the asthma is not well controlled, there are risks to the
pregnant woman and her fetus. The management of asthma in pregnant
women and nonpregnant women is basically the same, although a
pregnant woman may need to take different medications and needs to
monitor the fetus's health as well as her own.
What Increases Your Risk
Many factors may increase your risk of developing asthma. Some of these
are not within your control; others you can control. The major risk factors
for developing asthma as an adult are ongoing (chronic) wheezing when
you were a child and cigarette smoking. 5
Asthma risk factors that you cannot control
45
The following risk factors are not within your control:
Gender and age. Women and men seem to have the same risk of
developing asthma until they reach their 40s. After 40, women have a
higher risk for asthma.
A family history of allergies and asthma. People who have an allergy and
asthma usually have a family history of allergies or asthma.
Inherited tendency (genetic predisposition) to overreaction of the bronchial
tubes. People who inherit a tendency of the bronchial tubes (which carry
air to the lungs) to overreact often develop asthma.
A history of allergy. If you have an allergy, you are more likely than others
to develop asthma. Most children and many adults with asthma have
atopic dermatitis, allergic rhinitis, or both. Studies indicate that 40% to
50% of children with atopic dermatitis develop asthma. Having atopic
dermatitis as a child may also increase your risk of having more severe
and persistent asthma as an adult than someone who did not have atopic
dermatitis. 6
Rhinitis. Adults who have inflamed nasal passages (rhinitis) have a higher-
than-average risk of developing asthma.
Asthma risk factors that you can control
You may be able to change some factors to reduce your or your teen's risk
of developing asthma. These include:
Cigarette smoking. People who smoke are more likely to get asthma. If
you already have asthma and you smoke, it may make your symptoms
such as wheezing worse.
Cigarette smoking during pregnancy. Women who smoke during
pregnancy increase the risk of wheezing in their babies. Babies whose
mothers smoked during pregnancy also have worse lung function than
those whose mothers did not smoke.
46
Workplace exposure to irritants. Occupational asthma may develop after
exposure to a specific inhaled irritant or allergen in the workplace. Such
substances also can make symptoms worse in people with existing
asthma.
Dust mites. Exposure to dust mites is a risk factor in the development of
asthma. 7
Cockroaches. In one study, children who had high levels of cockroach
droppings in their homes were 4 times more likely to have a new diagnosis
of asthma than children whose homes had low levels. 7
Obesity. Studies have found that obese children may be more likely to
have asthma. But the reason for this is unclear. Experts don't know
whether one condition contributes to the other or whether some unknown
mechanism contributes to both. 8 Some people who are obese and who
lose weight may have fewer asthma symptoms. And sometimes
symptoms caused by obesity are thought to be asthma symptoms.
No one is sure if breast-feeding affects a child's risk of getting asthma.
Some studies show that breast-feeding protects a child from getting
asthma. 9, 10 Other studies show that breast-feeding, especially when
mothers with asthma breast-feed, may actually raise a child's risk of
getting asthma. 11 A large study following children until 14 years of age
found that breast-feeding had no effect on the development of asthma. 12
Mothers are encouraged to breast-feed their children for all the other
proven health benefits that come from breast-feeding.
Experts are also not sure about the effect that pets in the home have on
getting asthma. Some research shows that having cats or dogs in the
home raises an adult's risk of getting asthma. 13 But other research has
seemed to show that being around pets early in life might actually protect
a child against getting asthma. 14 If your child already has asthma and
allergies to pets, having a pet in the home will make his or her asthma
worse.
47
Risk factors that may make asthma worse (triggers)
Triggers that may make asthma worse and may lead to asthma attacks
include:
Infections, such as severe upper respiratory infections (URIs), sinusitis,
and influenza (flu). URIs cause more than half of the asthma attacks in
adults. 15, 16
Allergens, such as dust mites, mold, or pet dander. 7
When to Call a Doctor
If you have been diagnosed with asthma and have an asthma action plan,
do the following:
Call 911 or other emergency services immediately if you are having
severe asthma symptoms (in the red zone of your asthma action plan) and
you have followed the plan, but:
You are having severe difficulty breathing.
20 to 30 minutes after taking the extra medication, you do not feel better
and/or your peak expiratory flow (PEF) is still less than 50% of your
personal best measurement.
Call your health professional immediately if you:
Are in the red zone, and 6 hours after taking the extra medication the
following are true:
You still require inhaler medication every 1 to 3 hours.
Your PEF is below 70% of your personal best measurement.
Are in the yellow zone of the asthma action plan and continue to have a
PEF below 70% of your personal best measurement in spite of home
treatment using your asthma action plan.
