Treatment of Concomitant Diseases and Conditions

Many asthmatics will only respond once their concomitant sinusitis, GERD, thyroiditis, emotional stress, or pregnancy is under control. Moreover, the treatment of asthma requires close attention to concomitant colds, flu, bronchitis, environmental irritant or pollutant inhalation, recreational drug use, and emotional changes. Compliance is a significant problem, both with medication use and allergen avoidance and inhaler techniques. Thus, the physician who treats asthma needs to keep the whole patient in focus, as well as his work and family environment. On the other hand, proper treatment is nearly always effective and can be extraordinarily gratifying. It is common to convert "pulmonary cripples" into totally functioning humans in a matter of weeks.

Table 31 Anticholinergics

  1. Most useful in the asthmatic with bronchitis to help reduce mucus production
  2. Atrovent solution adds to P-agonist inhalation in emergency settings
  3. Combivent (a metered-dose inhaler combining albuterol with ipratropium) may be useful for asthma and bronchitis (DuoNeb is one nebulized form)

The proper treatment of asthma involves a close partnership between primary care physicians (PCPs) and specialists. Referral to specialists should result in significant insights into the cause and treatment of this disease, and the patient should receive important education in allergen avoidance and medication use, as well as written emergency treatment plans. The role of immunotherapy in allergic asthmatics as a useful long-term controlling (specific treatment) influence is gaining popularity again. In today's market, most immunotherapy is started by the allergist and provided in the PCP's office. Thus, immunotherapy and allergen-avoidance techniques, much like other approaches to asthma, can be started and explained by the specialist and supported and provided by the PCP.

SUGGESTED READING

Expert Panel Report 1: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education Program. NIH Publication 91-3642. Bethesda, MD: US Department of Health and Human Services, 1991.

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program. NIH Publication 97-4051. Bethesda, MD: US Department of Health and Human Services, 1997.

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program. J Allergy Clin Immunol 2002;110:S141. International Asthma Management Panel. International Consensus Report on Diagnosis and Management of Asthma. National Institutes of Health Publication 92-3091. Bethesda, MD: US Department of Health and Human Services, 1992. Kaliner MA. Current Review of Asthma. Philadelphia: Current Medicine Inc., 2003. Lemanske RF Jr, Busse WW. Asthma. J Allergy Clin Immunol 2003;111(2 suppl):S502-519. Self-Reported Asthma Prevalence and Control Among Adults—United States, 2001. MMWR 2003; 52(17):381-384.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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