Asthma - End Stage Organ Disease

Home Management:

Prompt Treatment Is Key Educating patients to recognize and treat exacerbations early is the best strategy.

• A written action plan and clear instructions on how to follow it.

• Instructions on how to recognize signs of worsening asthma and signs that indicate the need to call the doctor or seek emergency care.

• Prompt use of shortacting beta 2 -agonists (two puffs every 20 minutes for 1 hour) and, for moderate-to-severe exacerbations, the addition of oral steroids. Increased therapy should be maintained for several days to stabilize symptoms and peak flow.

• Monitoring the response to the medications.

• Followup with patients to assess overall asthma control, the need to increase long-term-control medications, and the need to remove or withdraw from allergens or irritants that precipitated the exacerbation.

Patients at high risk of asthma-related death (see box below) require special attention—intensive education, monitoring, and care. They should be counseled to seek medical care early during an exacerbation and instructed about when and how to call for an ambulance. Patients with moderate-to-severe persistent asthma or a history of severe exacerbations should have the medication (e.g., steroid tablets or liquid) and equipment (e.g., peak flow meter, compressor-driven nebulizer for young children) for assessing and treating exacerbations at home.