Have mild asthma symptoms that get worse, and you feel there is nothing
else you can do at home.
48
Are having a first attack of asthma symptoms, and your symptoms include
wheezing, chest tightness, and moderate difficulty breathing.
Are coughing up green, dark brown, or bloody mucus.
Call your health professional if you:
Have asthma symptoms, you do not have an asthma action plan, and your
symptoms are mild (chest tightness, cough, and slight shortness of breath
or tiring easily during exercise).
Are having symptoms in the yellow zone almost every day, and you need
to use your quick-relief inhaler medicine to control your symptoms.
Have asthma and your PEF has been getting worse for 2 to 3 days.
If you have not been diagnosed with asthma but have mild asthma
symptoms, call your doctor and make an appointment for an evaluation.
If your teenager has symptoms of asthma, it is important to see a doctor.
A large portion of teens with frequent wheezing may have asthma but are
not diagnosed with the disease. Teens who have asthma but are less
likely to be diagnosed are most often: 17
Girls.
Smokers, or teens who are exposed to household cigarette smoke.
Those with low socioeconomic status.
Those who have allergies.
African Americans, Native Americans, or Mexican Americans.
Watchful WaitingWatchful waiting is a period of time during which you and your doctor observe
your symptoms or condition without using medical treatment. Self-treatment is
not appropriate if you have asthma symptoms. See your doctor, even if you are
taking nonprescription medications and they relieve your symptoms.
If you have been getting treatment for 1 to 3 months but are not improving, ask
your doctor whether you need to see an asthma specialist.
49
Watchful waiting may be appropriate if you follow your asthma daily treatment
and action plans and stay within the green zone. Watch the symptoms and
continue to avoid asthma triggers.
Who to See
Health professionals who can diagnose and treat asthma include: Pediatricians. Family medicine physicians. Nurse practitioners. Physician assistants. Internists. You may need to see a specialist (allergist or pulmonologist) if you have: Severe persistent asthma. Other medical conditions that make it hard to treat asthma. A need for additional education or have difficulty following your daily
asthma treatment and action plans. Not met the goals of treatment after several months of therapy. Had a life-threatening asthma attack. Skin testing for allergies or you get allergy shots. Occupational asthma.
Exams and Tests
A diagnosis of asthma is based on your medical history, a physical exam, and lung function tests. If you developed asthma in adulthood, your doctor will ask about your job to determine whether you have occupational asthma.
Lung function tests can diagnose asthma, determine its severity, and check for complications.
Spirometry is the most common test used to diagnose asthma. It measures how quickly you can move air in and out of your lungs and how much air is moved. The test helps your doctor decide whether airflow is decreased because of inflammation in the bronchial tubes and whether the tubes can return to their usual size in a short time after using medication. Doctors also recommend the test at least every 1 to 2 years after asthma treatment has begun.
Testing of daytime changes in peak expiratory flow (PEF) is done over 1 to 2 weeks. This test is needed when you have symptoms off and on but have normal spirometry test results.
An exercise or inhalation challenge may be used if the spirometry test results have been normal or near normal but asthma is still suspected. These tests measure how quickly you can breathe in and out after exercise or after using a medication. An inhalation challenge also may be
50
done using a specific irritant or allergen if your doctor suspects occupational asthma.
Regular checkups
You need to monitor your condition and have regular checkups to keep
asthma under control and to review and possibly update your daily
treatment and action plans. The frequency of checkups depends on how
your asthma is classified. Checkups are recommended:
About every 6 to 12 months for people with intermittent or mild persistent
asthma that has been under control for at least 3 months.
Every 3 to 6 months for those with moderate persistent asthma.
Every 1 to 2 months for people with uncontrolled or severe persistent
asthma.
During checkups, your doctor will ask whether your symptoms and peak
expiratory flow have held steady, improved, or become worse and will ask
about asthma attacks during exercise or at night. You track this
information in an asthma diary. You may be asked to bring your peak
expiratory flow meter to an appointment so your doctor can see how you
use it. Based on the results, your asthma category may change, and your
doctor may change the medications you use or how much medication you
use.
Tests for other diseases
Asthma sometimes is hard to diagnose because symptoms vary widely
from person to person and within each person over time. Symptoms may
be the same as those of other conditions, such as influenza or other viral
respiratory infections or vocal cord dysfunction. Tests done to determine
whether diseases other than asthma are causing your symptoms include
the following:
Additional lung function tests may be needed if other lung diseases, such
as chronic obstructive pulmonary disease (COPD), are suspected.
