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Dr. Rajesh Swarnakar
Getwell Hospital and Research Institute
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Asthma Patient Diary

Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.
When your asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that your vital organs do not get enough oxygen. People can die from severe asthma attacks.
Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.
The things that trouble your lungs and make your asthma get bad are called triggers. Stuff like strong
smells, dust and smoke. Naturally, you should try to avoid those things. Specially smoking: if you smoke,
please stop, and if you don't smoke, avoid people who do. In my house, the dusting is done with a damp cloth so that the dust doesn't get around. And when the house is being pest-controlled, I make sure I am out of the house. Many people who have asthma are so worried about triggers that they put self-restrictions on everything, even food. But my lungs specialist said that I can eat anything I like because my asthma is not affected by any kind of food. That's the thing about asthma triggers - they are different for different people.

 What kinds of medicines are given for asthma, and how do I take them?

I just breathe it in with this little inhalation device. This way of taking medicine is called inhalation. And it takes the medicine straight to the lungs, so it's much faster-acting and safer than taking tablets or syrups. When my lungs specialist told me that I need to take an asthma medicine every day, first I was upset. But he gave me a good reason why: this medicine is called a Preventer, and if I take it every day it will help to protect my air tubes. My lungs specialist also said that if something irritates my lungs and I start coughing or can't breathe properly, then I have to take another medicine called a Reliever. Only in that situation, not otherwise. Still, I wanted to know: Do I really have to take the; Preventer regularly even when I am feeling OK? Why can't I just use the Reliever medicine as and when I have a problem? My lungs specialist explained it very nicely. He said, how do you keep your house safe from thieves? You employ a watchman. But suppose there has been no robbery in your house for quite some time. Then should you remove the watchman? No, because then thieves may enter. In the same way, the Preventer is like a watchman which prevents an asthma attack. And you should ensure that it is "on duty" every day! The point is, it's better to try to prevent a problem than to tackle it after it happens.
So here's my "Golden Rule" for staying healthy: Preventer regularly, Reliever rarely!
Here's a simple way to remember the names of your medicines: write them down here!

My Preventer medicine is _

My Reliever medicine is _

How can I be sure that it is really asthma?
your lungs specialist will examine you, and may also suggest some medical tests. Don't worry, these tests are simple and painless. Lungs specialist may ask you for details about your symptoms (that's the medical word for what you feel when you are not well), such as:'
• Is your cough worse at night or early morning?
• Have you ever heard a whistling sound coming
from your chest? (the medical word for this is
• Do you get a feeling of tightness in your chest
• Do you start coughing if you are exposed to dust, smoke, animals which are furry (like cats
  and dogs), or birds, or certain types of grass and plants? Are you allergic to these things or
  anything else?
• Does physical exertion like climbing stairs or walking fast make you start coughing or get
• Do you experience a problem during a change of season, specially when it gets colder?
• Does it happen if you laugh a lot, or get angry
about something?
• Have you ever been told that you have "bronchitis" or some kind of chest infection,
but then it did not go even with antibiotics?
• Have you ever taken a chest X-ray which didn't reveal anything, i.e., it came out clear?
Do you have problems when doing anything that requires physical exertion?
If physical exertion such as climbing stairs, running or even walking fast makes you get breathless and
tired easily, or start coughing, this could be a sign of asthma. Is your breathing affected by changes in temperature, particularly cold weather?
Do you have breathing trouble if you laugh a lot or
when you are emotionally disturbed?
Strong emotions lead to deep and fast breathing, and this can cause problems if you have asthma.

How did I get asthma?
In many people, the tendency to develop asthma is there right from birth. Asthma runs in some families,
but many people with asthma have no other family members affected. Asthma is not infectious. So you did not "catch" asthma from anyone else, and no one else at home or work can get "infected" by it. "

What happens in asthma?
Asthma affects the air tubes which carry air in and out of your lungs. The air tubes are swollen and extrasensitive. So they react badly to anything that irritates them. These things are called asthma triggers.
When you come in contact with an asthma trigger, the muscles around the walls of the air tubes tighten, so the air tubes become narrower. Often the air tubes also produce extra sticky mucus. All this makes it
difficult for air to go in and out of the air tubes, so you start coughing and get breathless.







