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IMA Releases Asthma White Paper

One should not ignore the first attack of asthma after the age of 40 and either cough or acidity may be the only signs of asthma, says the Asthma White Paper released by IMA on the occasion of World Asthma Day.

Elaborating on this, Padma Shri Awardees, Dr A Marthanda Pillai National President Indian Medical Association and Dr KK Aggarwal Honorary Secretary General IMA, said that if asthma is not controlled, it may be fatal. The following 20 points were also released on the occasion.

  1. Do not ignore the first attack of asthma after the age of 40, it may be of heart in origin.
  2. All wheeze is not asthma and all asthmatics do not wheeze.
  3. Only cough may be a sign of asthma.
  4. If you are able to speak a sentence during an asthma attack, you do not have severe asthma.
  5. If you get an attack of asthma more than twice in the night in a month or more than twice during day time in a week, you need continuous asthma treatment
  6. All asthmatics should be questioned about symptoms triggered by common inhaled allergens, at home, day care, school, or work
  7. Indoor allergens, such as dust mites, animal danders, molds, mice and cockroaches, are of particular importance.
  8. Food allergy rarely causes isolated asthma symptoms, although wheezing and cough can be symptoms of food-induced anaphylaxis.
  9. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may trigger symptoms of asthma in about 3-5% adult asthmatic patients.  Asthmatic patients with nasal polyps have a higher incidence of aspirin-exacerbated respiratory disease. Aspirin-sensitive asthma is uncommon in children.
  10. Non-selective beta-blockers, even in the very small amounts that are absorbed systemically from topical eye drops, can trigger severe attacks of asthma. Selective beta-1 blockers can also aggravate asthma in some patients, especially at higher doses.
  11. Gastric reflux is common among patients with asthma. The prevalence of the gastroesophageal reflux among patients with asthma ranges from 30-90%. Look for asthma symptoms after eating certain foods (e.g., high fat food, chocolate, peppermint, caffeine, alcohol).
  12. Well-controlled asthma means daytime symptoms no more than twice per week and night-time symptoms no more than twice per month.
  13. Exercise-induced asthma is asthma that occurs after exercise in many asthmatic patients. All patients with asthma, when exercising, should have a rapid-acting beta-agonist drug available for relief of asthma symptoms. In well-controlled asthmatic patients, but who frequently have asthma symptoms with exercise, prophylactic use of a rapid-acting beta-agonist about 10 minutes prior to exercise is recommended.  Avoiding exercise in cold, dry air can also reduce the stimulus for exercise-induced asthma. Oral theophylline and oral beta agonists are minimally effective or ineffective for exercise-induced asthma.
  14. All asthmatics should buy an asthma meter (peak flow meter) and keep it above 60% of normal range.
  15. Inhalers are better than oral drugs.
  16. Inhaled irritants include tobacco smoke, wood smoke from stoves or fireplaces, strong perfumes and odors, chlorine-based cleaning products and air pollutants. Patients should be cognizant of avoiding irritants and avoid exertion outdoors on days when levels of air pollution are high.
  17. Annual administration of influenza vaccine is recommended for patients with asthma as they are particularly at risk for complications of influenza infection. But, vaccination does not reduce the number or severity of asthma exacerbations during the influenza season. Physicians should ensure that patients understand this distinction.
  18. Administration of pneumococcal vaccination is recommended for all those adults whose asthma is severe enough to require controller medication and for children with asthma who require chronic treatment with oral steroids.
  19. Sulfite compounds are used in the food industry to prevent discoloration. Significant and reproducible exacerbations may occur after ingestion of sulfite-treated foods and beverages, such as beer, wine, processed potatoes, dried fruit, sauerkraut, or shrimp.
  20.  Near-fatal and fatal asthma exacerbations may occur in patients with mild, moderate, or severe asthma and the course may be either slow or rapid in onset. A recent history suggestive of poor asthma control or any prior history of endotracheal intubation and mechanical ventilation for asthma should alert the physician that the patient is at high-risk for near-fatal asthma exacerbations. Other factors include long duration of asthma, poor adherence to medical therapy, systemic glucocorticoid dependence, psychosocial problems, aspirin/NSAID sensitivity, cigarette smoke exposure, prior hospitalization for asthma and aeroallergen exposure in sensitized individuals.