51
An electrocardiogram (EKG, ECG) measures the electrical signals that
control the rhythm of your heartbeat. This test might be done to rule out
serious conditions with similar symptoms, such as chronic heart failure.
A bronchoscopy involves using a flexible scope called a bronchoscope to
examine the airways. Occasionally airway problems such as tumors or
foreign bodies will create symptoms that mimic those of asthma. The test
might be done if you have unequal wheezing in the lungs or a poor
response to asthma therapy. Biopsies of the airways can be done to look
for changes characteristic of asthma.
A chest X-ray may be used to see whether other lung diseases, such as
fibrous tissue caused by chronic inflammation (pulmonary fibrosis), are
causing symptoms.
A sweat test, which measures the amount of salt in sweat, may be used to
see whether cystic fibrosis is the cause of your symptoms.
Tests to identify triggers
If you have persistent asthma and take medication every day, your doctor
may ask about your exposure to substances (allergens) that cause an
allergic reaction. For more information about the following tests, see the
topic Allergic Rhinitis.
Allergy tests include: Skin tests. The skin on the back or arms is pricked with one or more small
doses of allergens that might cause an allergy. The amount of swelling
and redness at the sites of the skin pricks is measured to see which
allergens cause a reaction. Skin tests are quick, simple, and relatively
safe. Skin tests are necessary if you are interested in allergy shots
(immunotherapy).
Enzyme-linked immunosorbent assay (ELISA). A blood sample is taken
from a vein and tested for immunoglobulin E (IgE) antibodies, which are
produced in response to particular allergens.
52
Other tests may be done to see whether other conditions such as sinusitis,
nasal polyps, or gastroesophageal reflux disease (GERD) are present.
Treatment Overview
Although asthma cannot be cured, you can manage the symptoms with
medications, especially inhaled corticosteroids and beta2-agonists. You
will probably work with your doctor to develop a management plan
consisting of a daily treatment plan and an asthma action plan. These
plans help you meet treatment goals and get your asthma under control.
The goals of asthma treatment are to: 18
Prevent symptoms.
Keep your peak flow and lung function as close to normal as possible. Be able to do your normal daily activities, including work, school, exercise,
and recreation. Prevent asthma attacks. Have few or no side effects from medicine. For more information, see: Asthma: Taking charge of your asthma.
Emergency treatment
If you have a severe asthma attack (the red zone of your asthma action
plan), use medication based on your action plan and talk with a doctor
immediately about what to do next. This is especially important if your
peak expiratory flow (PEF) does not return to the green zone or stays
within the yellow zone after you take medication. You may have to go to
the hospital or an emergency room for treatment. Be sure to tell the
emergency staff if you are pregnant.
At the hospital, you will probably receive inhaled beta2-agonists and
corticosteroids. You may be given oxygen therapy. Your lung function and
condition will be assessed. Depending on your response, further treatment
in the emergency room or a stay in the hospital may be necessary.
53
Some people are at increased risk of death from asthma, such as people
who have been admitted to an intensive care unit for asthma or who have
needed a breathing tube (intubation) for asthma. These people need to
seek medical care early when they have symptoms.
Medical checkups
You need to monitor your asthma and have regular checkups to keep it
under control and to ensure correct treatment. The frequency of checkups
depends on how your asthma is classified. Checkups are recommended:
About every 6 to 12 months for people with intermittent or mild persistent
asthma that has been under control for at least 3 months.
Every 3 to 6 months for those with moderate persistent asthma.
Every 1 to 2 months for people with uncontrolled or severe persistent
asthma.
Every month if you are pregnant.
During checkups, your doctor will ask whether your symptoms and peak
expiratory flow have held steady, improved, or become worse and will ask
about asthma attacks during exercise or at night. You track this
information in an asthma diary. You may be asked to bring your peak
expiratory flow meter to an appointment so your doctor can see how you
use it.
Initial treatment
There are many components to managing asthma. After your diagnosis,
your doctor may only discuss the components you need to know
immediately. These include:
Oral or injected corticosteroids (systemic corticosteroids). These
medications may be used to get your asthma under control before you
start taking daily medication. In the future, you also may take oral or
injected corticosteroids to treat any sudden and severe symptoms (asthma
54
attacks), such as shortness of breath. Oral corticosteroids are used more
than injected corticosteroids. Oral corticosteroids include prednisone and
dexamethasone.
Inhaled corticosteroids. These are the preferred medications for long-term
treatment of asthma. They reduce the inflammation of your airways, and
you take them every day to keep asthma under control and to prevent
asthma attacks. Inhaled corticosteroids include beclomethasone,
triamcinolone, fluticasone, budesonide, and flunisolide.