What should I do to win against asthma?
 You can control asthma very well in two ways:

1. Try to identify the things that act as triggers for your asthma and then try to avoid them.
2. Make sure you take the right medicines regularly and exactly the way lungs specialist says, and go     for regular check-ups.
What kind of medicines is given for asthma?
There are two main kinds of asthma medicines. They are called Preventers and Relievers, and they work in different ways.

A Preventer protects your air tubes by making them less sensitive to asthma triggers which cause coughing and breathing difficulties. Taking the Preventer regularly is a good habit just like brushing your teeth daily!

 A Reliever should be used only when you suffer from coughing and breathing difficulties. It relieves these problems quickly by helping the air tubes to open wider so air can go in and out more easily. Ensure that you always carry the Reliever medicine (even when you go out) in case it is suddenly needed.

How are these medicines to be taken?
The best way to take asthma medicines is by inhalation. This is a way of breathing in the medicine through the mouth, using a small device called an inhaler.

Inhalation therapy is the most accepted way of asthma control worldwide. This is because inhalers have many advantages over tablets and syrups:

With an inhaler, the medicine goes only into the lungs where it is needed. Just like you put ointment on the skin for a skin problem or eye drops in the eye for an eye problem. Whereas with tablets and syrups, the medicine travels all over the body apart from going to the lungs.















Inhaled medicine takes a direct route into the lungs, so only a very small dose is required, and it acts fast.
Tablets and syrups take a longer route to the lungs so they act more slowly, they require a much bigger dose (could be anywhere between 10 and 50 times more!), and they cause more side effects.

In fact, inhaled asthma medicines are so safe that they are prescribed not just for children but even for infants, pregnant women, and babies and mothers who are breast -feeding.

One hears of "permanent solutions" and "cures" for asthma being offered by other types of treatment. Do they work?

You may read about such things, or even receive advice from family and friends. But remember, the best advice comes from your lungs specialist. Before you consider other types of treatment, consult your lungs specialist. It is safer to take medicines which have been scientifically tested and proved effective all over the world, rather than following unproven claims.

Does asthma affect women differently from men?

Asthma affects women and men's lungs in the same way, but women who have asthma may find that their symptoms get worse at certain times.

For example, some adolescent girls with asthma find that it gets worse around the time they have their first period. After the menstrual cycle becomes established, the asthma also usually settles down. But some women do notice that their asthma is harder to control just before or during their period. Also, some women who are going through menopause may develop asthma for the first time or, if they had asthma when they were younger, it may return. The reason is that the balance of various hormones (certain natural chemicals produced in the body) changes at the time of your period and during menopause, and this can affect your asthma.

What to do if you have an asthma attack

The chances of this happening are low if you are regular with your Preventer medicine and try to avoid coming into contact with asthma triggers. But you should be prepared with these steps:
1. Sit upright (do not lie down). Try to stay calm and relaxed. Loosen tight clothing.
2. Without delay, take the Reliever medicine in the dosage recommended by your lungs specialist.
3. Then wait for 5 minutes. If there is no improvement, take additional doses of the Reliever medicine as advised by your lungs specialist.
4. If you still do not get relief, call your lungs specialist immediately: Do not exceed the dose of the Reliever medicine without consulting your lungs specialist.

When you have fever, you can measure your temperature with a thermometer. Is there anything like that for asthma?

Yes. your lungs specialist may use a simple instrument called a Peak Flow Meter which measures how well you can blow air out of your lungs. your lungs specialist may also ask you to take a breathing test with a more advanced electronic instrument called a Spirometer. After starting treatment - and if you take your medicines regularly - you will feel encouraged to find that your breathing test results have improved.

How much difference can a good lungs specialist and the right treatment make in my life?

Make a list of al/ the problems that you are facing today with asthma. Now cross it out, because you can solve them all!

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