ABSTRACT
Various respiratory societies including the Global Initiative for Asthma (GINA), European Respiratory Society (ERS) and American Thoracic Society (ATS) define severe asthma as asthma that requires or remains uncontrolled despite treatment with systemic corticosteroids or high-dose inhaled corticosteroids plus another controller such as long acting beta agonist. The management of asthma as an entity is not straightforward due to inter-individual variability in assessment parameters. With the advent of science, targeted therapies are on the emergence for management of severe asthma. A biomarker can be used as a surrogate to phenotype a patient as well as to measure the response to therapy with any drug. Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. From a resource constraint perspective like countries in India, it is imperative to use biomarkers that are easily available are affordable cost. Choosing an ideal biomarkers is also important from a perspective of choosing a particular therapy. The cost associated with the biologicals is high and it is imperative to gauge the treatment effectiveness with the therapy at the earliest considering the out of pocket spends of the patients.
ABSTRACT
Pain is a result of nociceptive tissue injury and results in acute and chronic impact to patients. Acute pain management is the need of the hour as untreated or under-treated pain may progress to chronic pain. Pain irrespective of its temporality causes a negative impact on the quality of life of the patients. Many Indian emergency settings are not adequately equipped to handle pain due to the heavy load of patients and the lack of awareness about the pain management guidelines. This leads to undertreatment of pain or 'oligoanalgesia'. A pain management protocol can help prevent oligoanalgesia in an emergency setting. Proper utilization of triage systems that incorporate pain as one of the vital signs is necessary. The categorization of pain with the help of a pain scale helps determine the severity of pain and its appropriate management. Pain management is an ongoing process that does not end with the discharge of the patient. Post discharge management of pain is also an important factor to prevent chronic pain. This may involve various modalities for pain management under the preview of multimodal management of pain.
ABSTRACT
Epidemiologically the burden of asthma in India is alarming with a median prevalence of 7%. As the symptoms of asthma ascend the severity ladder, the prediction of the cause of asthma is important from the treatment point of view. The GINA 2020 states that the management of asthma should be individualized as per the patient depending on patient phenotype. The goal of asthma treatment is to achieve good control of symptoms, to reduce exacerbations and to improve quality of life. Guidelines recommend adapting the level of treatment to the level of disease severity, and this approach has been demonstrated to be effective in the majority of asthma patients overall. However, it is known that a small but significant proportion of patients do not achieve adequate control despite optimized treatment, and these patients are frequently prescribed high doses of oral steroids in an attempt to achieve control. For patients with severe uncontrolled asthma, monoclonal antibodies (mAbs) against IgE or IL-5 are available as add-on treatments to inhaled corticosteroid (ICS) plus long-acting ß2-agonist (LABA) therapy. With a plethora of available modalities, the fact still remains that there is a large treatment gap and the number of people living with asthma in India is predicted to be around 30 million. This article reviews the phenotypes/endotypes of asthma described in India and the current therapies for management.