Short-acting beta2-agonists. These medications are used for asthma
attacks. They relax the airways, allowing you to breathe easier. Short-
acting beta2-agonists include albuterol and pirbuterol.
A combination of an inhaled corticosteroid and long-acting beta2-agonist.
This combination is often used to treat persistent asthma.
Basic education about asthma. The more you know about asthma, the
more likely it is you will control symptoms and reduce the risk of asthma
attacks. Keep in mind that even severe asthma can be controlled, and
cases where the condition cannot be controlled are unusual.
Instruction on how to use a metered-dose inhaler (MDI) or dry powder
inhaler (DPI). Inhalers deliver medicine directly to the lungs. If you use
your inhaler correctly, you can control your symptoms and avoid asthma
attacks that can send you to the emergency room. Most doctors
recommend using a spacer with an MDI. For more information, see:
Asthma: Using a metered-dose inhaler.
Asthma: Using a dry powder inhaler.
Your short-term goal is to control your current symptoms. Long-term, your
goal is to prevent symptoms so that asthma does not impact your daily
activities.
Special considerations in treating asthma include:
Managing asthma during pregnancy. If a woman had asthma before
becoming pregnant, her symptoms may get better or worse during
55
pregnancy. Pregnant women whose asthma is not well controlled may be
at risk for a number of complications.
Managing asthma in older adults. Older adults tend to have worse asthma
symptoms and a higher risk of death from asthma than younger people.
They may also have one or more other health conditions or take other
medications that can make asthma symptoms worse.
Managing exercise-induced asthma. Exercise often causes asthma
symptoms. Steps you can take to reduce the risk of this include using
medication immediately before you exercise.
Managing asthma before surgery. People with moderate to severe asthma
are at higher risk of developing problems during and after surgery than
people who do not have asthma.
Ongoing treatment
After your initial treatment for asthma, it is important to learn more about
the condition and develop an overall plan to manage the disease. You and
your doctor will work together to do this. Because asthma develops from a
complex interaction of genetics, environmental factors, and the reaction of
the immune system, no one management plan is effective for everyone.
Asthma management consists of:
A daily asthma treatment plan. A daily asthma treatment plan outlines in
writing how to treat and control inflammation in your lungs. The plan helps
you keep asthma under control and prevent asthma attacks. The plan also
tells you which medications to take every day. A daily treatment plan may
include an asthma diary where you record your peak expiratory flow
(PEF), symptoms, triggers, and quick-relief medication used for asthma
attacks. This valuable tool helps you and your doctor manage your
asthma. A daily asthma treatment plan is often combined with an asthma
action plan.
56
An asthma action plan. An asthma action plan contains directions to treat
asthma attacks at home. It helps you identify triggers that can be changed
or avoided, be aware of your symptoms, and know how to make quick
decisions about medication and treatment. See an example of an asthma
action plan (What is a PDF document?) . For more information, see:
Asthma: Using an asthma action plan.
Monitoring peak expiratory flow. It is easy to underestimate the severity of
your symptoms. You may not notice them until your lungs are functioning
at 50% of your personal best peak expiratory flow (PEF). Measuring PEF
is a way to keep track of asthma symptoms at home. It can help you know
when your lung function is becoming worse before it drops to a
dangerously low level. You can do this with a peak flow meter. For more
information, see:
Asthma: Measuring peak flow.
A plan to deal with factors that can make asthma worse (triggers). Being
around triggers increases symptoms. Try to avoid situations that expose
you to irritants (such as smoke or air pollution) or to substances (such as
animal dander) to which you may be allergic. If substances at work are
causing your asthma or making it worse (occupational asthma), you may
have to change jobs. See information on:
Asthma: Identifying your triggers.
A plan to treat other health problems. If you also have other health
problems, such as inflammation and infection of the sinuses (sinusitis) or
gastroesophageal reflux disease (GERD), you will need treatment for
those conditions.
Using your prescribed medications correctly. Your doctor may adjust your
medications depending on how well your asthma is controlled.
Medications include:
Inhaled corticosteroids. These are the preferred medications for long-term
treatment of asthma. Inhaled corticosteroids include beclomethasone,
triamcinolone, fluticasone, budesonide, and flunisolide.
57
Long-acting beta2-agonists (such as salmeterol and formoterol), which are
used along with inhaled corticosteroids.
Oral or injected corticosteroids (systemic corticosteroids) to treat any
sudden and severe symptoms (asthma attacks), such as shortness of
breath. Oral corticosteroids are used more than injected corticosteroids.
