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20/Aug/2022

Best strategy to treat asthma

There are 4 components of asthma –

  1. Develop a patient-doctor partnership
  2. Identify risk factors and reduce exposure
  3. Assess, treat and monitor disease
  4. Manage exacerbations

The goal of management – improve control & reduce risk – NAEPP guidelines 2007

Recurrent exacerbations and the requirement for emergency room or hospital care can be avoided.

●Reduced lung growth in children and loss of lung function in adults can be avoided.

●Pharmacotherapy optimization with few or no side effects

What is the best strategy to treat asthma?

Best strategy to treat asthma inhaled corticosteroids such as beclometasone are the drugs of choice for the long-term treatment of patients with persistent asthma. Although there is no discernible difference in efficacy among inhaled corticosteroids, beclometasone is the one with which we have the most expertise. Ciclesonide (Alvesco, Nycomed then Takeda), another inhaled corticosteroid, has been tested in three double-blind trials versus budesonide and six trials versus fluticasone but none versus beclometasone. These tests revealed the “non-inferiority” of ciclesonide, especially in terms of a surrogate endpoint: the difference in compelled expiratory volume in one second (FEV1) after 12 or 24 weeks of treatment (primary endpoint). 

Which inhaled steroid do you prefer, and why?

However, the doses of ciclesonide used in these trials were higher than the standard doses while doses of the comparator corticosteroids were lower than the standard doses, thus favoring ciclesonide. Local negative effects of inhaled corticosteroids include oral candidiasis, sore throat, and hoarseness.  Best strategy to treat asthma a routine review guided by a Cochrane group recommends that ciclesonide does not have a better adverse effect profile than other inhaled corticosteroids used at equivalent doses. Corticosteroid inhalation can also show systemic absorption. The practical benefit of once-daily dosing with ciclesonide appears minor. In practice, ciclesonide is neither more useful than the inhaled corticosteroids with which it has been compared nor does it have fewer negative effects. It is better to continue to use beclometasone, a medicine with which there is more experience.

What is an optimal dose for starting ICS

Treatment naïve patient – step 2

Already on treatment – step 3

Daily v/s intermittent dosing of ICS, which is better?

Daily ICS was only periodic ICS in several indicators of lung function, airway inflammation, asthma control, and reliever use. Both treatments seemed safe, but a fair growth suppression was associated with daily, compared to intermittent, inhaled budesonide and beclomethasone. The clinician should carefully consider the possible benefits and injury of each therapy option, taking into account the unknown long-term (> one year) effect of intermittent treatment on lung growth and lung function decline.

What are the advantages of adding LABA to ICS?

Bronchodilator action of LABA provides immediate relief, and ICS sustained relief improves control, reduces symptoms, Best strategy to treat asthma daytime as well as nocturnal, improves lung functions, reduces the risk of exacerbations, hospitalization we use formoterol + budesonide it acts as a controller as well as reliever medicine, also used in exercise-induced asthma

Can LABA monotherapy be used?

LABA should not be used as monotherapy because they are only bronchodilators with no anti-inflammatory effects. Monotherapy is associated with an increased risk of exacerbation and mortality. When used as add they are superior to LTRA and theo. They reduce symptoms, improve control, and use of SABA, and reduce exacerbations and nocturnal symptoms. Only a fixed-dose combination with ICS is to be used (which improves adherence and reduces the risk of monotherapy).

What is the role of LTRA in asthma as monotherapy, as add on

LTRA has a mild bronchodilator and anti-inflammatory effects. They may be used as monotherapy in mild asthma and aspirin-sensitive asthma. However, they are inferior to ICS and cannot replace ICS as monotherapy.

As added on they may reduce the dose of ICS needed to achieve control and improve control. However, they are inferior to LABA.

What is the role of theophylline as monotherapy, as an add-on?

Data on monotherapy are lacking. An add it improves control when control is lacking with ICS alone. However, it is inferior to LABA. In some patients on ICS + THEO, withdrawal of theo leads to deterioration of control. Usage of lower dosage has a full anti-inflammatory effect, with fewer adverse effects and blood level monitoring is not required.

Is doxycycline better than dyphylline?

It is a debatable issue. Various clinical trials have been done some supporting and others not supporting. However, meta-analysis has so far not found the superiority of doxo over deri in terms of safety and efficacy profile.

What are the benefits of using LAMA in the management of asthma?

Newer ATS/ERS guidelines published in April 2014 suggest the addition of LAMA to ICS and LABA 1. Improve FEV1 2. Reduce the use of SABA 3. Reduce the risk of exacerbation. No studies on children, so not to be used on children


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20/Aug/2022

Medical Thoracoscopy is used to observe the pleura and take biopsies from abnormal areas. Sometimes it is used to break adhesions and treat septated pleural effusions. Medical Thoracoscopy performed by Best Thoracoscopy Expert Doctor in India. 

