Bronchial Asthma: Prevention and Rehabilitation

The basis for teaching a patient with asthma is:

• representation of the necessary information about the disease;
• creating an individual treatment plan;
• teaching the basic techniques of asthma control
• regular check-ups by a doctor.

Currently, the only proven variable environmental factor is to limit exposure to tobacco smoke during pregnancy and newborns.

Prevention of asthma exacerbations includes a full range of activities based on the principle of continuous monitoring (drug treatment, impact on risk factors, training and monitoring, exclusion of trigger factors, non-drug methods), as well as timely vaccination.

Preventive immunization for children with asthma is administered by all vaccines according to the general principles recommended for children with allergic diseases.

• vaccination is allowed during the period of remission of the disease;
• vaccinate if possible outside the action of the allergen (if you have pollen allergies, you cannot be vaccinated during the flowering season).

Physical rehabilitation trains the cardiopulmonary function:

• As a result of training with physical exertion, the maximum oxygen consumption increases and maximal ventilation of the lungs increases;
• According to the available observations, the use of training with aerobic load (swimming, figure skating, training of the respiratory muscles) improves the course of asthma.

Respiratory gymnastics (strong-willed elimination of deep breathing):

This complex involves a gradual decrease in the depth of breathing through a constant relaxation of the respiratory muscles, or breath holdings until the sensation of a slight lack of air appears. Training is done in conditions of rest and muscle relaxation. Breathe only through the nose.

The main stages of the methodology:

• sit down, relax, focus on breathing;
• do a calm breath for 3 seconds (a breath from the nose only reaches the clavicles);
• do a calm, restrained exhalation for 3-4 seconds;
• hold the breath after exhalation (at first for 3-4 seconds, then gradually increase the duration of the delay).
• take a quiet breath, etc.

Breathing exercises:

This gymnastics has a beneficial effect on the body as a whole, but it has no direct effect on the course of bronchial asthma:

• restores impaired nasal breathing;
• improves the drainage function of the bronchi;
• can help restore blood circulation and lymph circulation, eliminate local stagnant phenomena;
• positively affects the metabolic processes;
• increases the general resistance of the body, its tone, improves the nervous and mental state.

According to the foreign studies, the sensation of dyspnea may decrease, as a result of which the need for bronchodilator drugs decreases. Thus, the method can reduce the sensation of the disease.

However, this method does not affect inflammation, that is, the bronchi are still in a state of hyperreactivity. Therefore, it is dangerous to refuse basic therapy when using any non-drug method.

Vibration chest massage can have an effect when there is a cough with hard-to-recover sputum.

• initial position: the person lies on his stomach, with a slightly inclined head end down, with an inclination of 10-15 degrees;
• fingers are in the intercostal spaces;
• do vibrating movements without lifting your fingers;
• vibrations are made by the length of intercostal spaces.

Under the influence of such shakes, vibration is transmitted to the chest and bronchial walls, sputum “falls apart”, and due to the inclined trunk, it drains to the upper respiratory tract.

Massage is considered effective if a patient has a cough with sputum after it.

• There is no evidence that non-pharmacological methods can influence the course of asthma, large-scale clinical trials are required;
• Medical treatment of patients with confirmed asthma is a highly effective method of monitoring and improving the quality of life. However, it is necessary to take measures to prevent an exacerbation of asthma by reducing or eliminating the effect of risk factors;
• There are currently only a small number of activities that can be recommended for the prevention of asthma because the development of this disease involves complex mechanisms;
• Exacerbation of asthma can be caused by many risk factors (triggers). These include allergens, viral infections, pollutants and medications;
• Reducing the impact on patients of certain categories of risk factors can improve control over asthma and reduce the need for medications. ⠀

Primary prevention of asthma

• Elimination of the causative allergen in patients with already developed allergic asthma;
• Breastfeeding. There is evidence of a protective effect of breastfeeding in relation to the early development of asthma. It can play a role in preventing asthma in children. At the same time, there is no research of sufficient duration for the effect of the use of milk formulas on the early development of asthma;
• Nutrition supplements during pregnancy. There is a very limited number of studies on a protective effect of vitamins taken during pregnancy (fish oil, selenium and vitamin E). There is insufficient evidence to recommend any supplement to the diet of pregnant women as a means of preventing asthma;
• Allergen-specific immunotherapy (ASIT). Molecular ASIT is actively developing, due to which it will be possible not only to stop, but also to prevent respiratory allergy at a stage when it is available for blood analysis, but there are no symptoms. For today it is proved that ASIT can prevent the development of asthma in people with allergic rhinitis and stop asthma exacerbation;
• Microorganisms. There is insufficient evidence that the use of probiotics by a woman during pregnancy reduces the risk of developing asthma in a child;
• Give up smoking. Studies reveal an association between maternal smoking and an increased risk of a child. Parents and future mothers should be informed about the adverse effects of smoking on the child, including the risk of developing asthma.

Secondary prevention of asthma

1. Pollutants. Studies show the relationship between air pollution (increased concentrations of ozone, nitrogen oxides, acid aerosols and suspended solids) and exacerbation of asthma. Patients with controlled asthma usually do not need to avoid unfavorable environmental conditions.

Patients with poorly controlled asthma are advised to refrain from intensive physical loads:

• in cold weather;
• at a low atmospheric humidity;
• with a high level of air pollution.

2. House dust mites. Measures to reduce the concentration of house dust mite help to reduce the number of mites. But there is no evidence of a change in the severity of the course of asthma with a decrease in their concentration if they are not allergens for the person.

3. Pets. There are NO controlled studies on reducing asthma attacks after removal of pets (in patients whose allergic asthma is NOT caused by animal hair and in patients with non-allergic asthma). ⠀

Important:

• We speak about a person with a developed asthma;
• If a person is at risk, he is not recommended to have pets;
• A person can develop an allergy to an animal in the future. In this case, the animal’s hair becomes an allergen and the elimination of contact with it becomes a prerequisite for remission.

4. Smoking. Active and passive smoking has a negative impact on the quality of life.

Dietary recommendations for asthma

• Products and additives. Sulphites (preservatives that are often part of medicines and foods such as potato chips, shrimp, dried fruits, beer and wine) are often involved in the development of severe exacerbations of asthma. In the case of a proven allergy to a food or food supplement, the exclusion of this product may lead to a reduction in the frequency of asthma exacerbations;
• Obesity. Studies show the relationship between weight gain and symptoms of asthma. Overweight patients are recommended to lose weight to improve their health and the course of asthma.