Oral corticosteroids include prednisone and dexamethasone.
Quick-relief medication, such as short-acting beta2-agonists and
anticholinergics (ipratropium) for asthma attacks. If you are using quick-
relief medication on more than 2 days a week (except for exercise), you
probably need long-term treatment. Overuse of quick-relief medication can
be harmful.
Education. Continue to learn about asthma. This questionnaire can help
you determine what you already know about asthma and what you may
need to discuss with your doctor.
If you have persistent asthma and react to allergens, you may need to
have skin testing for allergies. Allergy shots (immunotherapy) may be
helpful. For more information, see:
Should I take allergy shots (immunotherapy) for allergic rhinitis and
allergic asthma?
You can expect to live a normal life if you control symptoms by following
your daily treatment and action plans. Control of your asthma symptoms
can help keep your lungs as healthy as possible.
Special considerations in treating asthma include:
Managing asthma during pregnancy. If a woman had asthma before
becoming pregnant, her symptoms may become better or worse during
pregnancy. Pregnant women whose asthma is not well controlled may be
at risk for a number of complications.
Managing asthma in older adults. Older adults tend to have worse asthma
symptoms and a higher risk of death from asthma than younger people.
They may also have one or more other health conditions or be taking
other medications that can make asthma symptoms worse.
58
Managing exercise-induced asthma. Exercise often causes asthma
symptoms. Steps you can take to reduce the risk of this include using
medication immediately before you exercise.
Managing asthma before surgery. People with moderate to severe asthma
are at higher risk of developing problems during and after surgery than
people who do not have asthma.
Treatment if the condition gets worse
If your asthma is not improving, make an appointment with your doctor to:
Review your asthma diary to see if you have a new or previously
unidentified trigger, such as animal dander. Talk to your doctor about how
best to avoid triggers.
Review your medications, to be sure you are using the right ones and are
using them correctly.
Review your asthma plans, to be sure they are suitable for your condition.
Determine whether you have a condition with symptoms similar to asthma,
such as sinusitis.
Make sure you are using your inhaler correctly.
If your medication is not working to control airway inflammation, your
doctor will first check to see whether you are using the inhaler correctly. If
you are using it correctly, your doctor may increase the dosage, switch to
another medication, or add a medication to the existing treatment.
Your doctor may suggest other medications, such as leukotriene pathway
modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your
doctor may recommend mast cell stabilizers (cromolyn or nedocromil) or
theophylline (Theo-Dur, Slo-bid, Uniphyl, or Uni-Dur).
If your asthma does not improve with treatment, you may require more
intensive treatment, including larger doses of corticosteroids or other
medication. An asthma specialist generally prescribes these medications.
If you have persistent asthma and react to allergens, you may need to
have skin testing for allergies. Allergy shots (immunotherapy) may be
helpful.
59
What to think about
If you have been diagnosed with asthma, it is important that you treat it.
You may feel good most of the time—so much so that you find it hard to
believe you have a long-lasting condition. But all asthma—even mild
asthma—may result in changes to your airways that speed up and make
worse the natural decrease in lung function that occurs as we age. 3
Prevention
Although there is no certain way to prevent asthma, you can take steps to
reduce airway inflammation and the likelihood of asthma attacks.
Preventing asthma attacks
The main focus of prevention is to reduce the number, length, and severity
of asthma attacks. By avoiding triggers, you may be able to prevent or
reduce the severity of symptoms. For more information on identifying your
triggers, see:
Asthma: Identifying your triggers.
If you can predict or often have asthma attacks when you exercise, use
your inhaler 10 minutes before you start the activity so you can avoid an
attack.
The following is information about specific triggers. If you know that any of
these cause your symptoms to become worse, you should avoid or limit
your exposure to them.
Irritants in the air
Common irritants in the air, such as tobacco smoke and air pollution, can
trigger asthma attacks in some people.
Controlling tobacco smoke is important because it is a major cause of
asthma symptoms in children and adults. If you have asthma, try to avoid
being around others who are smoking, and ask people not to smoke in
your house.
Pregnant women who smoke cigarettes during pregnancy increase the
risk of wheezing in their newborn babies.
60
Exposing young children to secondhand tobacco smoke increases the
likelihood that they will develop asthma and increases the severity of
symptoms if they already have the disease.
Consider staying inside when air pollution levels are high. Other irritants in
the air (such as fumes from gas, oil, or kerosene or wood-burning stoves)
can sometimes irritate the bronchial tubes, which carry air to the lungs.
Avoiding these may decrease your asthma symptoms.