Assessment is done prior to Medical Thoracoscopy

A diagnostic pleural tap is always done prior to the procedure. An exudative fluid indicates the need for thoracoscopy. A CT scan is necessary before a better CT scan procedure for contrast. This helps in assessing the pleura and the lung parenchyma beneath the fluid. A blood test that includes complete blood count, serum creatinine level, bleeding profile, and viral markers are also performed. COVID-19 PCR should be done prior to the procedure, depending on the prevalence of the infection in the area. Blood thinners need to be, stopped five days prior to the test.

Things to remember on the day of the procedure

Fasting is recommended for 6 hours for solid food and 4 hours for clear liquids. The routine medications should be continued for blood pressure. Diabetic patients should avoid their Insulin and hypoglycemic medicines on the day of the test.

Procedure

The procedure is conducted through a nick in the chest wall. You may get some intravenous (IV) injections prior to and during the sedation method. After local anesthesia at the site of nick, the scope is inserted. The pleura is observed and biopsies are taken. In the case of adhesions, they are broken with adhesiolysis forceps and the scope. After the scope is removed, a chest tube is left in place to drain the fluid. The procedure usually takes 30-40 minutes.

Precautions after the procedure

The patient controls to avoid any oral liquids or solids for another 2 hours after the procedure. A light meal is suggested after 2 hours. The chest tube would remain in the chest till the fluid stops coming, usually a couple of days (in case of malignant effusions, the duration may be longer). The common after-effects of the procedure are – pain at the site, soakage of dressing with fluid, sleepiness, and vomiting. These can be managed with symptomatic medicines. Usually, a patient is kept admitted for a day or two post-procedure. In certain cases, the patient may be sent home after the procedure. 

Follow-up

Medical thoracoscopy is a safe procedure and does not have any long-term complications. Once the chest tube is removed and the diagnosis is made, optimal treatment will be started. The microbiology and pathology reports come in 3-5 days’ periods. If mycobacterial cultures are applied they usually take 4 weeks. Medical thoracoscopy is a safe procedure with a minimal complication rate.

More More Information & Details Visit Immediately to the Dr. Sheetu Singh Top Pulmonologist in India or visit our website – www.drsheetusingh.com


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20/Aug/2022

Asthma Specialist Doctor in India: Asthma is a disease in which your lung airways narrow and swell. It creates excess mucus, that’s will be causing breathing difficulty and trigger coughing, a whistling sound when you exhale, and shortness of breath. For a few people, asthma is a minor issue. For others, it can be a critical issue that conflicts with everyday activities and should build a life-threatening asthma attack. During an asthma strike, the airways will swell, the tissues around them will stiffen, and it becomes dense for air to shift in and out of the lungs. Asthma is not an infection, but it is caused, by an overreaction of the human immune system. Only some people have sensitive immune systems which trigger asthma.

Asthma Specialist Doctor in India – Dr. Sheetu Singh

Asthma is a long-term condition affecting the Lungs. It involves infection and reduction inside the lungs, which reduces air supply. There are many reasons to cause asthma, like Animal hair or dander, Dust, Changes in the weather, Mold, Pollen, Respiratory infections, Tobacco smoking. Asthma can never be completely fixed, but its signs can be managed and controlled. Because asthma continually expands over time, you must handle it with your doctor to track your signs and symptoms and take your treatment as required.

Symptoms of Asthma

Asthma symptoms fluctuate from person to person. You will have infrequent asthma attacks and have symptoms only several times like when you did, exercising, running, polluted areas, dust.

Asthma symptoms include:

  • Shortness of breath
  • Chest tightness or pain
  • Wheezing when exhaling
  • Trouble sleeping caused by shortness of breath
  • Excessive Coughing or Wheezing

Asthma in Childhood

Asthma is the most common disease in children. It can occur at any age but, it is slightly more common in children than adults. Children aged 5–14 years were presumably to suffer from asthma.

Some Common Symptoms in Childhood Asthma Include – Respiratory infections and colds, cigarette smoke, including secondhand cigarette smoke, allergens, air pollutants, exposure to cold air, sudden changes in temperature, excitement, stress, exercise.

How to Diagnosis Asthma

If you think that you have asthma, visit your doctor. They will refer you to a lung disease expert, and they are called pulmonologists or a chest specialist. 

  • Breathing tests (Spirometry)
  • Health history
  • Physical exam
  • Chest X-ray
  • CT
  • Allergy tests

Asthma Treatment

Many asthma treatments can ease your symptoms and, treatments for asthma come into three main categories,

  1. breathing exercises
  2. quick-acting treatments
  3. long-term asthma control medications

Asthma can be managed by following some daily habits and daily routines. You can take steps every day to help yourself and reduce your risk for asthma attacks.

