Is there any new treatment approach for uncontrolled asthma?

Question

Hello doctor,

I am worried about my little girl. She has had uncontrolled asthma since she was 1.5 years old and has been on medications, including Fluticasone nasal spray, every day. Despite this, she has already been hospitalized three times for chest infections, and I just do not know how to get ahead of this. It is taking a toll on us, and I hate seeing her struggle to breathe, especially after all the treatments. Is there something more we can do to manage her asthma better?

I want to make sure she is not constantly in and out of the hospital. Should we be looking at different medicines or a new approach? Any advice would help, because we are feeling pretty stuck right now.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you already described, your daughter is suffering from bronchial asthma. Key to the treatment of asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers in the right dose are to be used with adequate technique, and they should be used regularly.

Investigations to be done on newly diagnosed or uncontrolled bronchial asthma:

1. Complete blood count.

2. Serum total IgE (immunoglobulin).

3. Chest X-ray.

4. Pulmonary function test (spirometry pre- and post-bronchodilator).

Causes for repeated exacerbations include:

1. Presence of comorbid conditions like allergic rhinitis, GERD (gastroesophageal reflux disease), and obesity.

2. Incorrect inhaler technique or if the inhaler is not being used regularly.

3. If incorrect inhaled medicines are being used.

4. Fungal sensitization and hypersensitivity.

5. Emotional stress.

6. Environmental factors, including pollution and pollen.

The following advice is to be followed if bronchial asthma is diagnosed:

1. Start regularly using an MDI (metered dose inhaler), Budetrol (corticosteroid) (200/6) inhaler, two puffs twice daily with a spacer followed by mouthwash, and stop using a Salbutamol (short-acting beta-2 adrenergic agonist) inhaler. Inhalers are to be used daily without any break for at least six months. No dose is to be skipped unless advised by a pulmonologist.

2. Mac spacer (it is to be attached to an inhaler; the technique of its usage can be learned online).

3. Consult a pulmonologist either physically or virtually regularly (at least once monthly).

4. Take vaccinations appropriate for the age if not taken already.

5. Control of co-morbid conditions, if any.

6. Inculcate regular exercise and physical activity into your routine.

7. Ensure intake of a balanced and nutritious diet.

Asthma can be very well controlled with adequate treatment and appropriate guidance.Get the investigation advised and follow up after one week, we will then evaluate if your asthma is controlled or not and if it requires any further kind of treatment.

Kindly consult a physician, discuss with them, and start taking the medications with their consent.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.