Allergens
If you are allergic to certain substances (allergens), you may decrease
your asthma symptoms by limiting exposure to these substances.
To help reduce your exposure to allergens:
Control cockroaches, especially if you live in an inner-city area or the
southern part of the United States.
Control dust mites. House dust mites have been linked with the
development of asthma in children. 1
Control animal dander and pet allergens. If you know your pet is a trigger,
you may need to think about giving it away. If that is too hard, taking steps
such as keeping your pet out of your bedroom and dusting and vacuuming
often may help your asthma.
Control indoor mold, especially if you live in an area with high humidity.
It also may be necessary to avoid exposure to other types of triggers that
cause asthma symptoms.
Get a flu shot (influenza vaccine) every year. Have your family members
get one too.
Control your exposure to pollens in the air. Check your local weather
report or newspaper for pollen counts in your area.
Avoid exercising outdoors in cold weather. The air may irritate your
airways. If you are outdoors in cold weather, wear a scarf around your
face and breathe through your nose.
61
Avoid foods that may cause asthma symptoms. Some people have
symptoms after eating processed potatoes, shrimp, nuts, and dried fruit, or
after drinking beer or wine. These foods and liquids contain sulfites, which
may cause asthma symptoms.
Avoid taking aspirin, ibuprofen, or other similar medications if they
increase asthma symptoms. Consider using acetaminophen (Tylenol)
instead. (Do not give aspirin to anyone younger than 20 because of the
risk of Reye's syndrome.)
Living With Asthma
You can control the impact asthma has on your life by following your
asthma plans consistently. A management plan can reduce inflammation
to decrease the severity, frequency, and duration of asthma attacks.
Following your plans may be difficult due to the many different factors
involved.
To help yourself remain consistent in following your asthma plans:
Educate yourself about asthma. By doing so, you can learn to control
symptoms and reduce the risk of asthma attacks. This questionnaire can
help you determine what you already know about asthma and what you
may need to discuss with your doctor.
Understand your barriers and solutions. What may prevent you from
following your plans? These may be physical barriers, such as living far
from your doctor or pharmacy, or emotional barriers, such as having
undiscussed fears about the condition or unrealistic expectations. Discuss
your barriers with your doctor, and work to find solutions.
Develop goals that relate to your quality of life. Being able to measure
your success gives you greater motivation to follow asthma plans
consistently. Decide what you want to be able to do. Have symptom-free
nights? Be able to exercise on a regular basis? Feel secure in knowing
you can deal with an asthma attack? Work with your doctor to see if your
goals are realistic and how to meet them.
62
Your asthma plans generally consist of the following:
Seeing your doctor regularly to monitor your asthma. The frequency of
checkups depends on how your asthma is classified. Checkups are
recommended about every 6 to 12 months for intermittent or mild
persistent asthma that has been under control for at least 3 months; every
3 to 6 months for moderate persistent asthma; and every 1 to 2 months for
uncontrolled or severe persistent asthma. Bring your asthma plans to
appointments.
Following your daily asthma treatment plan. This plan helps you control
your asthma and describes which medications to take every day. A daily
treatment plan also may include an asthma diary where you record your
peak expiratory flow, symptoms, triggers, and use of quick-relief
medication for asthma attacks. This valuable tool helps you and your
doctor manage your asthma. A daily asthma treatment plan is often
combined with an asthma action plan.
Following your asthma action plan. This contains directions for the
management of asthma attacks at home. It helps you better control
asthma attacks by being aware of symptoms and knowing how to make
quick decisions about medication and treatment. See an example of an
asthma action plan (What is a PDF document?) .
For more information on how to monitor and treat asthma, see:
Asthma: Taking charge of your asthma.
Asthma: Using an asthma action plan.
To effectively manage your asthma and use your daily asthma treatment
and action plans, you will have to know how to monitor your peak airflow,
identify asthma triggers, and take your asthma medication correctly.
Monitoring peak expiratory flow
People often underestimate the severity of their symptoms. They may not
notice symptoms until their lungs are functioning at 50% of their personal
best measurement. Measuring peak expiratory flow (PEF) is a way to
keep track of asthma symptoms at home; it can help you know when your
63
lung function is becoming worse before it drops to a dangerously low level.
You can do this with a peak flow meter. For more information, see:
Asthma: Measuring peak flow.
Identifying asthma triggers
A trigger is anything that can lead to an asthma attack. A trigger can be:
Irritants in the air, such as tobacco smoke or air pollution.
Substances to which you are allergic (allergens), such as pollen or animal
dander.
Other factors, such as a viral infection, exercise, stress, or dry, cold air.
