What to do when asthma flares up despite regular treatment?

Question

Hello doctor,

I am a 37-year-old female. I have asthma, and I am taking medications to keep it under control. But nowadays, I have a severe cough along with wheezing. Even after taking my asthma medications, it does not stay under control. Kindly suggest how to keep my asthma under control. Do I need nebulizers or any other medications to keep it under control?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

From your description, you seem to be suffering from bronchial asthma (a condition in which a person’s airways become narrow, swollen, and blocked by extra mucus). The key to the treatment of asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers in the right dosage have to be used with the appropriate technique, and they should be used regularly.

Investigations to be done for a new diagnosis of asthma or diagnosis of uncontrolled bronchial asthma are as follows:

Complete blood count.
Serum total IgE (immunoglobulin E).
Chest X-ray.
Pulmonary Function Test (spirometry pre and post bronchodilator).

Causes for repeated exacerbations include:

Presence of comorbid conditions like allergic rhinitis (an allergic reaction that causes congestion, sneezing, and sore throat), GERD (gastroesophageal reflux disease- a common condition wherein the stomach contents move back into the esophagus), and obesity.
Incorrect inhaler technique or if the inhaler is not being used regularly.
Use of incorrect inhaled medicines.

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

Start using inhalers regularly, like Formoterol and Budesonide (MDI Budetrol (200/6). Take two puffs twice daily with a spacer, followed by mouthwash. Inhalers are to be used on a daily basis without any break for at least six months. No dose is to be skipped unless advised by a pulmonologist (a physician who specializes in diagnosing and treating lung conditions).
A Mac spacer (it is to be attached to the inhaler) can be used. The technique of its usage can be learned online through various videos.
Consult a pulmonologist either physically or virtually regularly (at least once a month).
Take vaccinations appropriate for the age if not taken already.
Control of co-morbid conditions, if any.

Get all the investigations that I have mentioned above done, and follow up after one week with the results. I will then evaluate whether your asthma is under control or not.

I hope this helps you.

Do get back in case of any further queries.

Thank you.