  • Maintaining a healthy weight
  • Quitting smoking
  • Managing stress
  • Eating a healthier diet
  • Exercising regularly

When to see an Asthma Specialist Doctor

If you can feel symptoms of asthma such as weakness and can not perform daily activities, have wheezing, or a cough that does not go away, then visit your doctor immediately. If you can’t find a doctor for asthma, then you can come to Dr. Sheetu Singh. She is one of the best lungs specialists and pulmonologists in India. for Thermoplasty visit, www.drsheetusingh.com


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20/Aug/2022

Thermoplasty Specialist Doctor:

Asthma affects the airways to swell and become infected. The airways become tinier that making it more difficult for you to breathe. The walls of large airways have a layer of smooth tissue. This part will be thicker in people with severe asthma. During an asthma attack, the layer of tissue can constrict and narrow the airways. Bronchial thermoplasty is an infiltration asthma method in which a tube called a bronchoscope is inserted into a person’s mouth or nose and connected through the airways to the lungs. Once the pipe dilates, that widens the airway, allowing more air to flow into the lungs. Bronchial thermoplasty in the treatment of, asthma and gives relief to the patient to a great extent. Asthma is never completely cured, but this treatment controls asthma. 

Bronchial Thermoplasty Specialist | Risk, Treatment, Side effects

Bronchial thermoplasty is performed in three sessions, each surgery covering one-third of the lungs at a time. Bronchial thermoplasty is a modern yet hopeful treatment for severe asthma whose benefit for long-term asthma control exceeds the short-term danger of degradation and hospitalization in the days following the BT procedure. 

Bronchial Thermoplasty is performed through the Faculty of Bronchoscopy Endoscopy and takes about an hour to finish. The minimally invasive method like many other flexible endoscopy procedures is performed under mild sedation. Post-procedure, patients typically are observed and monitored for about 2-4 hours. You will go to a hospital to get the treatment of bronchial thermoplasty. It is presented in three separate sessions, each about three weeks. Each surgery takes less than an hour, and another part of your lungs gets treated each one time. Only professionals can do this treatment. When these surgeries are performed there is a risk of lung damage, so only experienced doctors can do it. Some side effects can also come from this surgery, let’s know the side effects of Thermoplasty.

Side Effects of Thermoplasty

The most common side effects of bronchial thermoplasty include:

  1. Coughing
  2. Wheezing
  3. Shortness of breath
  4. Pulmonary artery complications
  5. Respiratory infections

Benefits of Bronchial thermoplasty

  1. Decrease regular symptoms of asthma
  2. Decrease the number of sick days 
  3. Decrease the need for steroid medications
  4. Help keep you out of hospital or emergency department.

Bronchial thermoplasty does not relieve asthma. But it’s going to make you feel better and breathe better.

Eligibility of Bronchial Thermoplasty

You will be a good candidate for the BT if:

  1. 18 years of age or older,
  2. Severe Asthma
  3. Symptoms are not well controlled

If you’re considering bronchial thermoplasty, you’ll undergo a radical medical evaluation that has tests like pulmonary function tests (PFTs), as well as an assessment of what proportion asthma controller and rescue medication you’re using. Because inflammatory asthma might not improve with BT, you might even have blood tests to look at your level of inflammation.

Where To Go For Bronchial Thermoplasty

If you have severe asthma symptoms that you cannot control with medicine and an inhaler, you can immediately come to Dr. Seetu Singh.

She is one of the best Asthma Specialist Doctors in India. She has good experience in respiratory system surgery and operation Dr. Sheetu is a thermoplasty specialist doctor in Jaipur.


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20/Aug/2022

Asthma Specialist in Jaipur: In this article we are talking about the risk factor in Asthma Disease. Have you ever think, what puts a person at risk for developing asthma??? Any idea!!!! No, ok just have a look of this article. In below section we are describing some common risk factors that are normally responsible for developing asthma. Get best treatment form the top Asthma Specialist in Jaipur.

Asthma Specialist in Jaipur

Family history

If your parent or grandparent is suffer with asthma disease then the chances is automatically increases to four to seven times in you more than a person who doesn’t have any family history of asthma.

Viral respiratory infections

In most of the cases, person during its childhood or babyhood had any respiratory problems that causes breathe roughly in night or any child experienced viral lungs or respiratory infections then the chances is increases to develop chronic asthma.

Allergies

If any person is have any type of allergy then it may be possible that it is the main reason of asthma. Don’t take allergy in an easy, immediate consult with your doctor.

Occupational exposures

In your workplace, if you come in contact with certain substances or elements such as dusts (wood or industrial dust), chemical vapors, gases or fumes can cause the asthma symptoms.

Smoking

If you are smokers, then here we tell you smoking causes high risk of asthma. If a woman smokes during the time of pregnancy then the chances is automatically increases that her child will suffer from asthma in future.

Air Pollution

Air pollution is also increases in the risk of asthma. People who grew up in highly polluted area or in urban areas have raises the risk of asthma.

Obesity

Overweight means invitation of other diseases and asthma is one of those diseases. Due to obesity, person suffer with worse symptoms and use more medications and unable to control their asthma that a person who is fit and come in the healthy weight range. Dr. Sheetu Singh is Best Asthma Specialist in Jaipur. For any query or appointment purpose visit: www.drsheetusingh.com/


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