- Maintain the standards
- Home spirometry
- We are looking for patients with severe asthma
- A little good, a little bad
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The simplest answer to this question is trivial - the same as before the pandemic, i.e. effectively. Is it possible, especially when we have to stay in quarantine? Fortunately, modern communication options, despite the closure of many clinics, make it possible to contact a doctor and obtain advice.
Asthma is a chronic, inflammatory disease of the respiratory system. It manifests itself as bouts of coughing, wheezing, and a feeling of breathlessness. These symptoms come and go, which can sometimes make the diagnosis difficult. According to WHO, over 235 million people worldwide suffer from asthma, and over 400,000 die every year. In Poland, 10-12% of the population is ill, i.e. about 4 million people, and only half of them are diagnosed. The development of asthma is fostered by allergy - initially food allergy, skin allergy or inhalation allergy (allergic rhinitis, AR), which over time affects the bronchi. The second risk factor for the development of asthma is frequent respiratory infections, and the third - air pollution.
Maintain the standards
- During the quarantine, we maintain the same standards of medical procedure as before it - saysDr. med. Piotr Dąbrowiecki , specialist in internal diseases and allergology from the Military Medical Institute in Warsaw , chairman of the Polish Federation of Asthma, Allergy and COPD Patients.
- Currently, we meet patients less often than in the pre-pandemic times, but we follow the same rules during televisions or telephone consultations. The most important thing, however, is that the patient in isolation uses the asthma treatment plan prepared for him. An individually prepared plan allows the patient to remain autonomous and react to the change in well-being on an ongoing basis. Each patient has a treatment plan that clearly states when to increase the dose of the drug and what to take if the condition worsens. This allows you to conduct asthma therapy without contacting a doctor.
Home spirometry
Asthma has five clinical grades. Treatment is always selected according to the disease picture in a particular patient. In the case of level 4, 5, or severe asthma, patients are advised to use home devices to assess their respiratory fitness.
- Our patientshave peak flow meters in their homes (manual or electronic), which allow to measure the peak airflow through the lungs on exhalation - explains Dr. Dąbrowiecki.
- The device is easy to use. The patient only needs to breathe out one very strong exhalation. The result is recorded by the device when the highest air velocity appears during exhalation. The camera measures the PEF index. If the result of morning exhalation in relation to evening exhalation remains at a similar level or the difference is within the range of 5-10%, the patient has a stable disease, i.e. well-controlled asthma. When there are large differences between the results (15-20 percent or more), it means that the patient should intensify the anti-inflammatory treatment, i.e. increase the dose of the anti-inflammatory drug.
Patients with severe asthma are "armed" with home spirometers, which allow to assess not only the intensity of exhalation, but also the flow of air through all parts of the respiratory system. We know that the reduction of the most sensitive FEV1 parameter occurs a few days before the onset of an exacerbation of the disease. This is important information for the patient because he must respond to FEV1 reduction. So he checks in the treatment plan what to do. So it increases the dosage of the drugs. Once FEV1 has returned to normal, you know the situation is under control. If there is no improvement, the patient must urgently contact a doctor or use the so-called an emergency procedure (described in the treatment plan) and contact your doctor. In the most difficult cases, we have to meet the patient at the clinic or in the hospital.
- A patient in quarantine cannot leave the house, but fortunately we have the possibility to perform spirometry in his home. We can also auscultate the patient without leaving the office - adds Dr. Dąbrowiecki.
- And after taking the interview, I can propose a treatment that will improve the patient's well-being. Currently, the number of spirometric tests performed in the country has decreased significantly. This does not surprise me, because during the examination the patient empties most of the air in the lungs. The inhaled aerosol may be contagious. According to the recommendations of the European Respiratory Society and the Polish Society of Lung Diseases, spirometry is currently performed only in patients who need it absolutely. This means that the test is done to recognize the disease or assess the patient's clinical situation. Therefore, home spirometry can be useful, but especially for patients who have already performed spirometry tests.
We are looking for patients with severe asthma
The SARS-CoV2 pandemic did not discourage specialistsfrom looking for patients with severe asthma and implementing biological treatment in them, which is a chance not only to control the disease, but in many cases it saves their lives.
- The quality of life after the implementation of biological treatment improves significantly - says Dr. Piotr Dąbrowiecki. - People who could not sleep at night due to dyspnea, and during the day were not able to do any physical activity, return to school or work, they can be active and independent. It is extremely important. Of course, it is not yet a treatment available to all patients, but we hope that changes in drug program regulations will spread it.
A little good, a little bad
Coronavirus has left its mark on all areas of medicine. Family doctors work mainly by telephone, which does not solve all the problems of chronically ill patients. Besides, nurses and doctors also get sick, so the availability of advice is limited.
- Some patients, as they clearly emphasize, are afraid to use the traditional form of medical advice, i.e. visiting the office - emphasizes Dr. Piotr Dąbrowiecki. - There is no doubt that limitations in the planning of visits and examinations as well as the widespread fear of infection have worsened the quality of care for patients suffering from asthma, as well as other chronic diseases. The point is, however, that the existing limitations should not worsen the he alth of patients with asthma. We want there to be no increase in disease exacerbations or deaths from asthma. Fortunately, we do not observe such trends yet.
The good news is that patients treated for asthma who take inhaled steroids, bronchodilators and conduct therapy under the supervision of a physician under telemedicine, have a milder infection with coronavirus. The studies that are available show that the coronavirus is not a lethal threat to people with asthma. And even if an infection does occur, patients with asthma suffer less dynamically than patients with COPD or heart or kidney failure.
People with asthma who are treated properly are not more susceptible to infection than the rest of the population. On the contrary. They are less prone to this infection. Researchers of the problem suggest that this is due to the regular use of inhaled steroids, because these drugs inhibit the replication of the virus in the upper and lower respiratory tract.
Until recently, it happened that patients who were prescribed inhalation steroids without consulting a doctor, because they felt well. Now such situations occur less frequently, because the news has spread around the world that inhaled or nasal steroids reduce the risk of infection orprotect against the severe course of COVID-19. Personally, I am happy about it, because self-discipline has increased among patients with asthma and the vast majority of people follow the recommendations of taking inhaled steroids.
Unfortunately, there is no such good news for COPD patients, because SARS-CoV-2 is a great threat for people with damaged lung parenchyma. These patients should beware of the coronavirus, wear good FFP2 or FFP3 masks, and keep their distance.
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