Bronchial asthma (BA) is a well-studied disease. Science knows the causes, mechanisms of development, methods of treating bronchial asthma. However, statistics show that only one out of four patients has the disease under control 1 .
At the same time, the control of bronchial asthma is the main indicator when it comes to the effectiveness of therapy, and includes such characteristics as:
- severity of symptoms;
- the frequency of exacerbations;
- the need for emergency care;
- the need for emergency drugs;
- peak flow measurements 2 .
Every patient diagnosed with bronchial asthma is familiar with its symptoms: wheezing; feeling of congestion in the chest; suffocation; dry, with sputum difficult to separate, obsessive cough, including at night.
Depending on the frequency of symptoms, several levels of asthma control are distinguished. So, with well-controlled asthma, attacks may not bother the patient for a month, he does not wake up at night, which means he does not need drugs to relieve symptoms.
With partially controlled asthma, daytime symptoms recur at intervals of 1-2 times a week, nighttime awakenings from attacks are observed with the same frequency, respectively, there is a need for an emergency inhaler. You can talk about uncontrolled asthma when the number of symptoms, including nocturnal ones, is more than two per week. See table. 1+GINA.
The need for emergency medicines
Another marker of uncontrolled asthma is the need for drugs to relieve symptoms (the so-called bronchodilators ), which was partially mentioned above. A short-acting drug relieves symptoms by giving the illusion that all is well, when in fact the cause of the disease (inflammation) remains. As a result, the patient finds himself in a vicious circle: symptoms occur more often, and the need for bronchodilators increases. Thus, the number of applications of these drugs is one of the most important indicators of asthma control.
BA control methods
For a formal assessment of the patient’s condition, there are several methods for controlling asthma. One of them is peak flowmetry . It allows you to assess the patency of the bronchial tract, based on such an indicator as the peak expiratory flow rate (PSV), that is, the maximum speed at which a person can exhale air from the respiratory tract.
To measure PSV, a peak flowmeter is required – a device that every patient with bronchial asthma should have.
Measurements should be made and recorded in a special diary every day. This will allow not only to monitor your current condition, but also independently predict exacerbations. In addition, the indications of peak flowmetry are needed by the attending physician to correct your therapy 3,4,5 .
Special questionnaires also help control the disease. The best known are the Asthma Control Questionnaire (ACQ-5) 8 and the Asthma Control Test (AST) 9 . The methodology is approximately the same: the patient answers questions, with each answer corresponding to a certain number of points. The degree of disease control is assessed by the sum of these points (the scale is different for each questionnaire) 6,7,10 .
Control over future risks
Control of bronchial asthma is not only the absence or minimal severity of symptoms, but also “reduction of the potential risk associated with deterioration, the development of exacerbations, the progression of the disease, the manifestation of side effects of drugs” 1 . Accordingly, achieving good clinical control of asthma reduces the risk of exacerbations 2 .
It must be remembered that provoking factors, or so-called triggers, play an important role in the development of an exacerbation. Some of them are independent of the patient. For example, comorbidities. Others can be controlled by the patient. For example, the patient must definitely master the correct technique of inhalation, since the effectiveness of therapy depends on this.
Another important condition for the control of asthma is the fulfillment of doctor’s prescriptions.
Bronchial asthma is a variable disease, that is, its symptoms are not always pronounced: a person may feel good, but this does not mean that the disease does not exist. That is why there should be no talk of any self-treatment or self-cancellation of drugs.
In addition, for the control of asthma, external influences that can cause its exacerbation (allergens, stressful situations, etc.) are of great importance. Therefore, the task of the patient is to do everything possible to minimize their impact, and therefore reduce the risk of an attack.