What is the best way to treat long-term bronchial asthma?

Question

Hello doctor,

I am reaching out about my wife, who has had asthma her entire life, but her condition has been worsening recently. She is struggling with basic tasks, like walking up a flight of stairs, because she becomes short of breath. It is heartbreaking to see her frustration and exhaustion as she faces challenges with activities that were once easy for her.

Even though she is following her prescribed treatments, it feels like we are always playing catch-up with her symptoms. I am scared for her, especially with how unpredictable her asthma attacks have become.

Could you recommend any treatment options for someone whose asthma is not responding well to their current medications?
Also, how can I best support her during this time when she’s feeling defeated and overwhelmed?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you already described, your wife is suffering from bronchial asthma; the key to its treatment 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 for newly diagnosed bronchial asthma:

1. Complete blood count.

2. Serum total IgE.

3. Chest X-ray.

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

Causes for repeated exacerbation include:

1. Presence of comorbid conditions like allergic rhinitis, acid reflux, 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.

The following advice is to be followed for uncontrolled bronchial asthma:

1. Start regularly using the inhaler MDI Budetrol (200/6) with 2 puffs twice daily with a spacer followed by mouthwash. Inhalers are to be used on a daily basis without any break for at least 6 months. No dose is to be skipped unless advised by a pulmonologist.

2. Mac spacer (it is to be attached with an inhaler; the technique of its usage can be learned online via YouTube videos). It is necessary to use a spacer if you are using an MDI device.

3. Consult a pulmonologist either physically or virtually on a regular basis (at least once monthly).

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

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

What you should do for her:

1. Acknowledge her feelings and let her know it is okay to feel frustrated or defeated.

2. Motivate her to stay positive.

3. Encourage her to use inhalers regularly and on time.

4. Advise her to be patient since it takes time for symptomatic improvement after the appropriate treatment has been started.

Your support can make a huge difference in how she copes with her condition. It is tough to see someone you love struggle, but being proactive and present can help both of you navigate this challenging time together. Get the investigation advised and follow up after one week; we will then evaluate if her asthma is controlled or not, and if it requires any further kind of treatment.

Take care to follow up with the investigation or earlier if further queries are there.

I hope I have answered your query.

Let me know if I can assist you further.

Thank you.