asthma action plan and managing symptoms of allergic rhinitis can help.
Having a personalised asthma action plan and managing
symptoms of allergic rhinitis can help
Affecting about a tenth of the adult
population in Singapore, asthma is a
common enough chronic respiratory
condition. The management of it, however,
is highly dependent on the patient’s
understanding of his condition.
The patient learns to recognise triggers
and to avoid them, as well as to use
daily medications to control symptoms
and quick-relief inhalers to manage the
flare-ups.
But not all patients are able to maintain
good control. More frequent use
of quick-relief inhalers is a classic indication
that asthma control may be
deteriorating. The presence of nocturnal
symptoms such as breathlessness,
cough, phlegm and wheezing is also
another sign that reflects declining level
of control.
In a local longitudinal study conducted
by the Department of Research, SingHealth Polyclinics, it was found that
59% of asthma patients had nocturnal
symptoms at recruitment.
A key finding of the study was that
patients who were not on any asthma
action plan (AAP) were more likely to
have nocturnal symptoms compared
with those who were on a plan or had
updated it. The study was published in
Nature Partner Journals’ Primary Care
Respiratory Medicine.
The AAP is not just a personalised record
of the patient’s symptoms. It systematically
guides the patient how to
adjust the medication should symptoms
escalate so that an asthma attack
can be prevented. In the event of an
attack, it also informs the patient how
and where to seek immediate medical
attention.
“As the patient may not remember
what to do during the critical window
period, a written AAP allows them to
better control their asthma via symptom
recognition and appropriate line
of therapeutic action. It will give them
the confidence to adjust their medications
quickly and appropriately,” said
Dr Tan Ngiap Chuan, Principal Investigator
of the study.
Dr Tan’s team also found that patients
with allergic rhinitis were more at risk
for nocturnal symptoms. Appropriate
management of the allergic rhinitis can
thus lead to better asthma control in
the long-run.
WHAT PRIMARY CARE
PHYSICIANS CAN DO
“Primary care physicians are wellplaced
to assist patients to attain
asthma control by prescribing an
AAP, reviewing it regularly, and revising
the plan if necessary. They
can also educate their patients
and steer them towards evidencebased
treatment for allergic rhinitis,
which can range from periodic
anti-histamine alone to combination
of anti-histamine and nasal
steroid to immunotherapy,”
shared Dr Tan.
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