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Asthma

Asthma is a chronic inflammatory disease of the airways (small lung pipes) that affects about 14 to 15 million people in the U.S. Each year it results in more than 450,000 hospital admissions and about 5,000 deaths. It is a well-known fact among physicians and health care policymakers in this country that most of these deaths and admissions can be significantly reduced if current attitudes toward asthma management are improved. This change in attitude has to come from both patients and health care givers. The good news is that it won't be rocket science.

One of the recommendations of the Expert Panel Report 11, published in 1997 by the National Asthma Education and Prevention Program is patient education and active participation. This is not surprising considering the fact that in similar chronic illnesses such as diabetes and hypertension (high blood pressure), the best outcomes are seen in patients who are well informed of their conditions and play active roles in their outpatient treatments.

One of the ways we believe that patients can play active roles in their asthma management is by using a device called the peak flow meter. This is a portable device that measures one's maximum capacity to exhale air from the lungs. During use, the individual blows into the device, the exhaled air pushes a piston inside the meter up the scale. When the piston rises, it carries with it an indicator that shows a value, measured in liters per minute.

The real significance of these values rests not only in the fact that it can help doctors make important decisions about asthma treatments but when checked on a regular basis (preferably daily), it can help pick subtle changes in the airways even before the patient is aware of the symptoms of asthma. This is analogous to a diabetic patient checking their blood sugar levels at home.

It is interesting to report that a team of Canadian researchers led by Dr. Robert L. Cowie and colleagues at the University of Calgary in Alberta studied 150 asthmatic patients over a 6-month period testing whether outpatient peak flow monitoring is more effective than a symptom-based plan or no plan at all for poorly-controlled asthmatics. The conclusions from their study were striking: 55 persons in the no-plan group visited the emergency room for worsening of symptoms, 45 visits were made in the symptom based group and only 5 of 46 participants in the peak flow-based action plan required such a visit to the emergency room. It is thus clear from the study that the use of peak flow monitoring on outpatient basis can go a long way in reducing the failure of outpatient treatment on asthmatics. It is our recommendation that every asthmatic, regardless of the severity of their illness who can be taught how to use the peak flow monitor, should discuss the device with their doctor and be instructed how to use it in monitoring their asthma outpatient management.

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