Friday, March 19, 2010

Reasons Why Asthma Is Poorly Controlled

When I was a medical student and then when I taught medical students and residents, I used mnemonics.  Here's my mnemonic for when asthma remained poorly controlled.  It's based on my reaction when patients aren't responding well to a treatment plan.
Wrong diagnosis.  All that wheezes is not asthma.
Heterogeneity of asthma.  The causes of the asthma are not all treated identically.
Adherence is poor, or non-compliance.  Not taking meds when instructed.
Technique is poor.  Example, not taking inhalers properly.
Secondary factor.  Coexisting disease or drug interaction is preventing an optimal response to the treatment.
Understanding is poor.  Patients or caregivers do not understand why the meds should be taken.
Pathway resistance.  Patients have some difference in their physiology which prevents them from responding well to a traditional therapy despite being given to one who's correctly diagnosed and instructed.  Example - steroid resistance.
Think about this when your asthma or your loved one's asthma is not responding quickly and easily to your treatment plan.

1 comment:

bjg said...

And, then, kind sir, there are those of us who are very parochial and do follow the treatment recommended to a "T" and because of the nature of the "disease" dis-ease...hmmm, we simply are not controlled. Regardless of what we /do not do and, this includes use of alternative interventions: acupuncture for one, which has helped tremendously but has to be in conjunction with traditional medical intervention that is "responsive." I have had those medical interventions which were not responsive due to lack of knowledge, skill and or training on the part of the medical community who alleged to be "specialists" in their field of asthma intervention and treatment -- and that nearly cost me my life.

And, yes, I understand there are those individuals who do not follow their medical plan nor use medication appropriately but there are a percentage of asthma patients who are simply fall outside of the "box," as is the new analogy today, to be able to be fully controlled.

And, yes, with allergies involved it is even more difficult. I have had very severe reactions to Advair, Singualair [a/k/a/ Montelukast ] and most recently Dulera. Howver, I admit to having allergies to more "things" than not....

Thank you for your blog and yor candid presentation of information!

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