Avoiding triggers will help decrease the chance of having an asthma
attack and, in the case of allergens, will help control inflammation in the
bronchial tubes, which carry air to the lungs. For more information, see:
Asthma: Identifying your triggers.
If you have asthma triggered by an allergen, taking antihistamine
medication may help you manage the allergy and thus limit its effect on
your asthma.
Taking your asthma medication
Taking medications is an important part of asthma treatment. But because
you may need to take more than one medication, it can be difficult to
remember to take them. To help yourself remember, understand the
reasons people don't take their asthma medications, and then find ways to
overcome those obstacles, such as taping a note to your refrigerator.
Most medications for asthma are inhaled. Inhaled medications give a
specific dose of the medication directly to the bronchial tubes, avoiding or
decreasing the effects of the medication on the rest of the body. Delivery
systems for inhaled medications include metered-dose and dry powder
inhalers and nebulizers. A metered-dose inhaler is used most often.
Most doctors recommend that everyone who uses a metered-dose inhaler
(MDI) also use a spacer, which is attached to the MDI. A spacer may
deliver the medication to your lungs better than an inhaler alone, and for
many people it is easier to use than an MDI alone. Using a spacer with
64
inhaled corticosteroids can help reduce their side effects and result in less
use of oral corticosteroids.
It is important to keep track of the inhaler doses and discard the inhaler
when you have used the number of doses indicated on the package
labeling. This not only prevents you from having an empty inhaler when
you need medication, but it also prevents you from inhaling only propellant
after the medication has run out. For more information, see:
Asthma: Using a metered-dose inhaler.
Asthma: Using a dry powder inhaler.
Travel
Most people with asthma can travel freely. But if you travel to remote
areas and participate in intensive physical activity, such as long hikes, you
may be at increased risk for an asthma attack in an area where
emergency help may be difficult to find.
When traveling, always bring your medication with you, carry the
prescription for it, and use it as prescribed.
Give teens extra attention
Teens who have asthma may view the disease as cutting into their
independence and setting them apart from their peers. Parents and other
adults should offer support and encouragement to help teens stick with a
treatment program. It's important to:
Help your teen remember that asthma is only one part of life.
Allow your teen to meet with the doctor alone. This will encourage your
teen to become involved in his or her care.
Work out a daily management plan that allows a teen to continue daily
activities, especially sports. Exercise is important for maintaining strong
lungs and overall health.
Talk to your teen about the dangers of smoking and drug use.
Encourage your teen to meet others who have asthma so they can
support each other.
Medications
65
Medication does not cure asthma. But it is an important part of managing
the condition. Medications for asthma treatment are used to:
Prevent and control the underlying airway inflammation, to minimize
asthma symptoms.
Decrease the severity, frequency, and duration of asthma attacks.
Treat the attacks as they occur.
Asthma medications are divided into two groups: those for prevention and
long-term control of inflammation and those that provide quick relief for
asthma attacks. Most people with persistent asthma need to use long-term
medications daily. Quick-relief medications are used as needed and
provide rapid relief of symptoms during asthma attacks.
Because asthma develops from a complex interaction of genetics,
environmental factors, and the reaction of the immune system, different
people may use different medications and doses of medications. Special
consideration may be necessary if you:
Are pregnant. If a woman had asthma before becoming pregnant, her
symptoms may become better or worse during pregnancy. Pregnant
women whose asthma is not well controlled may be at risk for a number of
complications.
Are an older adult. Older adults tend to have worse asthma symptoms and
a higher risk of death from asthma than younger people. They may also
have one or more other health conditions or take other medications that
can make asthma symptoms worse.
Have exercise-induced asthma. Exercise often causes asthma symptoms.
Steps you can take to reduce the risk of this include using medication
immediately before you exercise.
Need surgery. People with moderate to severe asthma are at higher risk
than people who do not have asthma of developing problems during and
after surgery.
Medication delivery
66
Most medications for asthma are inhaled. Inhaled medications are used
because a specific dose of the medication can be given directly to the
bronchial tubes. Different types of delivery systems may be used to do
this, and one type may be more suitable for certain people or age groups
than another. Delivery systems include metered-dose and dry powder
inhalers and nebulizers. A metered-dose inhaler is used most often.
Most doctors recommend that everyone who uses a metered-dose inhaler
(MDI) also use a spacer, which is attached to the MDI. A spacer may
deliver the medication to your lungs better than an inhaler alone, and for
many people it is easier to use than an MDI alone. Using a spacer with
inhaled corticosteroids can help reduce their side effects and result in less
use of oral corticosteroids.
