My name is Professor Neil Thomson.
I'm based at the Institute of Infection, Immunity & Inflammation
at the University of Glasgow in the United Kingdom.
The title of today's talk is Non-Pharmacological Treatments for Asthma.
Patients with poorly controlled asthma should undergo careful assessment.
Firstly, is the diagnosis correct?
Or is there an alternative diagnosis
or, as is often the case, an additional diagnosis?
The next step is to assess what are the causes of the patients’ persistent symptoms.
Could this be due to non-adherence with their current drug therapy,
other important trigger factors, or co-morbidities
that are accounting for their persistent symptoms.
In some individuals, it may be possible to allocate
a particular sub-phenotype of asthma following these assessments.
There are a range of important trigger factors
that can precipitate attacks of asthma
and co-morbidities that can make asthma symptoms harder to control.
Exposure to allergens such as
house dust mite, pets, or dietary products
can precipitate attacks of asthma in a sensitised individual.
Some individuals can become sensitised to substances
at work and develop occupational asthma.
Environmental pollutants such as car exhaust
and passive smoke can trigger attacks of asthma
as well as viral infections.
Some patients with asthma are sensitive
to non-steroidal anti-inflammatory drugs,
and these agents should be avoided in these individuals.
All asthmatics should avoid beta-blockers.
Asthma may get worse pre-menstrually or during pregnancy.
Exercise is a particularly important trigger factor
as it effects many individuals.
Some of the co-morbidities that can make asthma symptoms worse
include a high BMI, vocal cord dysfunction,
dysfunctional breathing, and psychological factors.
An integrated management plan should be developed following the above assessments.
This should include the stepwise pharmacological treatment of asthma,
dealing with non-adherence if this is relevant,
the institution of self-management plans,
and, where appropriate, the use of non-pharmacological management approaches.
This talk will concentrate on non-pharmacological management of asthma.
A range of non-pharmacological interventions for asthma
are listed on this slide.
These include avoidance measures for allergens,
passive smoke and drugs as well as smoking cessation,
dietary intervention such as weight loss and nutritional supplements,
and injection allergen immunotherapy and vaccines.
Other non-pharmacological interventions include bronchial thermoplasty,
physical therapies, psychological treatments,
and complementary therapies.
The efficacy and safety of these interventions will now be discussed.
Does controlling house dust mite exposure improve asthma control
in house dust mite sensitive children and adults with asthma?
A systematic review of 55 randomised control trials
in over 3000 people with asthma looked at this.
There were 10 trials that used chemical methods to reduce house dust mite,
37 trials which used physical methods
such as mattress encasings, and 8 trials that used both methods.
The review concluded that there was no difference
in peak expiratory flow measurements,
asthma symptoms or medication use,
or in the number of patients reporting an improvement in their asthma symptoms
with the use of these measures versus control.
A systematic review concluded that chemical and physical methods
aimed at reducing exposure to house dust mite allergens
cannot currently be recommended.
Wright and colleagues undertook a clinical trial
to test the hypothesis that a domestic mechanical recovery ventilation system
in addition to allergen avoidance measures
can improve asthma control by attenuating recolonisation rates.
They undertook a randomised control trial
in which 60 homes had mechanical heat recovery ventilation units installed
and 59 homes in which there was a sham ventilation unit installed.
At the end of the 12-month study,
there was a reduction in relative humidity during the winter months
in the homes in which an active mechanical heat recovery ventilation unit was installed,
but there was no difference in house dust mite levels in these homes.
There was improvement in some indices of asthma control
such as shown in the figure a higher evening flow rate
in the active units.
Overall, however, the results do not suggest
that mechanical heat recovery ventilation units
should be used in the management of allergic asthma
in individuals who are sensitive to house dust mite.