Non pharmacological management in children and adults

Addressing the concern about avoidance of environmental, dietary and other triggers of asthma with patients, parents and carers is important (1).

Non-pharmacological management of asthma:

There is a common perception amongst patients and carers that there are numerous environmental, dietary and other triggers of asthma and that avoiding these triggers will improve asthma and reduce the requirement for pharmacotherapy. Evidence that non-pharmacological management is effective can be difficult to obtain and more well-controlled intervention studies are required.

Primary prevention:

• Primary prevention relates to interventions introduced before the onset of disease and designed to reduce its incidence:
  
  • Measures to reduce in utero or early life exposure to single aeroallergens, such as house dust mites or pets, or single food allergens, are not recommended for the primary prevention of asthma.
    
  • For children at risk of developing asthma, complex, multifaceted interventions targeting multiple allergens may be considered in families able to meet the costs, demands and inconvenience of such a demanding programme.
    
  • In the absence of any evidence of benefit and given the potential for adverse effects, maternal food allergen avoidance during pregnancy and lactation is not recommended as a strategy for preventing childhood asthma
    
  • Breast feeding should be encouraged for its many benefits, including a potential protective effect in relation to early asthma
    
  • obese and overweight children should be offered weight-loss programmes to reduce the likelihood of respiratory symptoms suggestive of asthma.
    
  • Current and prospective parents should be advised of the many adverse effects which smoking has on their children including increased wheezing in infancy and increased risk of persistent asthma

Secondary prevention:

• Secondary prevention relates to interventions introduced after the onset of disease to reduce its impact:
  
  • physical and chemical methods of reducing house dust mite levels in the home (including acaricides, mattress covers, vacuum cleaning, heating, ventilation, freezing, washing, air filtration and ionisers) should not be routinely recommended by healthcare professionals for the management of asthma
    
  • people with asthma and parents of children with asthma should be advised about the dangers of smoking and second-hand tobacco smoke exposure, and be offered appropriate support to stop smoking
    
  • weight-loss interventions (including dietary and exercise-based programmes) should be considered for overweight and obese adults and children with asthma to improve asthma control
    
  • air ionisers are not recommended for the treatment of asthma
    
  • breathing exercise programmes (including face-to-face physiotherapist-taught methods and audiovisual programmes) can be offered to adults with asthma as an adjuvant to pharmacological treatment to improve quality of life and reduce symptoms
    

Reference:

1. British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2019. British Guideline on the Management of Asthma. A national clinical guideline.