Dr. Yousef Najib Nawas Clinic
Dr. Yousef Najib Nawas sees pulmonary and internal medicine patients at his clinic in Al Khalidi Hospital’s outpatient building. His published scope includes as…
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Asthma is a chronic inflammatory disease of the airways that makes them hyper-responsive, so they narrow on exposure to a trigger — dust, smoke, cold air, exertion, infection or allergy — producing wheeze, breathlessness, cough and chest tightness, often worse at night or on exertion. The most dangerous misconception in asthma concerns inhalers, and correcting it can save a life: there are two entirely different kinds. The **reliever inhaler (rapid-acting bronchodilator)** widens the airways immediately and is used during an attack — but it **does not treat the inflammation**. The **preventer inhaler (inhaled corticosteroid)** is used daily and regularly even when the patient has no symptoms, and it is what actually reduces inflammation and attacks. The common error is relying on the reliever because it “gives instant relief” and stopping the preventer because “its effect is not felt”. The result is that inflammation stays active and attacks recur and worsen. **Increasing reliever use is a warning sign that asthma is uncontrolled and calls for reviewing the plan, not for more reliever.** The second decisive point is **inhaler technique**: much “treatment failure” is not drug failure but incorrect inhalation technique so the drug never reaches the lungs. Learning the technique in front of a doctor or pharmacist and using a spacer — especially for children — changes the outcome entirely. Rinsing the mouth after an inhaled corticosteroid prevents oral thrush. A complete plan also includes: identifying and reducing triggers; controlling rhinitis, allergy and reflux because they worsen asthma; seasonal vaccination; healthy weight; and a **written action plan** so the patient knows what to do when deteriorating and when to go to emergency care immediately.
1 specialists
Procedure steps
- 1
Diagnosis with lung function testing
Asthma is diagnosed from symptoms plus spirometry showing improvement after a bronchodilator, since wheeze and cough alone may have other causes.
- 2
Identifying triggers and comorbidities
History covers dust, smoke, animals, exertion, cold air and medications, with assessment of rhinitis, allergy and reflux, since controlling them improves the asthma itself.
- 3
Prescribing preventer and reliever clearly
A preventer is prescribed for regular daily use and a reliever for attacks, with the difference explained explicitly, since confusing them is the most dangerous asthma error.
- 4
Training inhaler technique
The patient is trained in technique in front of the doctor or pharmacist, with a spacer where needed, and technique is rechecked at every visit because it deteriorates over time.
- 5
A written action plan and control monitoring
A written plan sets out what to do as symptoms worsen, when to step up treatment and when to attend emergency care — and control is measured at each review with the dose stepped up or down.
Before the procedure
Bring **all your inhalers and medications in their original boxes** to the visit — your doctor needs to see what you actually use and to watch you use it to correct the technique. Before the visit record: how many times you used the reliever in the last week, how many nights symptoms woke you, and whether asthma stopped an activity or work — these numbers are what measure control. Report other medications, especially anti-inflammatory painkillers and beta-blockers (which can worsen asthma), and any allergy, reflux or snoring. Tell your doctor if you are pregnant — asthma in pregnancy is treated, not left, and leaving it is more dangerous to the fetus than its treatment.
After the procedure
**Use the preventer inhaler daily as prescribed even with no symptoms at all** — this is the real treatment, and stopping it is the commonest cause of a new attack. Rinse your mouth with water and spit after an inhaled corticosteroid. Recheck inhaler technique periodically and use a spacer if prescribed. Track reliever use: **needing it more than usual means asthma is uncontrolled — see your doctor rather than simply using more.** Reduce trigger exposure, avoid smoking and second-hand smoke completely, and have the seasonal vaccination. Carry the reliever with you always and keep your action plan. **Go to emergency care immediately for breathlessness that stops you completing a sentence, blue lips, no response to the reliever, very rapid breathing, or drowsiness and confusion — do not wait.**
Expected duration
First visit 30–45 minutes with spirometry; treatment is chronic with reviews every three to six months once controlled
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