What is well controlled asthma ?

” Control ” is a nice word ! It has very positive vibes. ” I am in control of my life.” “My finances are under my control.”

The word “control” has been used, by both patients and doctors, in chronic diseases like diabetes or high blood pressure. It conveys a meaning that is easy to understand. “My blood pressure is under control. Or, because of eating too many Diwali sweets, my blood sugar is out of control.” Asthma is another very common chronic disease. We are now using this word in asthma too, to convey whether asthma symptoms are controlled or not.

So what is good control of asthma ? To my mind, asthma is well controlled when the patient is able to live his or her life in a normal way and is able to do whatever he or she wants to do without asthma hindering it in any way. IN ANY WAY. That, to me, would be well controlled asthma.

Let us analyze this in a little more detail. Asthma is well controlled when the patient has no symptoms of cough, wheeze or breathlessness in the day or night. There is no need to take SOS medication or to visit the doctor as an emergency. Of course, there is no need for hospitalizations ! The lung functions, when they are tested, are normal and the bronchial tubes do not undergo any permanent changes or damage. And very importantly, there are no side effects of medications. This is what well controlled asthma would look like.

Is this definition of “good control of asthma” a utopian dream ? Is it possible to achieve this ? YES, indeed it is !! If both the patient and the doctor work sensibly together, it is possible to achieve this kind of control in about 95% of the asthmatics. This requires a combination of avoidance of allergen ( after finding out the allergy causing substances ), taking medications which are mostly inhaled, life style and dietary modifications and in selected cases, immunotherapy.

What about the remaining 5% ? These patients are what are called difficult to control asthma patients. Their asthma is intrinsically severe and it is difficult to control it to the satisfaction of the patient and the doctor. Here a compromise may have to be reached wherein asthma is reasonably, but not optimally controlled, with that medication level that does not give side effects. Some symptoms will persist and will have to be accepted and tolerated.

Thus we see that in a majority of the asthma patients, whether they are children, adults or elderly patients, it would be possible to control asthma. What would the patient have to do for this ? Here is my list, as a doctor who treats a lot of asthma patients, of expectations from patients of asthma :

• Know your allergens and triggers of asthma and try to avoid as many of those as could be done reasonably.
• Be regular with inhaled medication. If your asthma is present throughout the year, then take preventer inhalers throughout the year. If your asthma is only seasonal, as is the case in 20-30% of asthmatics, then take it only during the change of season. Don’t be in a hurry to stop the inhalers !
• Diet regulation, regular exercise, yoga and keeping an optimum weight helps. Try to work towards this.
• Be upbeat !!