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.

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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.

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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.

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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.

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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

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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.

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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.

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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