How to manage uncontrolled asthma in a 34-year-old adult?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Uncontrolled asthma can be incredibly challenging, both for him and for your family. The key to the treatment of asthma is the use of inhaled medications. For adequate asthma control, it is essential to use the appropriate inhalers in the right dosage with the proper technique, and they should be used regularly.

I suggest you undergo the following investigations for newly diagnosed or uncontrolled bronchial asthma:

1. Complete blood count.

2. Serum total immunoglobulin E (IgE).

3. Chest X-ray.

Pulmonary function test (spirometry pre and post-bronchodilator).

Causes for repeated exacerbations include:

1. Presence of comorbid conditions such as allergic rhinitis, gastroesophageal reflux disease (GERD), and obesity.
2. Incorrect inhaler technique or inconsistent use of the inhaler.
3. Use of incorrect inhaled medications.

I suggest you follow the below-mentioned advice if bronchial asthma is diagnosed:

1. Start using inhalers regularly, such as metered-dose inhalers containing Budesonide (corticosteroid) and Formoterol (β₂ agonist) 200/6 at two puffs twice daily with a spacer, followed by a mouthwash. Inhalers should be used daily without any breaks for at least six months. No doses should be skipped unless advised by a pulmonologist.
2. Use a spacer with the inhaler; the technique for its use can be learned online through videos.
3. Consult a pulmonologist either in person or virtually on a regular basis (at least once a month).
4. It is important to regularly review his medications, as sometimes doses need adjustment, or a different combination of medications may work better. Newer medications, such as biologics (like Omalizumab or Dupilumab), can be effective for severe asthma.
5. Take vaccinations appropriate for his age if he has not done so already.
6. Manage comorbid conditions, such as allergic rhinitis, since uncontrolled allergic rhinitis and GERD (gastroesophageal reflux disease)often exacerbate asthma, leading to poor control.
7. Ensure he has a written asthma action plan that outlines how to manage his symptoms and what to do in an emergency. This can help him feel more in control.
8. Avoid triggers: Identifying and avoiding triggers (such as smoke, pollution, pets, or certain foods) can significantly improve his condition.
9. Pulmonary rehabilitation: Some programs offer education and exercises to improve lung function and overall fitness.
10. Lifestyle changes: Regular exercise (as tolerated), maintaining a healthy diet, and managing stress can all contribute to better asthma control.
11. Monitoring and technology: Using a peak flow meter to monitor his lung function can help him detect worsening asthma early. There are also smartphone applications that can assist in tracking symptoms and medication use.
12. Emergency preparedness: Ensure he has an emergency plan in place, including access to emergency medications and knowledge of when to seek urgent care.

It is crucial to work closely with his treating doctor to find the best approach for him. With the right management, many individuals with asthma can lead full and active lives. Ask your brother to complete all the investigations and follow up in one week to evaluate whether his asthma is controlled.

Take care, and please follow up with the investigations.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.