1. ”Dama” is Easy fatigue ability. Pediatritians do not appreciate this because most of our children cannot communicate.

But in those who can “ Easy Fatigueability “ is always present. “ALL EASY FATIGUABILITY” patients are not asthma. But all asthma patients have Easy Fatiguability.

[Their airpipe [carburettor ] is choked.]Asthmatic may not wheeze or cough but he / she has easy fatigueability. Do PFT/PEFR and know for yourself.

SINGLE DIAGNOSTIC FEATURE OF EVERY PATIENT OF ASTHMA.

Asthma is a clinical diagnosis.

A clinical diagnosis has 2 issues.

1. Objective: One that the doctor sees.
2. Subjective.: One that patient feels.
He /She always has easy fatiguability.

ASK PATIENTS TO KEEP DAILY FATIGUE CHART.
To put a dot on the calendar at a.m. or p.m. position when they get tired earlier than usual days. AND YOU HAVE PATIENT’S OWN CHART LIKE A PEFR CHART. Asthamatics are “Touch me not plants.”

When they come across an offending substance/allergen, their airpipe,like the mimosa plant shrinks.

Asthma is like BARISH ( rains.} It can rain suddenly, torrentially and for weeks and without notice.

Every dehydrated child must get fluids. Every hypoxic child must get oxygen. Asthmatics are breathless due to Hypoxia. Every child with acute attack of asthma must get relief with Oxygen immediately and everytime.

In children,half the asthma attacks are induced by viral upper respiratory illnesses. If children are taught to keep themselves 2 arms away from other children and people having cough and cold and fever, they will have fewer illnesses and fewer asthma attacks. One sick child going to school gives illness to all other children. { They are like Hanumanji who burnt Lanka.] If schools draw a LAXMAN REKHA at the school entrance and allow no sick child to come in the school, he total illnesses of the country will go down. And illness induced asthma attacks will reduce. Crowds have many sick people. Asthmatics should whenever possible, keep away from crowds.

Mark every attack of asthma by a red dot on growth chart, and growth chart helps you to tell severity of asthma. Put one dot for mild attack, 2 dots for moderate and 3 dots for a severe attack.

Knowing is believing. Let everyone hear rhonchi with a stethoscope.Let them diagnose asthma for themselves. Give a stethoscope to parents to carry it home and auscultate SOS. Empower parents and patients with tools that we use.

OPD AREA: Keep computer in waiting room of your consulting room. Run asthma education programme in patient’s language. Create your own in powerpoint. Share it with IAP. Keep stethoscope, Spacer, Metered drug inhalor,etc. as toys for kids in the waiting area. Let them play with them. Their fear will go.They will accept is more easily.

Yogasans and Pranayam reduce body’s excitability. It reduces response to histamine from 4+ to 3+. Shuddhikriya of yoga teach how to clean the nose by putting saline lukewarm water in nose. It helps reduce allergic rhinitis, improves lung function [personal experience. I have Asthama ]

Computerised PFT [spirometry] costs Rs.5000 0. Less than our car.Buy it as charity to yourself and your patients. But it will gibe you great returns. It helps in diagnosis, and to monitor progress and thus manage Asthma patients. It costs less than an X ray machine and is more useful. 10 % population has tendency to have asthma. You must do all that 10% people need. So buy spirometry.

Why dilute 1 ml. Respirator solution with 10ml. Saline? You want to give medicine or saline nebulization?

Roll of newspaper makes an instant portable disposable universally available free of cost spacer.

Even a 5 day course of oral prednisolone causes gastritis in many children. That short course of prednisolone has no side effects is a myth.