It is important to keep track of the inhaler doses and discard the inhaler
when you have used the number of doses indicated on the package
labeling. This not only prevents you from having an empty inhaler when
you need medication, but it also prevents you from inhaling only propellant
after the medication has run out. For more information, see:
Asthma: Using a metered-dose inhaler.
Asthma: Using a dry powder inhaler.
Medication Choices
The most important asthma medications are:
Inhaled corticosteroids. These are the preferred medications for long-term
treatment of asthma. They reduce inflammation of your airways and are
taken every day to keep asthma under control and to prevent sudden and
severe symptoms (asthma attacks). Inhaled corticosteroids include
beclomethasone, triamcinolone, fluticasone, budesonide, and flunisolide.
Oral or injected corticosteroids (systemic corticosteroids) to get your
asthma under control before you start taking daily medication. You may
also need these medications to treat asthma attacks. Oral corticosteroids
are used much more than injected corticosteroids. Oral corticosteroids
include prednisone and dexamethasone.
67
Short-acting beta2-agonists for asthma attacks. They relax the airways,
allowing you to breathe easier. These medications include albuterol and
pirbuterol.
Other long-term medications for daily treatment include:
Leukotriene pathway modifiers (such as zafirlukast, zileuton, or
montelukast).
Long-acting beta2-agonists (such as salmeterol and formoterol). These
medicines are combined with inhaled corticosteroids as a single
medication.
Less commonly, your doctor may recommend mast cell stabilizers (such
as cromolyn or nedocromil) or theophylline (such as Theo-Dur, Slo-bid,
Uniphyl, or Uni-Dur).
Other medications may be given in some cases.
Anticholinergics (such as ipratropium) and magnesium sulfate are usually
used for severe asthma attacks.
Other medicine such as omalizumab may be used if asthma does not
improve with treatment. An asthma specialist generally prescribes this
medicine.
Medication treatment for asthma depends on a person’s age, his or her
type of asthma, and how well the treatment is controlling asthma
symptoms.
The least amount of medicine that controls the asthma symptoms is used.
The amount of medicine and number of medicines are increased in steps.
So if asthma is not controlled at a low dose of one controller medicine, the
dose may be increased. Or another medicine may be added.
If the asthma has been under control for several months at a certain dose
of medicine, the dose may be reduced. This can help find the least
amount of medicine that will control the asthma.
Quick-relief medicine is used to treat asthma attacks. But if you or your
child needs to use quick-relief medicine a lot, the amount and number of
controller medicines may be changed.
68
Your doctor will work with you to help find the number and dose of
medicines that work best.
What to Think About
Medications are usually added one at a time to keep the number of
medications low. The dosage of each medication should correspond to the
severity of your asthma. Sometimes your doctor will start you at a higher
dose within your asthma classification so that the inflammation is
immediately controlled. After a prolonged period of symptom
improvement, the dose of the last medication added is reduced to the
lowest possible dose for maintenance. This is known as step-down care.
Step-down care is believed to be a better way to control inflammation in
the bronchial tubes than starting at lower doses of medication and
increasing the medication if the dose is not enough. 19
Because quick-relief medication quickly reduces symptoms, people
sometimes overuse these medications instead of using the slower-acting
long-term medications. But overuse of quick-relief medications may have
harmful effects, such as decreasing the future effectiveness of these
medications. 20 Overuse of quick-relief medication is also an indication
that asthma symptoms are not being controlled. Be sure to talk with your
doctor immediately.
You may have to take more than one medication daily to manage your
asthma. It can be difficult to remember when to take your medication and
which medication to take. To help yourself remember, understand the
reasons people don't take their asthma medications, and then find ways to
overcome those obstacles, such as taping a note to your refrigerator to
remind yourself.
Using the fewest medications possible is important for older people,
because they may be taking medications for other conditions. Tell your
doctor about all the medications you are taking, so he or she can select
asthma medications that won't interfere with other medicines.
69
Some people only have symptoms during certain times of the year
(seasonal asthma). If you know when you will most likely have symptoms,
start using a medication to decrease inflammation before the symptoms
start.
Other Treatment
Allergy shots (immunotherapy) may be recommended for people who
have asthma symptoms when they are around substances to which they
are allergic (allergens). In some people, allergy shots have been shown to
reduce asthma symptoms and the need for medications. 21 But allergy
shots are not equally effective for all allergens. Allergy shots should not be
given when asthma is poorly controlled. For more information, see:
Should I take allergy shots (immunotherapy) for allergic rhinitis and
allergic asthma?
Allergy shots are similar to vaccinations, because they con
70
top related