It's time for ABC in Asthma

The goal of treatment in asthma is to attain control of the disease. This requires a team approach with the patient being an essential member of the team. Control of asthma is beneficial in that it improves the quality of life for the patient and reduces health care costs.

Controlling asthma is not easy for either patients or health care providers. From the patient’s perspective there are the environmental reduction and avoidance measures that are of primary importance. Then there are the medications, different types for different purposes; devices with a technique that needs to be mastered;  action plans that need to be followed as symptoms change which in turn requires daily monitoring of their physical status and responding to change; and exacerbations and family responses and so on. It isn’t easy to live with asthma and it takes considerable effort so that an individual can achieve control.

Control cannot be achieved by the patient alone. Help from a team that includes a knowledgeable health care provider is essential. Physicians are busy and required to know a lot about many diseases, asthma being just one of them. Thorsteinsdottir and colleagues propose a four-step approach and a mnemonic AIRSMOG, that will help not only the physician but also the asthma educator and the entire team to remember those components, control of which is crucial to getting and keeping the asthma under control.

The four steps to controlling asthma include:

  1. Assessment of symptoms using a validated questionnaire.
  2. The mnemonic AIRESMOG that helps recall the co-morbidities and clinical variable that make asthma difficult to control.
  3. Individualized patient education.
  4. cheduled on-going care.

The 2007 NEAPP guidelines offer three recommendations for assessing quality of life scores in patients. They are:

  • Asthma Therapy Assessment Questionnaire
  • Asthma Control Questionnaire
  • Asthma Control Test

Thorsteinsdottir and colleagues suggest the mnemonic AIRESMOG for the second step to achieving control.


A is for

  • Allergy
  • Allergic Bronchopulmonary Aspergillosis
  • Adherence to therapy

I is for

  • Infection
  • Inflammation

R is for

  • Rhinitis
  • Rhinosinusitis

 E is for 

  • Exercise
  • Error in diagnosis(vocal cord dysfunction, upper airway cough syndrome – formerly called post nasal drip, drug induced, pulmonary embolism, bronchial cancer, congestive heart failure, etc.)

S is for

  • Smoking
  • Sulfites
  • (p)Sychogenic factors (depression, lack of family support, inability to self-monitor, etc.)

M is for

Medications that interfere with asthma control (beta blockers, angiotensin-converting enzyme or ACE inhibitors, aspirin and NSAIDS)


O is for

  • Occupational exposure
  • Obesity
  • Obstructive Sleep Apnea

G is for

Gastroesophageal reflux disease


This mnemonic is an excellent way to remember all those clinical and non-clinical factors that inhibit control of asthma.

Patient education is the greatest factor in adherence and in understanding the disease. Individualised patient education, targeted to needs and fears is a prime factor in achieving control. But patient education is not a one-time exercise. It needs to be repeated time and again and hence scheduled on-going care becomes a requirement. Action plans need updating, medications may need adjustment, device technique needs to be reinforced or corrected; and situational and job changes have to be taken into account, It requires an active partnership of the patient, physician and health care team to achieve control of asthma and greatly improve the quality of life for the patient. But, before asthma control can be achieved, the co-morbidities need to be brought under control.


References

National Institutes of Health, National Heart, Lung and Blood Institute. Expert panel reports 2: guidelines for the diagnosis and management of asthma. NIH Publication #97-4051.
Thorsteinsdottir B, Volcheck GW, Enemark Madsen B, Patel AM, Li JT, Lim KG. The ABCs of asthma control. Mayo Clin Proc. 2008;83(7):814-20.